Atopi c diseases
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Transcript of Atopi c diseases
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Immunopathological reaction type IV (delayed type). Cutaneous and mucous contact allergy.
IgE mediated immunopathological reaction (type I, atopy).
Allergens. Allergic diseases – causes, symptoms and diagnostics.
Anaphylaxis (causes, symptoms and treatment).
Examples of diseases based on immunopathological reaction type I. Treatment.
Drug allergy.
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Immunopathological reaction type IV (delayed type). Cutaneous and mucous contact allergy.
IgE mediated immunopathological reaction (type I, atopy).
Allergens. Allergic diseases – causes, symptoms and diagnostics.
Anaphylaxis (causes, symptoms and treatment).
Examples of diseases based on immunopathological reaction type I. Treatment.
Drug allergy.
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Immunopathological reaction type IV (delayed type). Cutaneous and mucous contact allergy.
IgE mediated immunopathological reaction (type I, atopy).
Allergens. Allergic diseases – causes, symptoms and diagnostics.
Anaphylaxis (causes, symptoms and treatment).
Examples of diseases based on immunopathological reaction type I. Treatment.
Drug allergy.
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Atopic diseases
Allergic asthma is chronic inflammatory disease of the airways in which a wide variety of cells (mast cells. Eosinophils, TH2 lymphocytes) and mediators play a role.
Atopic dermatitis
Allergic rhinitis
Allergic asthma
• Allergic rhinitis is affection of the nose (and ocular conjunctiva) caused by IgE-mediated inflammation of nasal mucosa after allergen exposure.
• Atopic dermatitis is inflammatory disease of the skin which is mediated by T cells and stimulated by IgE-dependent reactions.
IgE mediated food allergy Alergie
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Mechanism of IgE–mediated reaction
Type I – Allergy
Allergen IgE bound to the surface of the mast cell
Degranulation, mediator release
+
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Allergicreaction
IL-4
IL-5
Eosinophil
IgE
B
T
T
Th2
APC
Allergen
T
Th1
IFN- BIgG
IL-12
IL-12
Th1/Th2 response
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Immunopathological reaction type IV (delayed type). Cutaneous and mucous contact allergy.
IgE mediated immunopathological reaction (type I, atopy).
Allergens. Allergic diseases – causes, symptoms and diagnostics.
Anaphylaxis (causes, symptoms and treatment).
Examples of diseases based on immunopathological reaction type I. Treatment.
Drug allergy.
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Diagnosis of allergy
History
Clinical examination
Skin tests
Specific IgE in the serum
Provocation and elimination tests
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Immunopathological reaction type IV (delayed type). Cutaneous and mucous contact allergy.
IgE mediated immunopathological reaction (type I, atopy).
Allergens. Allergic diseases – causes, symptoms and diagnostics.
Anaphylaxis (causes, symptoms and treatment).
Examples of diseases based on immunopathological reaction type I. Treatment.
Drug allergy.
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Anaphylaxis Grade Skin GI-tract Respiratory
tractCardiovascular system
I Itching, urticaria, flush, angioedema
- - -
II Itching, urticaria, flush, angioedema
Nausea, cramps
Rhinorrhoea, dyspnea
Tachycardia, arythmia, decrease of blood
pressure
III Itching, urticaria, flush, angioedema
Diarrhoea Laryngeal oedema,
bronchospasm
Cardiovascular shock, faints
IV Itching, urticaria, flush, angioedema
Diarrhoea Respiratory arrest
Cardial arrest
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Treatment of anaphylaxis
Adrenaline / Epinephrine:
Intramuscular – in patients with clinical symptoms of shock, oedema of the airways and pronounced dyspnoea
Dosage in adults:
0.5 ml - 1:1000 dilution In case of necessity repeat every 5-10 minutes
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Immunopathological reaction type IV (delayed type). Cutaneous and mucous contact allergy.
IgE mediated immunopathological reaction (type I, atopy).
Allergens. Allergic diseases – causes, symptoms and diagnostics.
Anaphylaxis (causes, symptoms and treatment).
Examples of diseases based on immunopathological reaction type I. Treatment.
Drug allergy.
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Treatment of allergic diseases
Alle
rgen
av
oida
nce
Pha
rmac
othe
rapy
Spe
cific
im
mun
othe
rapy
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Alle
rgen
av
oida
nce
• Anti-mites beddings
• Pollen filters
• Stay in mountains during pollen season
• Animal avoidance
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Pha
rmac
othe
rapy • Antihistamines
• Corticosteroids
• Symptomathic treatment
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Spe
cific
im
mun
othe
rapy
• Subcutaneous
• Sublingual
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APC
IgE
IL-4
IL-5 Allergicresponse
EosinophilTh2
B-cell
+
+
Tr1
IL-10
TGF-
--
+
IT
Th1
IgG
IFN-B-cell
IT -CD4
CD80/86
T cell
Allergen
TCRHLA
CD28
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Immunopathological reaction type IV (delayed type). Cutaneous and mucous contact allergy.
IgE mediated immunopathological reaction (type I, atopy).
Allergens. Allergic diseases – causes, symptoms and diagnostics.
Anaphylaxis (causes, symptoms and treatment).
Examples of diseases based on immunopathological reaction type I. Treatment.
Drug allergy.
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Definition – differential diagnosis
toxicity – high dose, disorder of metabolism or elimination of the drug
intolerance – sensitive individuals idiosyncrazy - intolerance based on another
defect other side effects of the drug (Jarish -
Herxheimer reaction, sy. Hoigne, alteration of enzyme function, candidasis, inhibition of histaminases, ...)
symptoms of the current disease
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Type of the immunopathological reaction
IgE cytotoxic reaction immunocomplex reaction delayed type of hypersensitivity
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IgE
PNC -barbiturates ACTH -gelatine insuline -opioids latex -etylenoxide myorelaxants
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Cytotoxic reaction
PNC, cephalosporines rifampicine alfametyldopa
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Immunocomplex reaction
PNC streptomycine cephalosporins PAS hydantoinates
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Delayed type of hypersensitivity
„para“ group - sulphonamides, procaine, PAS, azote colourants, prothazine, chlorpromazine
streptomycine PNC
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Local anaesthetics
paraaminobenzoic acid esthers
amides
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Local anaesthetics - diff. dg. of adverse events
vasovagal syncope surgical trauma adverse effect of adrenaline toxicity of administered drug reaction to conservants
(parabens, sulfits)
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Local anaestetics
Diagnostic procedures - skin tests – risk of false positivity
- provocation test
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Latex allergy
Contact type - additives
Immediate type - Hev b1 - Hev b 10
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Latex allergy
Risk groups: - healthcare personal (surgeons 2-6%) - patients with repeated surgeries (children with spina bifida - 20-30%)
Risk factors
- women - younger age - preexisting eczema
- atopy
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Latex allergy
Triggers
- gloves - drains - catheters - condoms
Immediate manifestation - urticaria, dyspnoea, tachycardia
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Latex allergy
Diagnosis
- skin test
- specific IgE in serum Solution
- hypoallergenic products (vinyl gloves etc.)
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Allergy to beta-lactam antibiotics
Penicillins:
frequency - max. 4 - 5 % of administrations (less severe skin disorders)
anaphylaxis <0,1 %
Cefalosporiny:
less frequent than in penicillins
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Manifestations
exanthemas, oedemas
anaphylaxis
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Risk factors
not atopy not allergy to molds i.v. administration