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Abbas: Cellular and Molecular Immunology, 9th Edition
Immediate Hypersensitivity

Test Bank

Multiple Choice

1. Which of the following is the most common disorder of immunity that affects 20% of
all individuals in the United States?
A. Atopy
B. Diabetes mellitus
C. Leukemia
D. IgA deficiency
E. Latent tuberculosis infection

ANS: A. Atopy, or allergy, is the most common disorder of immunity and affects 20% of
all individuals in the United States. Within this category, allergic rhinitis is perhaps the
most common allergic disease and is a consequence of immediate hypersensitivity
reactions to common allergens, such as plant pollen or house dust mites, localized to the
upper respiratory tract by inhalation. Selective IgA deficiency is the most common
known primary immunodeficiency.

2. All of the following are key mediators of immediate hypersensitivity reactions

EXCEPT:
A. Mast cells
B. Basophils
C. IgE
D. Macrophages
E. TH2 cells

ANS: D. The main cellular mediators of immediate hypersensitivity reactions are mast
cells, basophils, and eosinophils. IgE antibody plays a major role in sensitizing these
cellular mediators for subsequent activation. Activation of TH2 cells is required for
appropriate release of cytokines, such as interleukin (IL)-4 and IL-13, which stimulate
IgE class switching in B cells. In contrast, macrophages are effector cells in delayed-type
hypersensitivity reactions.

3. Immediate hypersensitivity differs from delayed-type hypersensitivity in which one

of the following ways?
A. Immediate hypersensitivity is a CD4+ T cell–mediated disease.
B. Immediate hypersensitivity does not require previous exposure to an antigen.
C. Immediate hypersensitivity does not involve inflammation.
D. Immediate hypersensitivity is driven by cytokines such as interleukin (IL)-4, IL-5,
and IL-13.
E. Immediate hypersensitivity typically leads to granuloma formation.

Copyright © 2018, Elsevier Inc. All rights reserved.

Test Bank 2

ANS: D. In contrast to delayed-type hypersensitivity (DTH), which is a TH1-mediated

disorder, immediate hypersensitivity is driven by cytokines, such as interleukin (IL)-4,
IL-5, and IL-13, and is therefore a TH2-mediated disorder. Note that both types of
hypersensitivity reactions involve CD4+ T cells (TH1 vs. TH2), although DTH also
involves CD8+ T cells. Importantly, both types of hypersensitivity reactions occur only
after prior exposure to an antigen, and they are both characterized by inflammation.
Granuloma formation, as a chronic response to persistent microbes, is a pathologic
feature more typical of DTH than immediate hypersensitivity.

Matching

Questions 4-10
Match the definitions in questions 4-10 with the mast cell mediator (A-G) that most
closely matches it.
A. Histamine
B. Tryptase
C. Prostaglandin D2
D. Leukotriene C4
E. Platelet-activating factor
F. Interleukin-5
 Tumor necrosis factor-

4. Lipoxygenase-pathway product of arachidonic acid metabolism that causes prolonged

bronchoconstriction, mucus secretion, and increased vascular permeability

ANS: D. Leukotriene C4 (LTC4) is rapidly synthesized by the lipoxygenase pathway of

arachidonic acid metabolism in activated mast cells. It is one component of a so-called
slow-reacting substance of anaphylaxis, which also includes LTD4 and LTE4. These
leukotrienes are major mediators of bronchoconstriction in allergic asthma.

5. Soluble factor that promotes eosinophil maturation and activation

ANS: F. Interleukin-5 is a cytokine synthesized by activated mast cells (as well as TH2
cells) and promotes eosinophilia and eosinophilic inflammation, which are characteristic
of chronic immediate hypersensitivity conditions.

6. Biogenic amine that transiently increases vascular permeability and smooth muscle
contraction

ANS: A. Histamine, one of several biogenic amines in mast cell granules, is partly
responsible for the rapid increases in vascular permeability causing wheals (or hives) and
for the smooth muscle contraction in bronchi and intestines, causing some of the
pulmonary and gastrointestinal symptoms of immediate hypersensitivity reactions.

Copyright © 2018, Elsevier Inc. All rights reserved.

Test Bank 3

7. Cyclooxygenase-pathway product of arachidonic acid metabolism that causes

vascular dilatation, smooth muscle contraction, and neutrophil chemotaxis

ANS: C. Prostaglandin D2 (PGD2) is the major arachidonic acid product of the

cyclooxygenase pathway in mast cells. PGD2 causes vasodilation and
bronchoconstriction, which contribute to the early signs and symptoms of immediate
hypersensitivity reactions. It also is a chemoattractant for neutrophils, which accumulate
in tissues as part of the late-phase inflammatory response to allergens.

8. Protein constituent of granules that contributes to tissue damage in immediate

hypersensitivity reactions

ANS: B. Tryptase is a neutral serine protease stored in mast cell granules. When released
into the extracellular matrix, this enzyme cleaves fibrinogen and activates collagenases,
contributing to tissue damage.

9. Soluble factor that promotes inflammation and late-phase reaction and activates
endothelial expression of adhesion molecules critical for sequential neutrophilic
infiltrate

ANS: G. When tumor necrosis factor- is released during IgE-mediated mast cell
activation, it activates endothelial expression of the adhesion molecules, accounting for
subsequent infiltration of neutrophils. As such, it is critical for inflammation and the late-
phase allergic reaction.

10. Membrane phospholipid derivative that causes bronchoconstriction, retraction of

endothelial cells, and relaxation of vascular smooth muscle

ANS: E. Platelet-activating factor (PAF) is synthesized after mast cell activation by

acylation of a membrane phospholipid derivative; it acts on bronchial smooth muscle
cells and endothelial cells. Genetic deficiency of an enzyme that inactivates PAF is
associated with asthma.

Copyright © 2018, Elsevier Inc. All rights reserved.

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