Allergy and Immunology Review Corner: Chapter 29 of Middleton’s Allergy
Principles and Practice, Seventh Edition, edited by N. Franklin Adkinson, et al.
Chapter 29: Pathophysiology of Allergic Inflammation (Pages 455-472)
Prepared by Jeremy Katcher, MD, University of Tennessee, and John Seyerle, MD, Ohio
State University
1. Through which mechanism are macrophages activated by allergen in the asthmatic
airway?
A. High affinity FcεRI receptors
B. Low affinity FcεRII receptors
C. High affinity FcγII receptors
D. Medium affinity FcεRIII receptors
2. Which cell’s presence in the airway smooth muscle differentiates asthma and chronic
eosinophilic bronchitis?
A. Eosinophil
B. Basophil
C. Mast Cell
D. Neutrophil
3. Which of the following is most selective for eosinophil recruitment in allergic
inflammation?
A. ICA M-1
B. PAF
C. LTB4
D. VLA4
4. Which of the following transcription factors is most associated with allergic
inflammation?
A. FOXP3
B. GATA-3
C. T-bet
D. RORγt
5. Which of the following statements regarding IL-4 and IL-13’s role in Th2 cell
differentiation is true?
A. IL-4 and IL-13 are both involved in Th2 cell differentiation.
B. Neither IL-4 nor IL-13 is involved in Th2 cell differentiation.
C. IL-13 is involved in Th2 differentiation, whereas IL-4 is not.
D. IL-4 is involved in Th2 differentiation, whereas IL-13 is not.
6. Which of the following stimulates Th1 differentiation?
A. IL-2
B. IL-10
C. IL-12
D. IFN7. In murine models, which of the following appears to be both necessary and sufficient
for induction of the asthmatic phenotype?
A. IL-4
B. IL-5
C. IL-12
D. IL-13
8. Which of the following may be regulated by IL-8?
A. Neutrophils
B. Mast cells
C. Th2 cells
D. Eosinophils
9. Thymic Stromal Lipoprotein acts on which cells?
A. Mast cells
B. Dendritic cells
C. Th2 cells
D. Eosinophils
10. Which of the following cells is activated by secretion of IL-11 by airway epithelial
cells?
A. Eosinophils
B. Th2 cells
C. Smooth muscle cells
D. Fibroblasts
Answers
1. B, page 457
Macrophages may traffic into the airways in asthma and be activated by allergen via low
affinity IgE receptors (FcεRII).
2. C, page 456
Mast cells in airway smooth muscle appear to distinguish asthma from chronic
eosinophilic bronchitis (i.e., no mast cells in eosinophilic bronchitis). Eosinophils are
present in both conditions. Role of basophils in asthma is uncertain. Neutrophils are not
active in eosinophilic bronchitis.
3. D, page 457
VLA4 expressed on eosinophils interacts with VCAM-1 on endothelial cells and appears
to be selective for eosinophils, while integrins interacting with ICAM-1 on endothelial
cells is not selective for eosinophils. PAF and leukotrienes are involved in eosinophil
migration, but are not selective.
4. B, page 467
GATA-3 regulates the expression of Th2 cytokine genes, while T-bet regulates Th1 cells.
The Th1/Th2 cell imbalance in allergic disease may reflect an increase in GATA-3 and
decrease in T-bet transcription factors. FOXP3 regulates CD4+CD25+ Tregs. RORγt is
associated with Th17.
5. D, page 461
IL-4, but not IL-13, is involved in differentiation of Th2 cells and therefore may be
critical in the initial development of atopy, whereas IL-13 is much more abundant in
established disease and may therefore be more important in maintaining the inflammatory
process.
6. C, page 458
IL-10 and IL-18 stimulate Th1 differentiation. IL-2 and IFN- are products of Th1 cells
while IL-10 is a product of regulatory T-cells and suppresses both Th1 and Th2.
7. D, page 458
While IL-4 may induce Th2 response and IL-5 recruits eosinophils, in murine models, Il13 appears to be both necessary and sufficient for induction of the asthmatic phenotype.
IL-12 induces a Th1 response.
8. A, page 462
CXC chemokines regulate neutrophilic inflammation, and there is evidence that CXCL8
(IL-8) is increased in the sputum of patients with severe asthma. Mast cells are regulated
by GM-CSF, Th2 cells by IL-4 and IL-13, and eosinophils by IL-5.
9. B, page 461
Mast cells secrete Thymic Stromal Lipoprotein (TSLP) which acts on immature myeloid
dendritic cells via a unique heterodimeric TSLP receptor to differentiate into mature
dendritic cells.
10. D, page 459
Epithelial cells may play a key role in translating inhaled environmental signals into
airway inflammatory response. GM-CSF, CCL11, CCL5, and CCL13 act on eosinophils;
CCL5, IL-16, CCL17, and CCL22 act on lymphocytes; PDGF, and EGF act on smooth
muscle cells; PDGF, FGF, IGF-1, and IL-11 act on fibroblasts.
Allergy and Immunology Review Corner: Chapter 32 of Middleton’s Allergy
Principles and Practice, Seventh Edition, edited by N. Franklin Adkinson, et al.
