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160 / CHAPTER 5ThymusOnce generated in bone marrow, T-lymphocyte precursors migrate to the thymus for maturation.The thymus is formed of the endoderm and mesoderm of third and fourth pharyngeal pouches.Thymic histology and architecture is detailed in Figure 5-1.The thymic epithelium is divided into the subcapsular zone, the cortex, and the medulla:The Subcapsular zone contains the most primitive lymphocyte progenitors derived frombone marrow.The Cortex contains small lymphocytes engaged in the division, expression, and selectionprocess of T cell receptors.The Medulla contains lymphocytes that are undergoing their final stages of selection andmaturation. (It also contains Hassall’s corpuscles.)Within the cortex:T cell receptors that are compatible with self-MHC molecules displayed on the thymicepithelium or stroma transmit a survival signal (positive selection).Autoreactive or nonfunctional T cell receptor-bearing T lymphocytes undergo apoptosis(negative selection).By way of the medulla:Mature T lymphocytes leave the thymus to circulate at the periphery or go to secondarylymphoid tissues.It should also be noted that, other than migrating to the thymus for maturation, some T-lymphocyte precursors from bone marrow migrate to cryptopatches (CPs), tiny mucosallymphoid aggregates found just under the intestinal epithelium, to form specialized T-lymphocyte populations.MnemonicTHYMUST-lymphocyte maturation occurs in the thymus.Hassall’s corpuscles are in the thymusYoung individuals have a thymus that is relatively large as its size decreases with age.Medulla, cortex, and subcapsular zone.U should remember both positive and negative selection occur in thymus.Subcapsular epithelium provides blood-thymus barrier.
ANATOMY, PHYSIOLOGY, AND PATHOLOGY / 161TrabeculaeMedulaVascular TissueABFigure 5-1. Thymus gland. (A) Histologic picture of human thymic tissue. (B) Thymusarchitecture showing Hassall’s corpuscle.(Image A: courtesy of Wikipedia; permission granted per the GNU Free Documentation License and the CreativeCommons Attribution ShareAlike 3.0 license. Image B: courtesy of Ankita Nair and Nikita Nair.)
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ACAUNOLOGY ACAAI REVIEWFORALLERGYTH
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American College of Allergy, Asthma
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CONTENTSContributing AuthorsSenior
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ImagingFlow Cytometry and Cell Surf
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Kusum Sharma, MDAssistant Professor
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Maurice R. G. O’Gorman, MSc, MBA,
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xviii
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Section 1. Basic Science1Immune Mec
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IMMUNE MECHANISMS / 3Composition of
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IMMUNE MECHANISMS / 5StructureKnowl
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IMMUNE MECHANISMS / 7In addition to
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IMMUNE MECHANISMS / 9Newly synthesi
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IMMUNE MECHANISMS / 11Peripheral To
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IMMUNE MECHANISMS / 13Table 1-6. To
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IMMUNE MECHANISMS / 15Figure 1-5. D
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IMMUNE MECHANISMS / 17IMMUNOGLOBULI
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IMMUNE MECHANISMS / 19Ig FormsTwo f
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IMMUNE MECHANISMS / 21Table 1-10. I
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IMMUNE MECHANISMS / 23Table 1-11. F
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IMMUNE MECHANISMS / 25Costimulation
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IMMUNE MECHANISMS / 27αβ TCRStruc
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IMMUNE MECHANISMS / 29Key FactNKT c
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IMMUNE MECHANISMS / 31Key FactZAP-7
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IMMUNE MECHANISMS / 33Note: Btk is
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IMMUNE MECHANISMS / 35Table 1-17. C
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IMMUNE MECHANISMS / 43IntegrinsImmu
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IMMUNE MECHANISMS / 45Immunoglobuli
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IMMUNE MECHANISMS / 47Figure 1-11.
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IMMUNE MECHANISMS / 49Table 1-24. R
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IMMUNE MECHANISMS / 53Figure 1-14.
