Allergic diseases SLIDES

Аllergic diseases.
Immunopathology of the аllergy.
Other allergic (non-atopic) diseases:
• types,
• immunopathogenesis,
• immunodiagnostic,
• immunotherapy.

Food Infants/Young
children
Older
Children And
Adults
Anaphylaxi
s
Milk (cow/goat) • •
Chicken egg • •
Soy •
Peanut • • •
Tree nuts (walnut, hazel/filbert, cashew,
pistachio, Brazil , pine nut, almond)
• •
Wheat •
Fish •
Shellfish (shrimp, crab, lobster, oyster,) • •
Fruit • •
Vegetables • •
Seeds (cotton, sesame, psyllium, mustard) • •
Common Food Allergens

Inhalant
Allergen
Food Allergens
Birch pollen Apple, raw potato, carrot, celery, hazelnut, pear,
peach, plum, cherry
Mugwort pollen Celery, apple, peanut, kiwi fruit, carrot, parsley,
spices (fennel, coriander, aniseed, cumin)
Ragweed pollen Melons, watermelon, bananas
Latex Avocado, kiwi fruit, chestnut
Typical cross reactivity associations include:

 Allergic disease is the 5th leading chronic
disease among all ages
 3rd common chronic disease among children
under 18 years old; up to one child in three is
affected
 Trends indicate that by 2015, half of all
Europeans may be suffering from an allergy

 Allergies affect people from the early stages
of their life and continue until their late adult
ages

Stages of allergic reactions:
 pre immunological- formation of a
complete (full) allergens (antigens);
 immune - in the shock organs occurs
antigen-antibody reaction. This reaction is
strictly specific and caused only by the
introduction of a specific allergen;
 pathochemical - resulting in formation of an
antibody-antigen complex is released
approximately 20 biologically active
substances (histamine, heparin, serotonin,
kinin). The reaction is not specific;
 pathophysiological - manifested
pathogenic action of biologically active
substances in various organs and tissues.

Nose Pharynx
Stomach
Oesophagus Lungs
““Global diseases” – due to the largeGlobal diseases” – due to the large
spectrum of symptoms affecting the wholespectrum of symptoms affecting the whole
bodybody
Skin
Food allergyFood allergy
Allergic rhinitisAllergic rhinitis
AsthmaAsthma
EczemaEczema
UrticariaUrticaria
Allergic dermatitisAllergic dermatitis

I. Allergic anamnesis. A detailed anamnesis is a basic
information source, necessary for diagnostics and treatment
of the allergic diseases.
While examining patients with the allergic diseases special
attention should be paid to:
 1. variability of the symptoms (they develop and disappear
rapidly, they develop in the specific place or in the specific
season)
 2. individual allergic anamnesis
 3. family allergic anamnesis

The organs and the systems, which are most frequently
affected with the allergic diseases:
 the skin,
 eye,
 respiratory organs are examined especially attentively.

Basic principles:
 1. Not to fail to note the affection of the skin,
it is necessary to investigate the entire skin.
 A patient can not mention about the skin
manifestations, considering them
insignificant, not related to the disease or
feeling shy of them.

 1) An increase in the number of the
eosinophils up to 5-15%.
 2) Absolute and relative lymphocytosis.
 In exacerbation of the allergic diseases
eosinophils predominate among the cells in
the smears of the phlegm, discharge from the
nose or eyes, in the concomitant infection
there are neutrophils

 An increase in the total level of IgE in the
serum confirms the diagnosis of the allergic
disease, although the normal level of IgE does
not exclude it.
 4. Determination of the levels of specific IgE in
blood serum
 (IFA diagnostics,
 ELISA and immunoblotting) to different
allergens.

 The signs of the allergic diseases:
 - Absolute and relative lymphocytosis;
 - Eosinophilia;
 - An increase (more than 2.8) in the index of
immunoregulation (Tx/Tc) (CD4/CD8):
 - An increase in the absolute and relative quantity of the
B-lymphocytes;
 - A reduction of the complement content;
 - An increase in the levels of the circulating immune
complexes;
 - An increase autoantibodies to the tissues of the organs
- targets (the skin, mucous membrane of the nose,
bronchi, lungs)

 There are cutaneous – puncture and
scarification and intracutaneous tests.
 The positive results of skin tests (erythema and
blister at the site of the allergen introduction)
are of a diagnostic value only in combination
with the data of the anamnesis, physical and
laboratory investigations.

 Skin-prick testing remain the "gold standard"
for identifying clinically relevant allergens.

Grade Criteria Significance
+ / - Mild erythema and no
edema
Doubtful
1 + Erythema, edema and
induration
Positive
isolated vesicles
Positive
confluent vesicles
Positive
Grading of Patch Tests

 The allergen extracts in the dilution of 1: 100 are
used for the intracutaneous tests.
 When less than five puncture or scarification tests
are positive, intracutaneous tests can be carried out
immediately.
 If the positive puncture or scarification tests are
more, intracutaneous tests are carried out next day.
 Intracutaneous tests with the food allergens are not
made.

 1) Impairment of the technology of skin tests, the use of
the allergen preparations with expired date, the tests
made against the background of treatment with drugs
decreasing skin sensitivity lead to the pseudonegative
results.
 The intake of H1- blockers is withdrawn for 48 hr,
hydroxizine, terfenadine, loratadin and tricyclic
antidepressants – for 96 hr and astemizole - 4 weeks prior
to the study.
 Theophylline, adrenostimulators (inhalation and for the
internal administration) and cromolin do not influence the
skin sensitivity.

 is a method of development of sensitization, based on
the introduction of the allergen in the target organ.
 Provocative tests (endonasal, inhaled,
conjunctival).

