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Allergy
cause of allergy
Food allergens
 Non-food protein allergens
 Toxins interacting with proteins
 Genetic basis
 Allergens in the air
 Insect bits
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food allergens
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One of the most food allergens is against nuts
Paenuts, Tree nuts, including pecans, pistachios,
pine nuts, and walnuts
They are contain oils where protein is present,
which may elicit an allergic reaction
Egg allergies affect about one in fifty children
Lactose intolerance
Other foods containing allergenic proteins include
soy, wheat, fish, shellfish, fruits, vegetables,
spices, synthetic and natural colors, chicken
and chemical additives.
non-food protein allergens
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Latex can trigger a body, brathing or systemic
allergy(less then 1%)
Latex and banana sensitivity may cross-react;
furthermore, patients with latex allergy may also
have sensitivities to avocado, kiwi and chestnut
toxins interacting with proteins
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Another non-food protein reactionare urushiolinduced contact dermatitis, originates after contact
with poison ivy, eastern poison oak, western
poison oak or poison sumac.
on the percent of the population that will have an
immune system response.
Approximately 25 percent of the population will
have a strong allergic response.
80 percent to 90 percent of adults will develop an
allergy
genetic basis
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identical twins are likely to have the same allergic
diseases about 70%
non identical twins are likely to have the same
allergic diseases about 40%
Allergic parents are more likely to have allergic
children
allergens in the air
Grass
 Pollen of the flowers and the trees
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insect bits
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With people with bees or wasp's poison allergy it comes to
additional reactions.
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These can be:
nettle rash-like skin rash,
Swells in the face and in the neck,
Breathlessness,
Circulatory failure.
a insect bit
common symptoms of allergy
Nose: swelling of the nasal mucosa (allergic
rhinitis)
 Eyes: redness and itching of the conjunctiva
 Sinuses: allergic sinusitis
 Airways: Sneezing, coughing, bronchoconstriction,
attacks of asthma
 Ears: feeling of fullness, possibly pain, and
impaired hearing
 Skin and body: laryngeal edema,eczema
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allergic
eczema
diagnosis
skin testing
 blood testing
 challenge testing
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skin test
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Skin tests:
Skin testing is also known as "puncture testing" and
"prick testing"
In the forearm or in the back
due to the series of tiny puncture or pricks made into
the patient's skin
Small amounts of suspected allergens and/or their
extracts (pollen, grass, mite proteins, peanut extract,
etc.) are introduced to sites on the skin marked with
pen or dye
Is the patient allergic to the substance, then a visible
inflammatory reaction will usually occur within 30
minutes
The reaction is like a insect bit
skin test
blood testing
Number of antibodies in the body
 A low number of antibodies= high risk to
become an allergy
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blood testing
challenge testing
small amounts of a suspected allergen
are introduced to the body orally
 through inhalation
 or other routes
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inhalation
treatment/therapy
Pharmacotherapy
 Immunotherapy
 Unproven and ineffective treatments
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pharmacotherapy
Several antagonistic drugs are used to block the action
of allergic mediators or to prevent activation of cells
and degranulation processes
 include antihistamines, glucocorticoids, epinephrine
(adrenaline), theophylline and cromolyn sodium. Antileukotrienes, such as Montelukast (Singulair) or
Zafirlukast (Accolate),
 Anti-cholinergics, decongestants, mast cell stabilizers,
and other compounds thought to impair eosinophil
chemotaxis, are also commonly used.
 These drugs help to alleviate the symptoms of
allergy, and are imperative in the recovery of acute
anaphylaxis
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immunotherapy
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Long term treatment
Desensitization or hyposensitization
treatment in which the patient is gradually vaccinated with
progressively larger doses of the allergen in question
This can either reduce the severity or eliminate
hypersensitivity altogether
A second form is to involves the intravenous injection of
monoclonal antibodies ->e.g food allergens
Sublingual immunotherapy
an orally-administered therapy which takes advantage
of oral immune tolerance to non-pathogenic antigens
such as foods and resident bacteria.
 This therapy currently accounts for 40 percent of
allergy treatment in Europe.
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unproven and ineffective
treatments
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In alternative medicine, a number of allergy
treatments are:
practitioners,
particularly naturopathic,
herbal medicine,
homeopathy,
traditional Chinese medicine
kinesiology
epidemiology
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statistics in the USA
allergic rhinitis->35.9 million (about 11% of the
population
Asthma-> 9% of the population
food allergies-> 1.1% of the population
insect venoms-> Around 15% of adults have mild,
localized allergic reactions.
systemic reactions occur in 3% of adults and less
than 1% of children
history
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The concept of "allergy" was originally introduced
in 1906 by the Viennese pediatrician Clemens von
Pirquet
In 1963, a new classification scheme was
designed by Philip Gell and Robin Coombs
that described four types of hypersensitivity
reactions, known as Type I to Type IV
hypersensitivity
type 1
The reaction occurs in the second contact within seconds
till few minutes. Antigens are in the pathological allergy
case free / relaxed molecules which are evaluated by the
immune system erroneously as menacing or foreign to body
 The reaction can fall out from relatively mildly up to lifemenacing.
