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  <head>
    <title>058-02 Systemic hypersensitivity, immune-defect localisation, and transplant complications</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Hypersensitivity, immune defects, and transplant complications">
      <outline text="Localising immune disorders">
        <outline text="Ask which defensive or regulatory function failed"/>
        <outline text="Allergy: inappropriate response to harmless trigger"/>
        <outline text="Immunodeficiency: lost protection at typical sites"/>
        <outline text="Autoimmunity: effectors turned toward self"/>
        <outline text="Too much or too little immunity">
          <outline text="Fever, rash, infiltrates, cytopenia fit either"/>
        </outline>
      </outline>
      <outline text="Immunoglobulin E allergy and recognising anaphylaxis">
        <outline text="Sensitisation: class switch under T-helper signals"/>
        <outline text="Cross-linking releases preformed and new mediators">
          <outline text="Leak lowers effective volume"/>
          <outline text="Airway and gut smooth muscle constricts"/>
        </outline>
        <outline text="Severity not predicted by skin-test wheal"/>
        <outline text="Anaphylaxis is a clinical diagnosis">
          <outline text="Skin findings absent in profound shock"/>
          <outline text="Normal pressure does not exclude airway danger"/>
        </outline>
        <outline text="Uncertainty must not delay adrenaline"/>
      </outline>
      <outline text="Treating anaphylaxis">
        <outline text="Intramuscular adrenaline first-line">
          <outline text="Alpha-one reverses vasodilation and oedema"/>
          <outline text="Beta-one supports the heart"/>
          <outline text="Beta-two bronchodilates, cuts mediator release"/>
        </outline>
        <outline text="Repeat promptly if no improvement"/>
        <outline text="Sudden sitting or standing">
          <outline text="Empty-ventricle arrest with low venous return"/>
        </outline>
        <outline text="Supportive care never replaces adrenaline"/>
        <outline text="Antihistamines only for itch after stabilisation"/>
        <outline text="Corticosteroids too slow, no biphasic prevention"/>
        <outline text="Refractory: infusion and early airway plan"/>
      </outline>
      <outline text="Follow-up and allergy labels">
        <outline text="Tryptase supports mast-cell activation">
          <outline text="Normal result does not exclude anaphylaxis"/>
        </outline>
        <outline text="Reconstruct trigger, route, timing, cofactors"/>
        <outline text="Action plan, autoinjector, technique, referral"/>
        <outline text="Vague labels cause inferior antibiotics and delay">
          <outline text="Clarify by targeted testing or challenge"/>
        </outline>
      </outline>
      <outline text="Angioedema and food allergy testing">
        <outline text="Histaminergic: itchy wheals, responds to adrenaline"/>
        <outline text="Bradykinin: no itch, slower, poor drug response">
          <outline text="Protect airway, arrange targeted inhibitor"/>
        </outline>
        <outline text="Food testing starts from reproducible phenotype">
          <outline text="Broad panels lower positive predictive value"/>
        </outline>
        <outline text="Intolerance and coeliac disease are not allergy"/>
        <outline text="Staple-food removal risks growth failure"/>
      </outline>
      <outline text="Localising immunodeficiency">
        <outline text="Infection pattern over infection count"/>
        <outline text="Antibody: sinopulmonary encapsulated bacteria, Giardia"/>
        <outline text="T-cell: opportunists, diarrhoea, thrush, poor growth"/>
        <outline text="Neutrophil: deep abscesses, impaired pus"/>
        <outline text="Terminal complement: invasive Neisseria"/>
        <outline text="Tests chosen by phenotype">
          <outline text="Infant ranges, protein loss, recent immunoglobulin"/>
          <outline text="Normal screen does not exclude a strong pattern"/>
        </outline>
      </outline>
      <outline text="Secondary impairment, asplenia, and viral infection">
        <outline text="Far more common than primary disease"/>
        <outline text="Net state from combined therapies">
          <outline text="Prophylaxis follows integrated state, not drug name"/>
        </outline>
        <outline text="Asplenia: rapid encapsulated sepsis">
          <outline text="Fever means immediate assessment"/>
        </outline>
        <outline text="Antiretroviral therapy starts promptly">
          <outline text="Undetectable load prevents transmission"/>
        </outline>
        <outline text="Immune-reconstitution syndrome is not failure"/>
      </outline>
      <outline text="Immune therapy risks">
        <outline text="Glucocorticoids: dose, duration, combination">
          <outline text="Abrupt withdrawal: adrenal crisis and relapse"/>
        </outline>
        <outline text="Tumour-necrosis-factor blockade breaks granulomas"/>
        <outline text="B-cell depletion: hypogammaglobulinaemia"/>
        <outline text="Complement inhibition: meningococcus despite vaccine"/>
        <outline text="Checkpoint inhibitors release T-cell restraint">
          <outline text="Immune events may lag well behind a dose"/>
          <outline text="Exclude infection before immunosuppression"/>
        </outline>
        <outline text="Vaccinate before suppression">
          <outline text="Live vaccines later unsafe"/>
          <outline text="Inactive responses weaker, recheck antibodies"/>
        </outline>
        <outline text="Prophylaxis follows cumulative regimen and host"/>
      </outline>
      <outline text="Solid-organ transplant complications">
        <outline text="Hyperacute, acute, and chronic rejection"/>
        <outline text="Thrombosis, leak, recurrence, toxicity mimic rejection">
          <outline text="Exclude infection before escalating suppression"/>
        </outline>
        <outline text="Infection shifts with time after transplant">
          <outline text="Maximal suppression: cytomegalovirus, Pneumocystis"/>
        </outline>
        <outline text="Calcineurin inhibitors: narrow therapeutic window">
          <outline text="Azole, macrolide, grapefruit interactions"/>
          <outline text="Interpret trough with timing and adherence"/>
        </outline>
        <outline text="Never interrupt suppression without a plan"/>
        <outline text="Non-adherence explored without blame"/>
      </outline>
      <outline text="Stem-cell transplantation and surveillance">
        <outline text="Donor lymphocytes attack malignancy and host"/>
        <outline text="Graft-versus-host disease: skin, gut, liver"/>
        <outline text="Sequential infection risks, revaccination needed"/>
        <outline text="Pair every benefit with a surveillance map"/>
      </outline>
    </outline>
  </body>
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