Immunology PCL (COW)
In response to requests from the class, the intended case and topic (SLE) for this week have been abandoned. Instead, three self-learning topics are presented to stimulate PCL discussion for April 26.
1. Vaccination Myth and Reality How will you respond when a patient says?: "I don't want to have my child vaccinated because vaccines can cause autism and/or mercury poisoning". Opposition to vaccination is growing and, if immunization rates fall, public health measures to deal with preventable disease may be compromised. Does MMR vaccine in fact cause autism? Is it likely that the mercury preservative (thiomersal) contained in some vaccines causes problems?
2. Risk of Anaphylaxis Outside Hospitals What is the incidence of severe anaphylaxis in public places? Review the OMA guidelines for Management of Children with Life Threatening Allergies particularly as they relate to school and nursery personnel. Discuss the use and administration of emergency adrenaline outside hospitals, i.e. EpiPen use. What are indications for the prescription of an EpiPen and is the 'EpiPen Epidemic' a concern?
3. Transplantation of an Allergy Case A 22-year-old man with a history of allergic reactions to peanuts was admitted to the hospital in a coma. After inadvertently ingesting satay sauce, which contains peanuts, during a Chinese meal, he had become unwell and had had a cardiorespiratory arrest that resulted in cerebral anoxia, coma, and brain death. A high level of peanut-specific IgE was detected in his serum ... multiple organs were subsequently procured. The donor's HLA phenotype was A1,24;B8,44;DRB1*03,13.
...the donor's liver and right kidney were given in transplantation to a 35-year-old man, and the left kidney and pancreas were given to a 27-year-old woman. The man (HLA phenotype, A2,19;B12,-;DRB1*07,13) had end-stage renal failure.... The woman (HLA phenotype, A1,24;B8,44;DRB1*03,04) had chronic renal failure....
Both transplant recipients received immunosuppressive induction therapy with muromonab-CD3 (OKT3) and corticosteroids, azathioprine, and cyclosporine. Neither had ever had any allergy to peanuts.
Three months after transplantation, the recipient of the liver-kidney transplant reported a skin rash and laryngeal dyspnea after eating peanuts. Allergy to peanuts was diagnosed on the basis of the clinical findings; the absence of specific IgE antibodies before transplantation, their presence at the time the symptoms appeared, and their decline thereafter; and a positive basophil degranulation test.
Some questions and additional information are available here.