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IMMUNE MECHANISMS / 55M cells are n
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IMMUNE MECHANISMS / 57Non-IgE-Media
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IMMUNE MECHANISMS / 59ABO blood gro
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IMMUNE MECHANISMS / 61Key FactChanc
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IMMUNE MECHANISMS / 63Autocrine T l
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IMMUNE MECHANISMS / 65Table 1-30. I
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IMMUNE MECHANISMS / 67PRRs identify
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IMMUNE MECHANISMS / 69TLR 4 binds t
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2Cells Involved in ImmuneResponsesL
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CELLS INVOLVED IN IMMUNE RESPONSES
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3Specific Immune ResponsesIMMEDIATE
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SPECIFIC IMMUNE RESPONSES / 99Diffe
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SPECIFIC IMMUNE RESPONSES / 101Neut
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SPECIFIC IMMUNE RESPONSES / 103Secr
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SPECIFIC IMMUNE RESPONSES / 105Figu
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SPECIFIC IMMUNE RESPONSES / 107effe
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Page 131 and 132: 4Laboratory TestsIMMUNOGLOBULIN MEA
Page 133 and 134: LABORATORY TESTS / 113The amount of
Page 135 and 136: LABORATORY TESTS / 115Methods to Ch
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Page 139 and 140: LABORATORY TESTS / 119- + - +Phosph
Page 141 and 142: LABORATORY TESTS / 121Specific Ig L
Page 143 and 144: LABORATORY TESTS / 123MEDIATOR DETE
Page 145 and 146: LABORATORY TESTS / 125Study note: T
Page 147 and 148: LABORATORY TESTS / 127Table 4-4. Ce
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Page 155 and 156: LABORATORY TESTS / 135Table 4-13. C
Page 157 and 158: LABORATORY TESTS / 137Table 4-16. T
Page 159 and 160: LABORATORY TESTS / 139Anergy can be
Page 161 and 162: CD27LABORATORY TESTS / 141IgD-CD27+
Page 163 and 164: Granzyme BLABORATORY TESTS / 143Nor
Page 165 and 166: LABORATORY TESTS / 145Figure 4-21.
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Page 171 and 172: LABORATORY TESTS / 151IMMUNE COMPLE
Page 173 and 174: LABORATORY TESTS / 153DIAGNOSTIC TE
Page 175 and 176: LABORATORY TESTS / 155T Cell Recept
Page 179: 5Anatomy, Physiology, andPathologyL
Page 183 and 184: ANATOMY, PHYSIOLOGY, AND PATHOLOGY
Page 201 and 202: 6Research PrinciplesEXPERIMENTAL DE
Page 203 and 204: RESEARCH PRINCIPLES / 183Weaknesses
Page 205 and 206: RESEARCH PRINCIPLES / 185observatio
Page 207 and 208: RESEARCH PRINCIPLES / 187EPIDEMIOLO
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Page 211 and 212: Section 2. Clinical Science7Hyperse
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HYPERSENSITIVITY DISORDERS / 211The
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HYPERSENSITIVITY DISORDERS / 213lev
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HYPERSENSITIVITY DISORDERS / 215AKC
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HYPERSENSITIVITY DISORDERS / 217Cas
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HYPERSENSITIVITY DISORDERS / 219Gen
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HYPERSENSITIVITY DISORDERS / 221Tab
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HYPERSENSITIVITY DISORDERS / 231ALL
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HYPERSENSITIVITY DISORDERS / 233Key
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HYPERSENSITIVITY DISORDERS / 235Dia
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HYPERSENSITIVITY DISORDERS / 237Lab
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HYPERSENSITIVITY DISORDERS / 241CHR
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244 / CHAPTER 7IgE MediatedNon-IgE
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246 / CHAPTER 7Food Associated, Exe
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248 / CHAPTER 7Sweat test, especial
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250 / CHAPTER 7o Aggregation leads
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252 / CHAPTER 7Compensatory Mechani
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254 / CHAPTER 7Table 7-27. Histamin
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256 / CHAPTER 7STINGING INSECT ALLE
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258 / CHAPTER 7DiagnosisClinical Hi
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260 / CHAPTER 7Table 7-31. Indicati
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262 / CHAPTER 7Table 7-32. Subclass
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264 / CHAPTER 7CephalosporinsCross-
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266 / CHAPTER 7Local Anesthetic Age
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268 / CHAPTER 7Serum SicknessSerum
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270 / CHAPTER 7to desensitization i
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272 / CHAPTER 7Physical UrticariaCo
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274 / CHAPTER 7Hypocomplementemic U
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276 / CHAPTER 7Figure 7-11. Linear
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278 / CHAPTER 7Table 7-35. Excipien
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280 / CHAPTER 7Systemic contact der
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282 / CHAPTER 7months; and for pack
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284 / CHAPTER 7Collagen vascular di