Hypersensitivity Reactions
Types of immunological reactions:
Type 1 – Anaphylactic (Preformed IgE
antibodies - immediate a hypersensitivity
reaction) anaphylactic shock,
bronchoconstriction angioedema)
For example: penicillins.


There are two clinical subgroups of IgE-
mediated allergy:
 atopy and
 anaphylaxis.

 1. Atopy—The term “atopy” is applied to a group of
diseases
 (allergic rhinitis, allergic asthma, atopic dermatitis, and
allergic gastroenteropathy) occurring in persons with an
inherited tendency to develop antigen-specific IgE
reaction to environmental allergens or food antigens.
 Aeroallergens such as pollens, mold spores, animal
danders, and house dust mite antigen are common
triggers for allergic conjunctivitis, allergic rhinitis, and
allergic asthma.
 There is a strong familial tendency toward the
development of atopy.

 Type II: cytotoxic reaction: IgM or IgG
antibodies bind to antigen on the surface
of cells and activate complement
cascade:
 Autoimmune hemolytic anemia
 Transfusion reaction
 thrombocytopenia,

Hypersensitivity Reactions (cont.)
Types of immunological reactions:
 Type 3 –Immune complex reaction- Immune
complex mediated (antigen antibody‐ ‐
complexes deposited in vessels and cause
an inflammatory response) : serum sickness
(Fever, arthritis, lymphadenopathy, rashes),
pneumonitis, glomerulonephritis, vasculitis.

 Type 4 – Delayed/Cell mediated (sensitized‐
T lymphocytes release inflammatory
mediators) (hypersensitivity delayed type):
contact dermatitis
 For example, antibiotic ointment

 Eczematous skin lesions (age dependent)
 Early onset and typical localization of skin
lesions according to age
 Pruritis
 Stigmata of atopy
 Personal or family history of atopy
 IgE mediated sensitization (demonstrated
by skin prick test serum IgE measurement

 Dry skin
 Hyperlinearity of palms and soles
 Linear grooves of fingertips
 Dennie-Morgan fold (atopy fold, doubled intraorbicular
fold)
 Periorbital shadow (halo)
 White dermatographism

 They are used:
 - in acute states - parenterally (prednisolone, hydrocortisone,
dexamethasone)
 - systematically - orally and intramuscularly prolonged forms -
drugs- depot – effect for a month (polcortolon, diprospan)
 - locally - inhalation forms, nasal sprays, ointments and creams.
Antihistamine drugs (blockers of H1 -Antihistamine drugs (blockers of H1 -
histamine receptors)histamine receptors)
They are effective only upon transfer from theThey are effective only upon transfer from the
pathochemical stage to the pathophysiological one.pathochemical stage to the pathophysiological one.

 Competitive (with histamine) blockade of H1 - receptors – drugs
should be taken frequently (3-4 times in a 24 hour period), and in the
large doses (risk of the toxic action);
 - penetrate through the blood-brain barrier - sedative side-effect
(sleepiness) + potentiate the effect of analgesics and antipyretics;
 - Irritate the GIT mucosa - the side-effect is diarrhea, therefore the
intake is after meal;
 - In the prolonged intake (more than 10 days) tachyphylaxis develops
(addiction) - effectiveness is lowered;
 - muscarine-like effect (anticholinergic action) - they decrease the
secretion of the mucous glands of the respiratory system – they are
contraindicated in diseases of the respiration organs in presence of
the thick phlegm in the bronchi (they reduce the drainage function of
the bronchi).

 Hismanal, histalong (Astemizol), Claritin (Loratadine),
Zirtek (Cetirizine), Cestin (Ebastine), Trexil (terfenadine)
 Peculiarities of pharmacokinetics and the mechanism of
action:
 They are noncompetitive blockade of H1 - histaminic
receptors; they do not penetrate through the blood-brain
barrier; they do not irritate the GIT mucosa; tachyphylaxis
does not develop; do not bind with the blood proteins;
anticholinergic action is absent.

 Telfast (Fexofenadine), Erius (dezloratadine), Aleron
(levocetirizine)

 According to the last recommendations of allergologists
intake of the drugs of the first generation is indicated in the
emergency allergic states, since they are in the injection
forms, and the administration of the drugs of the second and
third generation is indicated for the course therapy.
 At the same time the drugs of the second and third
generation do not exceed those of the first generation in the
manifestation of the antiallergic effect.
 Furthermore, many people are noted to have individual
sensitivity (selective) to the antihistamine drugs. There may
be higher efficacy in intake of the drugs of the first generation
and minimum reaction after the intake of the drug of the
second or third generation.

 They are effective at the pathochemical stage and ketotifen - upon
transfer from the pathochemical stage to the pathophysiological one.
 Cetotifen, sodium cromolin (intal, cromolin, cromogexal,
cromoglin etc), Nedocromil of sodium (Tiled).
Anti-leucotriene drugs (inhibitors of leucotriene
metabolism)
Selectively binds to human immunoglobulin E
(Omalizumab)
Specific immunotherapy

Thank you for your attention!Thank you for your attention!

Allergic diseases SLIDES

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