 Typical clinical pictures of the immediate type reaction are
the allergic conjunctivitis (conjunctivitis),
allergic coryza (hay fever),
allergic asthma,
nettle rash (Urticaria),
larynx cutaneous dropsy,
serious to life-menacing forms, how the angioneurotische
cutaneous dropsy (angioedema) ,
the serum accident
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type 2
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Type II: Cell-engaged antigens, Antikörper-mediierter, zytotoxischer type
Type IIa
With hypersensitivity reactions of the type IIa are antibody against bodycelllengaged antigens (autoantibody)..
Typical ilnesses are:
Drug-induced deficiency of coagulation panel (Thrombopenie)
Drug-induced deficiency of erythrocyte (hämolytische anaemia)
The Goodpasture syndrome with which autoantibodies are formed against
collagen IV in the lung and the kidneys
Type II b Stimulatorische immune response / reaction with hormone receptors
Type II interaction like with type IIa, leads, however, the connection not to the
cell destruction, but about receptor connection to the activation of specific cell
functions. The antibodies work as hochaffine neurotransmitters
Typical examples are
the morbus Basedow with which autoantibodies are formed against the TSH
receptor
the chronic Urtikaria with which autoantibodies are formed against the IgE
receptor.
Type II b Stimulatorische immune response / reaction
with hormone receptors
 Type II interaction like with type IIa, leads, however, the
connection not to the cell destruction, but about
receptor connection to the activation of specific cell
functions. The antibodies work as hochaffine
neurotransmitters
 Typical examples are
the morbus Basedow with which autoantibodies are
formed against the TSH receptor
the chronic Urtikaria with which autoantibodies are
formed against the IgE receptor.
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type 3
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Type III: Immune complex Typ/Arthus type dependent on
antibody
Type III-hypersensitivity reactions are marked by antibody
education against dissolvable antigens.
The formed immune complexes can deposit, on the one hand, in
the blood capillaries (e.g., in the kidney) and thus lead to damages,
activate on the other hand, however, also complement what leads
to inflammation reactions.
Typical illnesses are:
blood serum disease,
exogenic-allergic Alveolitiden (for example, the occupational
diseases farmer's lung, bird's holder's lung,
cheese trader's lung and baker's lung
type 4
type IV: late type / delayed type / cell-mediierter type / tuberculin type
independent of type / antibody
 type IV :Hypersensitivity reactions are brought on by the
activation of t
cells specific for allergen. Three subtypes are distinguished. With a positive
reaction are found beside erythema and infiltration also Papeln and vesicle.
The test reactions (erythema, vesicle, Papeln) can also appear after the
test area.
 type IVa1
 Activation of TH1 cells, the reaction is directed against dissolvable antigens
and leads to the activation of macrophages. Examples for this are the
nickel-contact dermatitis and the tuberculin test in what with the latter the
tuberculin causes a reaction with sensitised t lymphocytes with the
bringing in in the skin which were formed in a possible contact with
tuberculosis causes.
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type IVa2
 Activation of TH2 cells. The reaction is directed against dissolvable
antigens and leads to the activation of eosinocytes. Typical
illnesses are an allergic asthma and the atopische dermatitis.
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type IVb
Activation of zytotoxischen lymphocytes, reaction is directed
against cell-engaged antigens, Lyse of the affected cells.
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Typical diseases are:
Contact dermatitis
Stevens Johnson syndrome
chronic asthma
 chronic allergic coryza
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drugs against allergies
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Symptomatic therapy
The most allergies are treated with drugs which reduce the occurrence of allergic
symptoms or prevent, but can cause no healing of the allergic illness.
These Antiallergika are applied according to disease form and gravity of the illness in
different forms (tablets, nasal sprays, asthma sprays, eye drops, creams, ointments and
injections) and in different intervals (with acute need, prophylactically, permanently).
Used agents are:
Antihistaminika, e.g. Loratadin
Mastzellstabilisatoren, e.g. Cromoglicinsäure
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Leukotrienrezeptor-Antagonisten by asthma, e.g. Montelukast
Theophyllin by asthma
Severe acute cases (how angioedema, serum accident) are life-menacing and require
medical emergency measures. Adrenalin, plasmaexpander and cortisone are used.
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An adrenalin syringe (EpiPen ®) which they should carry for emergency case
always on themselves can be prescribed for the patient with which is known
that they run the risk to suffer an anaphylaktic shock
(e.g. with insect allergies).
Quellen
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