====== Immunology ======

Immunology examines immune system physiology, inflammatory signaling pathways, hypersensitivity reactions, and pharmacologic modulation of immune responses.

This section progresses from immune physiology → inflammatory mediators → hypersensitivity → immune-targeting pharmacology → clinical disease integration.

Immunology underlies:

  * [[allergy:clinical:allergic_rhinitis|Allergic Rhinitis]]
  * [[allergy:clinical:anaphylaxis|Anaphylaxis]]
  * [[respiratory:clinical:asthma|Asthma]]
  * [[gastroenterology:clinical:inflammatory_bowel_disease|Inflammatory Bowel Disease]]
  * [[rheumatology:clinical:rheumatoid_arthritis|Rheumatoid Arthritis]]
  * [[dermatology:clinical:psoriasis|Psoriasis]]
  * [[infectious_disease:clinical:sepsis|Sepsis]]
  * [[transplant:clinical:transplant_rejection|Transplant Rejection]]

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===== High-Yield Framework =====

  * Innate immunity initiates inflammation.
  * Adaptive immunity provides specificity and memory.
  * Th1/Th17 drive autoimmune inflammation.
  * Th2 drives allergic disease.
  * COX pathway → prostaglandins.
  * 5-LOX pathway → leukotrienes.
  * NSAIDs block COX.
  * COX-2 inhibitors selectively block inflammatory COX-2.
  * Leukotriene modifiers block bronchoconstrictive leukotrienes.
  * Corticosteroids suppress upstream inflammatory transcription.
  * Biologics target specific cytokines.

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===== I. Core Immune Physiology =====

==== Innate Immunity ====

  * [[immunology:innate_immunity|Innate Immunity]]
  * [[immunology:complement_system|Complement System]]
  * [[immunology:leukocyte_recruitment|Leukocyte Recruitment & Chemotaxis]]
  * [[immunology:cytokines_overview|Cytokines Overview]]

Major innate mediators:

  * [[immunology:tnf_family|TNF-α]]
  * [[immunology:interleukins_master|IL-1 / IL-6]]
  * [[immunology:interferons|Type I Interferons]]

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==== Adaptive Immunity ====

  * [[immunology:adaptive_immunity|Adaptive Immunity]]
  * [[immunology:antigen_presentation_mhc|Antigen Presentation & MHC]]
  * [[immunology:t_cell_activation|T Cell Activation]]
  * [[immunology:b_cell_activation_class_switching|B Cell Activation & Class Switching]]
  * [[immunology:th1_th2_th17_tfh_treg|T Helper Subsets]]
  * [[immunology:igg_iga_igm_ige_igd|Immunoglobulin Classes]]

Dominant T-helper patterns:

  * Th1 → [[rheumatology:clinical:rheumatoid_arthritis|Rheumatoid Arthritis]]
  * Th2 → [[allergy:clinical:allergic_rhinitis|Allergic Disease]] / [[respiratory:clinical:asthma|Asthma]]
  * Th17 → [[dermatology:clinical:psoriasis|Psoriasis]] / [[gastroenterology:clinical:ibd|IBD]]
  * Treg → immune tolerance

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===== II. Inflammatory Mediator Networks =====

==== Arachidonic Acid Cascade ====

Membrane phospholipids →
Phospholipase A2 →
Arachidonic Acid →

→ COX pathway → **Prostaglandins & Thromboxanes**  

→ 5-Lipoxygenase Pathway → **Leukotrienes**

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==== Upstream Inhibition ====

Phospholipase A2 blockade:

  * [[endocrine:drug_classes:corticosteroids|Corticosteroids]]

Used in:

  * [[respiratory:clinical:asthma|Asthma]]
  * [[gastroenterology:clinical:ibd|IBD]]
  * [[rheumatology:clinical:rheumatoid_arthritis|Rheumatoid Arthritis]]
  * [[dermatology:clinical:psoriasis|Psoriasis]]

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==== Nonselective COX Inhibitors ====

  * [[cardiovascular:eicosanoids:nsaids|NSAIDs]]
  * [[cardiovascular:eicosanoids:aspirin|Aspirin]]

Used in:

  * [[rheumatology:clinical:rheumatoid_arthritis|Rheumatoid Arthritis]]
  * Inflammatory pain conditions

==== COX-2 Selective Inhibitors ====

  * [[cardiovascular:eicosanoids:cox2_inhibitors|COX-2 Inhibitors]]

Used in:

  * [[rheumatology:clinical:rheumatoid_arthritis|Rheumatoid Arthritis]]
  * Osteoarthritis

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==== Prostaglandin Receptor Agonists ====

  * [[cardiovascular:eicosanoids:misoprostol|Misoprostol]]
  * [[cardiovascular:eicosanoids:alprostadil|Alprostadil]]
  * [[ophthalmology:drugs:latanoprost|Latanoprost]]

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==== Leukotriene Pathway =====

Drug modulation:

  * [[respiratory:drug_classes:leukotriene_modifiers|Leukotriene Modifiers]]

Used in:

  * [[respiratory:clinical:asthma|Asthma]]
  * [[allergy:clinical:allergic_rhinitis|Allergic Rhinitis]]

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==== Histamine Pathway =====

Drug modulation:

  * [[allergy:drug_classes:first_generation_h1|First Generation Antihistamines]]
  * [[allergy:drug_classes:second_generation_h1|Second Generation Antihistamines]]
  * [[endocrine:drug_classes:corticosteroids|Corticosteroids]]
  * Epinephrine

Used in:

  * [[allergy:clinical:allergic_rhinitis|Allergic Rhinitis]]
  * [[allergy:clinical:anaphylaxis|Anaphylaxis]]

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==== Complement Pathway =====

Drug Modulation

  * [[immunology:drug_classes:complement_inhibitors|Complement Inhibitors]]

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===== III. Immune-Modulating Drug Classes =====

==== Broad Immunosuppressants =====

  * [[endocrine:drug_classes:corticosteroids|Corticosteroids]]
  * [[immunology:drugs:methotrexate|Methotrexate]]
  * [[immunology:drugs:azathioprine|Azathioprine]]
  * [[immunology:drugs:mercaptopurine|6-Mercaptopurine]]

Calcineurin inhibitors:

  * [[immunology:drug_classes:calcineurin_inhibitors|Calcineurin Inhibitors]]

Used in:

  * [[transplant:clinical:transplant_rejection|Transplant Rejection]]
  * Autoimmune disease

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==== Targeted Immune Therapies ====

[[immunology:biologics:anti_tnf_agents|Anti-TNF Agents]]

  * [[immunology:biologics:infliximab|Infliximab]]
  * [[immunology:biologics:adalimumab|Adalimumab]]
  * [[immunology:biologics:etanercept|Etanercept]]
  * [[immunology:biologics:certolizumab|Certolizumab]]
  * [[immunology:biologics:golimumab|Golimumab]]

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[[immunology:biologics:anti_il_12_23_agents|Anti-IL-12/23 Agents]]

  * [[immunology:biologics:ustekinumab|Ustekinumab]]

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[[immunology:drug_classes:il_23_inhibitors|IL-23 Inhibitors]]

  * [[immunology:biologics:guselkumab|Guselkumab]]
  * [[immunology:biologics:risankizumab|Risankizumab]]
  * [[immunology:biologics:tildrakizumab|Tildrakizumab]]
  * [[immunology:biologics:mirikizumab|Mirikizumab]]

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[[immunology:drug_classes:il_17_inhibitors|IL-17 Inhibitors]]

  * [[immunology:biologics:secukinumab|Secukinumab]]
  * [[immunology:biologics:ixekizumab|Ixekizumab]]
  * [[immunology:biologics:brodalumab|Brodalumab]]
  * [[immunology:biologics:bimekizumab|Bimekizumab]]

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[[immunology:drug_classes:il_6_inhibitors|IL-6 Inhibitors]]

  * [[immunology:biologics:tocilizumab|Tocilizumab]]
  * [[immunology:biologics:sarilumab|Sarilumab]]
  * [[immunology:biologics:siltuximab|Siltuximab]]

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[[immunology:drug_classes:il_1_inhibitors|IL-1 Inhibitors]]

  * [[immunology:biologics:anakinra|Anakinra]]
  * [[immunology:biologics:canakinumab|Canakinumab]]
  * [[immunology:biologics:rilonacept|Rilonacept]]

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[[immunology:drug_classes:anti_ige_agents|Anti-IgE Agents]]

  * [[immunology:biologics:omalizumab|Omalizumab]]

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[[immunology:biologics:anti_integrin_agents|Anti-Integrin Agents]]

  * [[immunology:biologics:vedolizumab|Vedolizumab]]
  * [[immunology:biologics:natalizumab|Natalizumab]]

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[[immunology:drug_classes:jak_inhibitors|JAK Inhibitors]]

  * [[immunology:drugs:tofacitinib|Tofacitinib]]
  * [[immunology:drugs:baricitinib|Baricitinib]]
  * [[immunology:drugs:upadacitinib|Upadacitinib]]
  * [[immunology:drugs:filgotinib|Filgotinib]] (non-US approval varies)
  * [[immunology:drugs:ruxolitinib|Ruxolitinib]]

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[[immunology:drug_classes:complement_inhibitors|Complement Inhibitors]]

  * [[immunology:biologics:eculizumab|Eculizumab]]
  * [[immunology:biologics:ravulizumab|Ravulizumab]]
  * [[immunology:biologics:avacopan|Avacopan]]
  * [[immunology:biologics:pegcetacoplan|Pegcetacoplan]]

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[[immunology:drug_classes:costimulation_blockers|Costimulation Blockers]]

  * [[immunology:biologics:abatacept|Abatacept]]