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286 / CHAPTER 7Etiology80% of croup
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288 / CHAPTER 7
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290 / CHAPTER 8HAE Type III: Normal
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292 / CHAPTER 8CONGENITAL (PRIMARY)
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294 / CHAPTER 8Table 8-2. Etiology
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296 / CHAPTER 8Table 8-3. Evaluatin
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298 / CHAPTER 8Table 8-4. Cellular
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300 / CHAPTER 8Table 8-6. Antibody
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302 / CHAPTER 8Table 8-6. Antibody
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304 / CHAPTER 8Table 8-7. Evaluatin
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306 / CHAPTER 8Table 8-8. Clinical
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310 / CHAPTER 8Primary complement d
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312 / CHAPTER 8within the host’s
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314 / CHAPTER 8progresses to the fi
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316 / CHAPTER 8HIV PreventionMother
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318 / CHAPTER 8Table 8-18. Prophyla
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320 / CHAPTER 8Table 8-19. Summary
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322 / CHAPTER 8*Köbner’s phenome
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324 / CHAPTER 8Obstructive airway d
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326 / CHAPTER 8Clinical FeaturesThi
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328 / CHAPTER 8DRB1*1103. The diffe
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330 / CHAPTER 8MLR donor A’s mono
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332 / CHAPTER 8Syngeneic and Alloge
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334 / CHAPTER 8SCID (with B-lymphoc
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338 / CHAPTER 8Immune Mechanisms—
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340 / CHAPTER 8Immune dysregulation
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342 / CHAPTER 8IMMUNOLOGIC RENAL DI
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344 / CHAPTER 8present with nephrot
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346 / CHAPTER 8there is rapidly det
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348 / CHAPTER 8Serum Autoantibodies
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350 / CHAPTER 8Pemphigoid VariantsA
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352 / CHAPTER 8Treatment—Diagnosi
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354 / CHAPTER 8Anterior uveitis: to
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356 / CHAPTER 8ExtremitiesTrunkButt
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358 / CHAPTER 8ss- or ds-DNAS. cere
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360 / CHAPTER 8Treatment—Treatmen
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362 / CHAPTER 8IMMUNOLOGIC NEUROPAT
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364 / CHAPTER 8Table 8-33. Immunolo
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366 / CHAPTER 8endocarditis is a fo
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368 / CHAPTER 8HODGKIN’S LYMPHOMA
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370 / CHAPTER 8Α-1 globulin= α-1
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372 / CHAPTER 8Diagnosis—SPEP sho
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374 / CHAPTER 8Types II and III cry
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376 / CHAPTER 8o Churg-Strauss synd
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378 / CHAPTER 8Secondary Amyloidosi
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380 / CHAPTER 8PathogenesisActivati
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382 / CHAPTER 8DEXA scanning and ca
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384 / CHAPTER 8Cold-reactive AIHA
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386 / CHAPTER 8CYSTIC FIBROSISEpide
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388 / CHAPTER 8PulmonaryChest physi
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390 / CHAPTER 8Humoral Immunity—C
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392 / CHAPTER 8IMMUNOLOGIC ASPECTS
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394 / CHAPTER 8Humoral immunity has
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396 / CHAPTER 8HEPATITISHepatitis A
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398 / CHAPTER 8Hepatitis CDiagnosti
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400 / CHAPTER 8suspected, further d
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402 / CHAPTER 9Carpet removal and r
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404 / CHAPTER 9Studies Demonstratin
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406 / CHAPTER 9Doses and Dosing Sch
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408 / CHAPTER 9Table 9-5. Typical D
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410 / CHAPTER 9Table 9-6. Four Type
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412 / CHAPTER 9Table 9-7. Antihista
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414 / CHAPTER 9Figure 9-2. Theophyl
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416 / CHAPTER 9Key FactAlbuterol bi
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418 / CHAPTER 9Venom immunotherapy
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420 / CHAPTER 9Clinical Uses of Leu
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422 / CHAPTER 9BronchoprotectionPre
