HYPERSENSITIVITY

Type I
Type II

Type III
Type-IV

Type I Hypersensitivity (Allergy or Immediate or Atopic )

 Under some circumstances, a harmless molecule can initiate an immune
response.
 Such exaggerated, inappropriate responses are termed hypersensitivity
reactions or allergic reaction.
 Type I hypersensitivity is mediated by mast cells and eosinophils.
 The effects are felt within minutes of exposure.
 Type I hypersensitivity provoked by reexposure to a specific type
of antigen referred to as an allergen.
 Insect stings wasp and bee stings, and certain foods, including eggs, fish,
cow’s milk protein, peanuts, and tree nuts may also precipitate.
 Medicinal products particularly associated with anaphylaxis include blood
products, vaccines, antibacterials,aspirin and other NSAIDs, heparin, and
neuromuscular blocking drugs.
 Exposure may be by ingestion, inhalation, injection, or direct contact.
Why do some people react and others not?
The tendency to develop allergic responses (known as atopy) shows strong
heritability.

 Secretion of active mediators such as histamine, leukotriene ,

and prostaglandin that act on the surrounding tissues.
 The principal effects of these products are vasodilation and smooth-
muscle contraction (Spasm ) .
 The reaction may be either local or systemic.

HISTAMINE

 Histamine is a naturally-occuring amine

 It is found in most body tissue in an inactive bound form, predominantly
within tissue, mast cells.
Actions.

Smooth muscle.
 In general, histamine causes smooth muscle to contract (excepting arterioles

Blood vessels.
 Arterioles are dilated, with a consequent fall in blood pressure.
 Capillary permeability also increases causing oedema.
Skin.
 Histamine release in the skin can cause itch.
Gastric secretion.
 Histamine increases the acid and pepsin content of gastric juices.

Anaphylactic shock,
 It is due in large part of histamine release, is characterised by circulatory
collapse and bronchoconstriction.

Clinical features
 Symptoms vary from mild to severe
1-urticaria
2-Rhinitis-Runny nose Hay fever
3-Conjunctivitis. –Redness & Itching of eye
4-Eczema ( atopic dermatitis )
5-Asthma

Hypersensitivity)--------- Anaphylaxis(Anaphylatic reaction) / Anaphylatic shock

(Allergic reaction)

Treatment
Avoidance is the first-line of therapy.

Antihistamines are effective for many immediate hypersensitivity reactions (but

have no role in the treatment of asthma).
 ANTIHISTAMINES

 Antihistamines mainly block H1, H2 Receptors and little muscarinic &

serotonin receptors

Antihistamines. (Histamine H1-receptor antagonists).

A-Nonsedative agents

 Differences lie principally in their duration of action.

Cetirizine (tl/2 7 h),
loratadine (tl/215 h)
terfenadine (tl /2 20 h) -Mcq
Acrivastine (tl /2 2 h)
desloratadine,
fexofenadine
Astemazole.

B-Sedative agents

 Chlorpheniramine (priton ) is effective when urticaria is prominent.-Mcq

 Promethazine (Phenagan )-Mcq is so strongly sedative that it is used as an
hypnotic in adults and children.
 Diphenhydramine is strongly sedative and has antimuscarinic effects; it is
also used in parkinsonism and motion sickness
 Alimemazine,
 azatadine,
 brompheniramine,
 demastine,
 cyproheptadine,
 diphenylpymline,
 doxylamine, hydroxyzine
 Triprolidine.
Adverse effects.
Sedation Mcq
dizziness,
fatigue,
insomnia,
nervousness,
tremors,

Histamine H2-receptor antagonists:

cimetidine,
famotidine,
nizatidine,
ranitidine

Histamine H3-receptor antagonists:

1.Betahistidine (Betaserc )

USES OF ANTIHISTAMINES

 allergic rhinitis – inflammation of the nasal passages

 atopic eczema – a common allergic skin condition
 urticaria – also known as itchy rash.
 allergic conjunctivitis – inflammation of the eyes
 allergic reactions caused by insect bites or stings
 mild or moderate allergic reactions caused by food allergies
 more severe allergic reactions (anaphylaxis)

Other uses

stomach ulcers ,
motion sickness.
Vertigo –H3 receptor antagonist
Parkinsonism
They are negligible use in asthma, in which non histamine mediators, such as the
cysteinyl-leukotrienes, are the predominant constrictors.
Corticosteroids
Production of prostaglandin and leukotriene mediators is suppressed,
Vasoconstriction leads to reduced cell and fluid leakage from the vasculature.

Leukotriene receptor antagonists (LTRAs)

Inhibit leukotrienes
(e.g. montelukast, used in asthma, particularly aspirin induced).

ANAPHYLAXIS

 Anaphylaxis is a serious allergic reaction that is rapid in onset and may

cause death. ( A life threatening condition).
 More serious sequelae are hypotension, bronchospasm, laryngeal
 oedema and cardiac arrhythmia or infarction.
 Laryngeal oedema, airway obstruction and respiratory arrest
leading to death.
 Death may occur within minutes.
  Anaphylactic shock requires prompt treatment of laryngeal oedema, severe
bronchoconstriction and hypotension ( shock )

.
 First-line treatment of anaphylaxis includes securing the airway, restoration
of blood pressure (laying the patient flat and raising the legs,) and
administration of adrenaline (epinephrine) injection.

 Adrenaline is given i.m in a dose of 500 micrograms (0.5 mL adrenaline

injection 1 in 1000); to raise the blood pressure and to dilate the bronchi.

 High flowoxygen administration and intravenous fluids are also of primary

importance.

 An antihistamine (e.g. chlorphenamine), given by slow intravenous injection

or intramusular injection in a dose of 10 mg, is a useful , given after
adrenaline injection.

 Continuing respiratory deterioration requires further treatment with

bronchodilators including inhaled or intravenous salbutamol inhaled
 ipratropium intravenous aminophylline or intravenous magnesium sulphate
in addition to oxygen, assisted respiration and possibly emergency
tracheotomy may be necessary.

 An intravenous corticosteroid e.g. hydrocortisone in a dose of 200 mg is of

secondary value in the initial management of anaphylactic shock.

 Patient education is necessary and many are instructed in the self-

administration of adrenaline (epinephrine) and carry pre-loaded syringes.