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CHAPTER 12
Over-reactions of the Immune System
Questions
12–1
Describe how the antigens differ between the following subsets of hypersensitivity reactions. (A)
Type I/type III versus type II; (B) TH1- or TH2-dependent type IV versus type IV involving
cytotoxic T cells.
12–2
How do mast cells contribute to innate immunity?
12–3
What are the effects of histamine binding to the H1 receptor on smooth muscle, mucosal
epithelia, and the endothelial cells of blood vessels.
12–4
The antigens that provoke hypersensitivity reactions are referred to as
a. T-independent antigens
b. superantigens
c. subunit vaccines
d. attenuated vaccines
e. allergens.
12–5
Which of the following allergens is not likely to be encountered through inhalation?
a. plant pollen
b. metals
c. animal dander
d. mold spores
e. house dust mite feces.
12–6
Which of the following are matched correctly? (Select all that apply.)
a. type I hypersensitivity: IgE
b. type II hypersensitivity: IgG
c. type III hypersensitivity: immune complexes
d. type IV hypersensitivity: IgG
e. type IV hypersensitivity: delayed-type hypersensitivity.
12–7
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Which of the following are associated with soluble antigen? (Select all that apply.)
a. type I hypersensitivity
b. type II hypersensitivity
c. type III hypersensitivity
d. type IV hypersensitivity
e. mast-cell activation.
12–8
An example of type III hypersensitivity is _____.
a. contact dermatitis
b. asthma
c. serum sickness
d. tuberculin reaction
e. allergic rhinitis.
12–9
Explain how some drugs trigger type II hypersensitivity reactions.
12–10
(A) What is a cross-match test? (B) Why is it carried out? (C) How is it carried out?
12–11
Match each of the following blood groups with the type(s) of blood a person with the first blood
group can safely receive in a transfusion.
1, group O; 2, group A; 3, group B; 4, group AB.
a, group O; b, group A; c, group B, d, group AB.
12–12
Explain why serum sickness is usually self-limiting.
12–13
An allergic reaction to poison ivy is associated with _____.
a. mast-cell activation
b. an Arthus reaction
c. eosinophil activation
d. complement activation
e. cytotoxic T-cell activation.
12–14
Which of the following distinguishes IgE from the other antibody isotypes?
a. IgE binds to Fc receptors on NK cells.
b. IgE binds to Fc receptors in the absence of antigen.
c. IgE is found in mucosal secretions.
d. IgE binds to matrix-associated antigens.
e. IgE stimulates receptor-mediated endocytosis by eosinophils.
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12–15
_____ express FcRI and contain granules containing inflammatory mediators. (Select all that
apply.)
a. macrophages
b. activated eosinophils
c. mast cells
d. natural killer cells
e. basophils.
12–16
Match the mast cell product in column 1 with its biological effect in column 2.
Column 1
Column 2
___ a. IL-4
1. activates endothelium
___ b. CCL3
2. amplifies TH2-cell response
___ c. TNF-
3. increases vascular permeability
___ d. histamine
4. connective tissue matrix remodeling
___ e. tryptase
5. chemotaxis
12–17
Aspirin (acetyl salicylate) inhibits prostaglandin synthesis by binding irreversibly to
prostaglandin synthase, the first enzyme in the _____ pathway.
a. cyclooxygenase
b. carboxypeptidase
c. metalloprotease
d. lipooxygenase
e. peroxidase.
12–18
Which of the following is associated with hypereosinophilia? (Select all that apply.)
a. IL-5-induced proliferation
b. endocardium damage
c. neuropathy
d. B-cell lymphoma
e. decreased bone marrow function.
12–19
Inhaled allergens possess which of the following features that promote the priming of TH2 cells
that drive IgE responses? (Select all that apply.)
a. They are proteins.
b. They are processed into peptides that bind HLA class I.
c. Many are proteases.
d. They are encountered at high dose.
e. They are of high molecular weight.
f. They are highly soluble.
g. They have low solubility, which favors processing.
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12–20
Which of the following genetic polymorphisms is associated with a predisposition to asthma?
(Select all that apply.)
a. promoter variants of IL-5
b. structural variant of IgG receptor
c. HLA class II allotypes
d. 2-adrenergic receptor variant
e. promoter variants of 5-lipoxygenase gene.
12–21
The wheal and flare inflammatory reaction is an example of
a. an immediate type I allergic response
b. a late-phase type I allergic response
c. a late-phase type IV allergic response
d. an immediate type III allergic response
e. a late-phase type III allergic response.
12–22
The _____ occurs 6–8 hours after an initial type I allergic response in which mast cells produce
leukotrienes, chemokines, and cytokines.
a. Arthus reaction
b. late-phase reaction
c. delayed-type hypersensitivity reaction
d. condition known as anaphylactic shock
e. skin rash known as chronic urticaria.
