case 19 zeb pike, leia king, mary currier, ashley sherertz, and manuella de carvalho
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Case 19Zeb Pike, Leia King, Mary Currier, Ashley Sherertz, and Manuella De Carvalho
Symptoms
Garret Danigan - 27 year old man● Awoke to hand shaped rash on leg● One week earlier - received mangos and
rested his hand on his leg while peeling the fruit
● Contact Dermatitis
Contact Dermatitis
● More than 3 million cases in the U.S. yearly
● Skin rash caused by contact with a certain substance or irritant
Test and Diagnosis
Identifying what's causing symptoms and figuring out whether you have the irritant or allergic type● A thorough medical history
and physical exam● A patch test - contact
delayed hypersensitivity allergy test
Patient History
A previous occurrence of the rash happened during a summer a few years earlier● On hands, arms, and legs● Most likely due to poison ivy
Past Summer Exposure
● Benadryl - not effective● One week of corticosteroids cleared up
the contact dermatitis
Corticosteroids
Used when the body’s immune system causes an unwanted response● Lessen inflammation by limiting the
amount of inflammatory signals that cells can produce
● Inhibit cell proliferation
Corticosteroids
Can be taken by:● Mouth - Help treat inflammation associated with
chronic conditions● Inhaler or intranasal spray - Control
inflammation associated with asthma and nasal allergies
● Topically - Help heal skin conditions● Injection - Help treat inflammation of tendinitis
Benadryl
● Antihistamineo blocks the action of
histamine in the body
o helps to relieve the symptoms
● Was ineffective
More Recent Response from Mangos
● The most recent rash● Exposure to the mango peel o Caused delayed contact dermatitis
http://www.kitchenfrau.com/wp-content/uploads/2013/11/IMG_0056a-1024x682.jpg
Type IV Hypersensitivity
● “Delayed hypersensitivity reaction”● First, local immune response to foreign
antigeno Increase endothelial cell adhesion molecule
expression → leukocyte accumulation at tissue site
● Antigen engulfed by macrophages and monocytes
Type IV Hypersensitivity
● Antigen presented to specific T-cell receptor● Macrophages → secrete interleukin and
lymphokines → form giant cells● Interleukins mediate communication● Activation of cytotoxic T-cells is possible● Key mediators:
o CD 4+ Helper T-cellso CD8+ T-cells
Immune Response
https://www.youtube.com/watch?v=e1X_7jqxEzA - Type IV Hypersensitivity - Delayed Type [HD Animation]
Question 1
Type IV hypersensitivity responses to poison ivy result in damage to the skin at the point of contact. What type(s) of cells are responsible for this damage?
Question 1
Cytotoxic T-cells and macrophages can respond to affected areas when activated by an APC● Cytotoxic T-cells
○ respond to target cells● Macrophages
○ manufacture large amounts of hydrolytic enzymes
○ responds in a less specific target approach
Question 2
● Mangos and poison ivy belong to the
same plant family, Anacardiaceae
● Both poison ivy and mango trees create
urushiols
o Urushiols cause irritation upon contact
Urushiols
● Organic allergen● Mango flesh - very low levels of
urushiol● Most sensitive people can eat
the fruit without problem as long as someone else peels it
http://www.cyberlipid.org/images/pict208.jpg
Question 3
Type 1 (immediate) - response caused by the IgE mediated response of histamine released by mast cells and basophils
Type 4 (delayed) - T- cell mediated response and occurs by CD4+ cells and Th1 cells releasing cytokines to attract CD8+ cytotoxic T-cells to destroy marked cells.
Question 4
Benadryl is an antihistamine● Does not affect the rash due no histamine
being produced ● Type 4 hypersensitivity does not trigger
mast cells or basophils● Treatment for that kind of immune
response does not work
References
● http://www.mayoclinic.org/diseases-conditions/contact-dermatitis/basics/definition/con-20032048
● http://my.clevelandclinic.org/health/drugs_devices_supplements/hic_Corticosteroids
● http://www.bio.umass.edu/micro/immunology/poisoniv.htm
● http://en.wikipedia.org/wiki/Anacardiaceae● http://www.nutritionatc.hawaii.edu/HO/2005/309.htm● http://www.mayoclinic.org/diseases-conditions/contact-d
ermatitis/basics/tests-diagnosis/con-20032048
References
http://www.benadryl.ca/remember-the-dryl/how-to-treat-allergic-reactionshttp://www.aascare.com/our-services/patch-testing/https://docs.google.com/presentation/d/1QDV_-bQ0EAOdzgGlYd7Sn26wdGxXXTALBoGitp8nTz8/edit#slide=id.gae9c55747_0_0http://www.ncbi.nlm.nih.gov/books/NBK10756/
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