Hypersensitivity and Allergy

Module details

Title

Hypersensitivity and Allergy

Type

Specialist

Module code

SLS135

Credits

10

Requirement

Compulsory

Aim of this module

This module will provide the trainee with knowledge and understanding of the mechanism of hypersensitivity and allergy. They will understand the clinical presentation and investigation of a range of conditions associated with hypersensitivity and allergy. They will become familiar with methods and strategies to investigate hypersensitivity and allergy and gain experience of the interpretation of patient results in a variety of clinical settings.

Competencies

#	Learning outcome	Competency	Action
# 1	Learning outcome 1	Competency Select the appropriate immunological assay to investigate whether the immune system of the patient is producing an allergic response.	Action View
# 2	Learning outcome 1,2	Competency Perform immunological testing of allergic response using the appropriate assay.	Action View
# 3	Learning outcome 2	Competency Perform allergy testing including all of the following (to be performed after observation of the procedure): skin prick test patch test oral challenge mast cell tryptase and histamine release assays ELISA/ImmunoCAP component-resolved diagnostics.	Action View
# 4	Learning outcome 3	Competency Interpret allergy test data in light of clinical details and on patients with a range of common allergies including food allergy inhalant allergy drug allergy.	Action View
# 5	Learning outcome 3	Competency Interpret immunological data in light of clinical details.	Action View
# 6	Learning outcome 3,4	Competency Identify cases requiring urgent intervention (e.g. anaphylaxis) and be able to offer clinical advice on follow-up and/or further management.	Action View

Assessments

You must complete:

• 2 case-based discussion(s)
• 2 of the following DOPS/ OCEs:

Perform a test to measure IgE to an allergen	DOPS
Perform the test to determine total IgE levels in the serum of a patient	DOPS
Perform the test in the laboratory to measure the level of mast cell tryptase in a patient	DOPS
Authorise the result of tests for mast cell tyrptase report on the significance of these results	DOPS
Authorise the result of tests for IgE to different allergens in at least 5 different patients	DOPS
Perform an assay on Component resolved diagnostics to an allergen	DOPS
Undertake a skin prick test on a patient and explain to the patient how it is used by the lab	OCE
Observe a patch test on a patient and explain to the patient how it is used	OCE
Take a patient history for a patient with a suspected allergic reaction	OCE
Take a history taking of a patient with a suspected allergic reaction to bees or wasps	OCE
Observe the discussion between the clinician and patient when the patient is offered immunotherapy for their allergic reactions and describe to the patient the nature of the tests	OCE
Take a patient history where there is suspected angioedema or urticaria	OCE
Obtain a patient history from a normal volunteer or typical patient referred to your service and present the findings to a colleague or peer	OCE

Learning outcomes

1. Select appropriate methods to investigate hypersensitivity and immunology laboratory tests for specific IgE.
2. Perform clinical and laboratory investigation of hypersensitivity and allergy.
3. Interpret and report results of investigations of hypersensitivity and allergy in the correct clinical context.
4. Work in partnership with other clinical specialisms in the investigation of hypersensitivity and allergy.

Learning outcomes

1. Define and explain ‘atopy’ and the factors involved in the development of atopic disease.
2. Define and explain allergy, distinguishing it from hypersensitivity.
3. Explain and distinguish between the four types of hypersensitivity.
4. Explain the production of immunoglobulin E (IgE) by B cells in response to allergen.
5. Explain how IgE triggers mast cells to deregulate and describe the clinical features of mast cell degranulation in the allergic patient.
6. Discuss the important features of allergic rhinitis, atopic eczema and anaphylaxis.
7. Describe the design, operation and performance of hypersensitivity skin testing, including contraindications, limitations and precautions to be taken.
8. Describe the design, operation, use and limitations of immunology laboratory tests for specific IgE.
9. Discuss the important causes of and explain the mechanism of allergic contact dermatitis.
10. Describe the partnership between the clinical immunology laboratory and other clinical specialisms in the investigation of hypersensitivity and allergy and patient care.

Indicative content

• Type I Immediate hypersensitivity
  • Pathogenesis
  • Allergic diseases (asthma; allergic rhinitis; allergic eczema; urticaria)
  • Anaphylaxis
  • Desensitisation
• Type II Antibody-dependent cytotoxic hypersensitivity
  • Organ-specific autoimmune diseases
  • Autoimmune cytopenias
  • Haemolytic disease of the newborn
• Type III Immune complex-mediated hypersensitivity
  • Serum sickness
  • Allergic alveolitis
  • Lepromatous leprosy
  • Systemic lupus erythematosus (SLE)
  • Cutaneous vasculitis
  • Arthus reaction
• Type IV Delayed cell-mediated hypersensitivity
  • Contact hypersensitivity
  • Tuberculous reactions
  • Granulomas
  • Graft rejection and graft versus host disease (GVHD)
• Type V Stimulatory hypersensitivity
  • Autoantibodies against cell receptors (thyroid stimulatory autoantibodies)

Activities

• Identify a patient with mild, moderate or severe allergy, understand the care pathway of the patient from the initial consultation, investigations, follow-up appointment and treatment, and understand the role of Clinical Immunology in the care pathway.
• Observe history taking in patients with a range of conditions associated with hypersensitivity and use the information to suggest appropriate investigation strategies based on this information.
• Attend clinics and multidisciplinary team meetings at which patients are being investigated for hypersensitivity and allergy, and discuss the allergic mechanisms and potential treatments for each patient with your training supervisor.
• Critically appraise the internal quality control and external quality assessment performance of methods used in allergy testing.
• Observe the treatment of adults and children with allergy and discuss the effect of a chronic disease on quality of life.
• Observe the treatment of adults with eczema and the non-pharmacological and pharmacological treatment regimens that are available and discuss the impact of eczema on quality of life with your training supervisor.