Allergy And Immunology

Overview

Allergy and immunology involves the management of disorders related to hypersensitivity or

altered reactivity caused by release of immunologic mediators or by activation of inflammatory

mechanisms. An understanding of immunology is essential for mastery of subspecialty areas

within all of the major disciplines of internal medicine and most of its allied specialties.

The general internist should be able to offer primary care for several diseases involving altered

immunity or hypersensitivity. For these diseases, the general internist should be able to initiate

diagnostic evaluation and therapy with or without the help of a subspecialist. The general

internist should also be able to recognize many other diseases in which altered immunity plays

an important role.

Common Clinical Presentations

· Anaphylaxis

· Conjunctival and bulbar inflammation, chemosis, ocular pruritus

· Dyspnea, cough, wheezing, sputum production, use of accessory muscles of respiration

· Nasal obstruction and pruritus, rhinorrhea, sneezing

· Skin whealing, angioedema, bullous formation, eczematous and papular eruptions,

morbilliform rashes, purpura, pruritus

Procedure Skills

· Spirometry and spirometric response to bronchodilators

· Wright-Giemsa stain of nasal and pulmonary secretions

Primary Interpretation of Tests

· Delayed-hypersensitivity skin tests

Ordering and Understanding Tests

· Drug desensitization protocols

· Computed tomography of lungs, sinuses

· Immediate skin tests for IgE-mediated reactions to inhalants, food, certain drugs

· In vitro test for specific IgE

· Levels of complement component, C1 esterase inhibitor

· Methacholine inhalation challenge

· Patch tests

· Prick and intradermal skin tests

· Pulmonary function tests (including spirometry, lung volume, diffusion)

· Serum Immunoglobulin levels

· Serum theophylline levels

· T- and B-cell quantitation and subtyping (CD classification)

· Total eosinophil count