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424 / CHAPTER 9Role in asthma: Reco
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426 / CHAPTER 9Osteopenia or osteop
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428 / CHAPTER 9Table 9-10. Other Th
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430 / CHAPTER 9Adverse Effects—Co
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432 / CHAPTER 9CIDPOff-label uses i
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434 / CHAPTER 9given weekly. Howeve
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436 / CHAPTER 9CYTOKINES AS THERAPE
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438 / CHAPTER 9Table 9-13. Summary
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440 / CHAPTER 9Table 9-15. Comparis
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442 / CHAPTER 9Table 9-16. Anticyto
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444 / CHAPTER 9only 50%. In Wiskott
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446 / CHAPTER 9Time to EngraftmentM
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448 / CHAPTER 9Table 9-18. Re-Immun
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450 / CHAPTER 9Table 9-19. Vaccine
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452 / CHAPTER 9Selective COX-2 inhi
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454 / CHAPTER 9zafirlukast) are eff
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456 / CHAPTER 9cleansing or enemas.
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458 / CHAPTER 9Do not forget that,
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460 / CHAPTER 9Table 9-21. Topical
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462 / CHAPTER 9ADA-SCID: An ADA-enc
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464 / CHAPTER 10Can be utilized as
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466 / CHAPTER 10o ImmunoCAP® syste
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468 / CHAPTER 10dosages can be comp
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470 / CHAPTER 10Figure 10-1. Types
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472 / CHAPTER 10Bronchial Provocati
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474 / CHAPTER 10Table 10-5. Compari
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476 / CHAPTER 10NASAL AND SPUTUM SM
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478 / CHAPTER 10MUCOCILIARY FUNCTIO
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480 / CHAPTER 10AsthmaGenetic defec
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482 / CHAPTER 10Figure 10-4. Sandwi
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484 / CHAPTER 10Figure 10-7. SPEP s
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486 / CHAPTER 10Table 10-11. Serolo
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488 / CHAPTER 10MOLECULAR DIAGNOSTI
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490 / CHAPTER 10Fluorescent in situ
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492 / CHAPTER 10Detection of these
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494 / CHAPTER 10Figure 10-9. CT sca
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496 / CHAPTER 10Magnetic Resonance
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498 / CHAPTER 10Figure 10-14. Flow
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500 / CHAPTER 10Table 10-14. Common
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502 / CHAPTER 10Figure 10-18. Autoi
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504 / CHAPTER 10Applied Kinesiology
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506 / CHAPTER 10which a patient is
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508 / CHAPTER 10Table 10-15. Specif
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510 / CHAPTER 11Figure 11-1. Grass
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512 / CHAPTER 11Chenopod and Amaran
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514 / CHAPTER 11Marshelder (Iva)Riv
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516 / CHAPTER 11Figure 11-10. Pine
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518 / CHAPTER 11Figure 11-14. Maple
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520 / CHAPTER 11Sweetgum (Hamamelid
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522 / CHAPTER 11Immune Response: Bo
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524 / CHAPTER 11AspergillusCommon,
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526 / CHAPTER 11AscomycetesRainy da
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528 / CHAPTER 11Environmental Contr
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530 / CHAPTER 11Can f 3: dog serum
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532 / CHAPTER 11POLLUTANTSAir Quali
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534 / CHAPTER 11Key FactThere is no
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536 / CHAPTER 11Phenol—0.4% pheno
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538 / CHAPTER 11Burkard Spore Trap
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540 / CHAPTER 11AUTOANTIGENSAutoant
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542 / CHAPTER 11Table 11-7. Example
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544 / CHAPTER 11Table 11-9. Example
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546 / CHAPTER 11Table 11-11. Virule
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548 / CHAPTER 11Table 11-12. Major
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550 / CHAPTER 11Table 11-14. Cross-
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552 / CHAPTER 11StandardizationHone
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