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  <head>
    <title>058-01 Foundations</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Allergy, immunodeficiency, transplantation, immune therapy">
      <outline text="Orientation">
        <outline text="Eliminate threats without injuring self or harmless antigens">
          <outline text="Failure: allergy, autoimmunity, immunodeficiency"/>
        </outline>
        <outline text="Immune-modifying treatments carry toxicities"/>
        <outline text="Find the defective pathway, prevent complications first"/>
      </outline>
      <outline text="Hypersensitivity mechanisms">
        <outline text="Immediate: allergen cross-links bound immunoglobulin E">
          <outline text="Histamine, tryptase, leukotrienes, prostaglandins"/>
          <outline text="Vasodilation, leak, smooth-muscle contraction">
            <outline text="Urticaria, angioedema, bronchospasm, shock"/>
          </outline>
        </outline>
        <outline text="Sensitisation is not always clinical allergy"/>
        <outline text="Cytotoxic antibodies: cells, matrix, complement, receptors"/>
        <outline text="Immune complexes inflame vessels, glomeruli, joints, skin"/>
        <outline text="Delayed: T-cell mediated, hours to days">
          <outline text="Contact dermatitis, many drug eruptions"/>
        </outline>
      </outline>
      <outline text="Allergy history and testing">
        <outline text="Record trigger, route, dose, timing, prior tolerance"/>
        <outline text="Cofactors amplify: exercise, alcohol, infection, asthma"/>
        <outline text="Separate allergy from intolerance, toxicity, vasovagal">
          <outline text="Inaccurate label denies first-line therapy"/>
        </outline>
        <outline text="Specific immunoglobulin E tests show sensitisation">
          <outline text="Alter probability, not severity"/>
          <outline text="Broad food panels create false positives"/>
        </outline>
        <outline text="Supervised challenge often the diagnostic standard"/>
      </outline>
      <outline text="Anaphylaxis">
        <outline text="Rapid systemic threat to airway, breathing, circulation">
          <outline text="Skin features sometimes absent"/>
          <outline text="Treat without laboratory confirmation"/>
        </outline>
        <outline text="Intramuscular adrenaline into anterolateral thigh"/>
        <outline text="Supine, legs elevated; standing risks collapse">
          <outline text="Lateral in pregnancy, recovery if unconscious"/>
        </outline>
        <outline text="Oxygen, access, rapid isotonic crystalloid"/>
        <outline text="Adjuncts do not replace adrenaline">
          <outline text="Antihistamines relieve skin symptoms only"/>
          <outline text="Corticosteroids not immediately life-saving"/>
        </outline>
        <outline text="Refractory: monitored intravenous adrenaline infusion">
          <outline text="Beta blockade may blunt response, consider glucagon"/>
        </outline>
        <outline text="Biphasic recurrence guides observation"/>
        <outline text="Discharge: referral, autoinjector, action plan"/>
      </outline>
      <outline text="Urticaria, angioedema, and allergic disease">
        <outline text="Wheals migrate and resolve within a day"/>
        <outline text="Chronic spontaneous urticaria often autoimmune">
          <outline text="Second-generation antihistamines first-line"/>
        </outline>
        <outline text="Histamine angioedema: itch, wheals, allergy therapy"/>
        <outline text="Bradykinin angioedema">
          <outline text="From converting-enzyme inhibitors or hereditary defects"/>
          <outline text="No urticaria, poor response to adrenaline"/>
          <outline text="Protect airway, cause-specific inhibitors"/>
        </outline>
        <outline text="Atopic diseases share barrier and type-two pathways"/>
        <outline text="Oral immunotherapy raises threshold, not free intake"/>
      </outline>
      <outline text="Primary immunodeficiency">
        <outline text="Antibody, T-cell, phagocyte, complement, regulation"/>
        <outline text="Warning patterns beyond common infection">
          <outline text="Severe, recurrent, opportunistic, unusual sites"/>
          <outline text="Poor growth, abscesses, delayed cord separation"/>
        </outline>
        <outline text="Tests by phenotype; age, drugs, illness alter results"/>
        <outline text="Immunoglobulin replacement for antibody failure"/>
        <outline text="Avoid live vaccines in cellular defects"/>
        <outline text="Stem-cell transplant or gene therapy if severe"/>
      </outline>
      <outline text="Secondary immunodeficiency">
        <outline text="Pattern predicts organisms">
          <outline text="Neutropenia: bacteria and fungi"/>
          <outline text="T-cell impairment: viral, mycobacterial, protozoal"/>
          <outline text="Antibody failure: encapsulated bacteria"/>
        </outline>
        <outline text="Human immunodeficiency virus depletes CD4 T cells">
          <outline text="Prompt combination therapy suppresses virus"/>
        </outline>
        <outline text="Asplenia: fulminant encapsulated infection"/>
      </outline>
      <outline text="Immune-suppressive and biologic therapy">
        <outline text="Glucocorticoids broadly suppress inflammation">
          <outline text="Metabolic, bone, eye, mood toxicity"/>
          <outline text="Adrenal suppression: avoid abrupt withdrawal"/>
        </outline>
        <outline text="Toxicity follows mechanism">
          <outline text="Tumour-necrosis-factor blockade reactivates tuberculosis"/>
          <outline text="Complement blockade raises meningococcal risk"/>
          <outline text="Checkpoint inhibitors inflame almost any organ"/>
        </outline>
        <outline text="Screen and give non-live vaccines beforehand"/>
        <outline text="Fever muted, infection with normal leukocytes"/>
        <outline text="Febrile neutropenia: immediate antipseudomonal cover"/>
      </outline>
      <outline text="Transplantation">
        <outline text="Rejection by timing">
          <outline text="Hyperacute: minutes to hours"/>
          <outline text="Acute: days to months"/>
          <outline text="Chronic: vascular and interstitial injury"/>
        </outline>
        <outline text="Other graft insults often need biopsy"/>
        <outline text="Calcineurin inhibitor, antiproliferative, corticosteroid">
          <outline text="Calcineurin toxicity needs level monitoring"/>
        </outline>
        <outline text="Infection: early surgical, later opportunistic"/>
        <outline text="Stem-cell conditioning damages marrow and mucosa">
          <outline text="Graft-versus-host disease, graft-versus-tumour benefit"/>
        </outline>
      </outline>
    </outline>
  </body>
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