Chapter 32: Aerobiology of Outdoor Allergens – Pages 509-537
Prepared by Jacob Turnquist, MD, and Christopher R. Martin, M.D., Walter Reed Army
Medical Center
1. Which of the following is TRUE regarding pollen-producing plants?
A. Anemophilus flowers release large quantities of pollen during cool, damp weather.
B. Anemophilus plants represent 10% of the pollen-producing plants.
C. Entomophilus plants often have stamen organized in catkins.
D. Depending on the season, entomophilus plants may produce spore concentrations of
100 grains/m3.
2. Which of the following is TRUE regarding aeroallergen samplers and detection?
A. Sedimentation samplers, such as the Durham sampler, provide results that can be
extrapolated to ambient air concentrations.
B. The Rotorod sampler has a trapping efficiency of 90% at 5 μm making it useful for
fungal spore estimates.
C. Cascade impactors, such as the Burkhard and Hirst-type samplers, are the preferred
detectors for outdoor allergens.
D. Airborne pollen counts consistently and accurately reflect the total airborne allergen
concentration.
3. Which of the following is TRUE regarding grasses?
A. Grass pollens are morphologically similar, monoporate, and have a narrow size range.
B. Bahia and Bermuda grasses belong to the same subfamily.
C. Because grasses have limited cross-reactivity between species within a subfamily,
immunochemical differentiation is useful in pollen identification.
D. Bahia, Bermuda, and Johnson species are found in the southern US and tropical
climates.
4. Which of the following tree species and its pollen grain description are CORRECTLY
paired?
A. Oak (Quercus): quadrangular shape, tetracolpate
B. Cedar (Juniperus): thin exine, distinctly stellate intine
C. Pine (Pinus): inaperturate, thin exine with warty surface
D. Birch (Betula): two distinct bladders, or “wings”
E. Poplar (Populus): triporate with protruding domes extending around apertures
(aspidate) and large onci (thickened intine below pores)
5. Which of the following statements regarding weeds is TRUE?
A. Ragweed species are not yet found in Hawaii or Japan.
B. Nearly all weed pollen grains are 30-45 μm.
C. Sagebrush and mugwort pollen grains have characteristic starch inclusion bodies.
D. Russian thistle (Salsola kali) is the most important cause of ‘hay fever’ among the
chenopods.
6. It is estimated that up to 80% of patients with confirmed asthma have positive skin test
reactions to fungi. The most common fungal allergen linked to asthma and allergic
rhinitis is?
A. Alternaria alternata
B. Alternaria tenuissima
C. Aspergillus fumigatus
D. Penicillium notatum
7. The largest phylum of fungi, it contains over 50% of total known fungal species.
A. Zygomycota
B. Ascomycota
C. Basidiomycota
D. Deuteromycetes
8. The largest and most important group of Deuteromycetes is?
A. Sphaeropsidales
B. Melaconiales
C. Mycelia sterilia
D. Moniliales
9. Commonly called rust, it produces rust colored spores on the leaves and stems of a
primary host (usually oats or wheat).
A. Epicoccum nigrum
B. Fusarium moniliforme
C. Puccinia graminis
D. Rhizopus stolonifer
10. Measurement of this is a reliable indicator of total fungal biomass and total spore
counts, but does not help with defining individual taxa.
A. Extracellular polypeptide
B. Ergosterol
C. Extracellular polysaccharide
D. Alt a 1
Answers
1. B, page 509
Catkins are stamen well-exposed to wind; entomophilus plant pollens are heavy, sticky,
and scant; anemophilus flowers release pollen best during warm, dry weather.
2. C, page 510-512
Cascade impactors provide both large pollen and small fungal spore ambient air
concentrations and currently represent the state-of-the-art. Rotorod samplers have low
fungal spore efficiency. Pollen grains may be void of allergens at times whereas allergens
are often found in high concentration on small particle fractions when there are no pollen
grains (advantage of immunoassay over microscopic identification).
3. D, page 513
Grasses have a large size range (20-100 μm). Bahia and Johnson are in the same
subfamily, Panicoideae. Grasses have extensive cross-reactivity within subfamilies
limiting immunochemical differentiation.
4. B, page 514-518
Ash (Fraxinus): quadrangular shape, tetracolpate
Oak: tricolporate with large bulging furrows and “warty” surface.
Pine: two distinct bladders, or “wings”
Birch: triporate with protruding domes extending around apertures (aspidate) and large
onci (thickened intine below pores)
Poplar: inaperturate, thin exine with warty surface
5. D, page 519
Ragweed (Ambrosia) is not a chenopod – it is a composite belonging to the Asteraceae
family; it is highly invasive and found in Hawaii, Japan, and Europe. Dock and Sorrel
pollen grains have starch inclusion bodies. Nearly all weed pollen grains are 15-30 μm
(except the smallest – Nettle – which are 12-14 μm).
6. A, page 525
A. alternata is the most commonly implicated organism.
7. B, page 526
The largest phylum, it is characterized by the development of the ascus, a saclike cell in
which the sexual spores develop without wall attachments.
8. D, page 527
The Moniliales group contains most of the allergenic fungi in the Deuteromycetes
phylum.
9. C, page 529
10. B, page 531
The total quantity produced depends on the surface area and growth conditions
encountered by the fungus.