12–23
Which of the following tests is used to determine whether a particular allergen is responsible for
asthma?
a. Measure wheal and flare diameter after intradermal injection of allergen.
b. Measure Arthus reaction diameter after intradermal injection of allergen.
c. Inject a controlled amount of allergen intradermally and observe urticaria.
d. Measure peak expiratory flow rate (PEFR) after inhalation of allergen.
e. Measure eosinophils in nasal secretions after inhalation of allergen.
12–24
Systemic anaphylaxis is caused by the presence of allergen in _____.
a. the gastrointestinal tract
b. the respiratory tract
c. the circulation
d. the skin
e. mismatched blood transfusions.
12–25
Which of the following are consequences of anaphylactic shock? (Select all that apply.)
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a. smooth muscle contraction
b. immune complex deposition on blood vessels
c. loss of blood pressure
d. constriction of airways
e. complement activation.
12–26
Which of the following are correct matches between a hypersensitivity reaction and the
underlying cause? (Select all that apply.)
a. wheal and flare: subcutaneous introduction of insect allergen
b. contact dermatitis: mismatched blood transfusion
c. urticaria: ingestion of shellfish allergen
d. arthritis: immune complex deposition in joint spaces
e. systemic anaphylaxis: intradermal introduction of allergen
f. allergic conjunctivitis: inhalation of house dust mite allergen.
12–27
During the course of a successful desensitization process, the patient’s antibodies will change
from an _____isotype to an _____ isotype.
a. IgG4: IgE
b. IgE: IgM
c. IgA: IgM
d. IgG1: IgG4
e. IgE: IgG4.
12–28
Which of the following are potential means by which type I allergic reactions can be managed or
treated? (Select all that apply.)
a. Use antihistamines to block histamine binding to H1 histamine receptors.
b. Use corticosteroids to suppress inflammation.
c. Desensitize the patient by feeding them allergen and skewing the immune response from
an IgE to an IgA response.
d. Anergize allergen-specific T cells through vaccination with allergen-derived peptides.
e. Administer Il-4, IL-5, or IL-1 to promote TH1 responses.
f. Block high-affinitiy IgE receptors to prevent mast-cell degranulation.
12–29
What type of hypersensitivity reaction would result from a mismatched blood transfusion?
a. type I
b. type II
c. type III
d. type IV.
12–30
Which of the following antigens must be compatible between a donor and a recipient of a blood
transfusion? (Select all that apply.)
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a. ABO
b. Rh
c. HLA class I
e. HLA class II.
12–31
What is the name of the clinical test used to determine the compatibility between a donor and
recipient requiring a blood transfusion?
a. desensitization
b. cross-match test
c. Arthus reaction
d. HLA typing
e. delayed-type hypersensitivity reaction.
12–32
_____ is associated with a type III hypersensitivity reaction. (Select all that apply.)
a. allergen binding to cell-surface components and creating foreign epitopes
b. cross-linking of IgE on mast cells
c. formation of small immune complexes that are deposited in blood vessel walls
d. complement fixation
e. hemorrhaging
f. antibody excess.
12–33
Which of the following can induce a type III hypersensitivity reaction? (Select all that apply.)
a. penicillin
b. gliadin
c. therapeutic monoclonal antibodies
d. tuberculin
e. streptokinase
f. mold spores
g. lepromin
h. dust mite feces
i. pentadecacatechol.
12–34
Which of the following can induce a type IV hypersensitivity reaction? (Select all that apply.)
a. penicillin
b. gliadin
c. therapeutic monoclonal antibodies
d. tuberculin
e. streptokinase
f. mold spores
g. lepromin
h. dust mite feces
i. pentadecacatechol.
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12–35
Which of the following is associated with an immune response towards poison ivy? (Select all
that apply.)
a. contact sensitivity
b. highly reactive lipid-like molecule forms covalent bonds with host proteins
c. immune complexes with pentadecatechol
d. mast-cell degranulation
e. CD8 T-cell epitopes.
12–36
Which of the following is characterized by intestinal atrophy, HLA-DQ2 or DQ8 gluten-derived
peptide complexes, and anti-transglutaminase autoantibodies?
a. type I hypersensitivity to food allergens
b. celiac disease
c. contact sensitivity
d. hypereosinophilia
e. eczema.
12–37
Hypersensitivity reactions to carbamazepine, an anticonvulsant drug used by epileptics, is
correlated with _____. (Select all that apply.)
a. a risk of developing Stevens–Johnson Syndrome (SJS)
b. IgE-producing B cells
c. serum sickness
d. HLA class I allotype HLA-B*1502
e. delayed-type hypersensitivity reactions.
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Answers
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