ALLERGY

ALLERGY
“An altered response (different from the normally seen) to an offending
agent”
 Atopy

 Hypersensitivity
 Manifestations
 Rhinitis

 Asthma

 Urticaria

 Eczematous (atopic dermatitis)

 Anaphylaxis

(Alone or combinations)
 Systemic mastocytosis
 Anaphylactic materials

1. Heterologous proteins:
 Hormones (Ins, VP, PTH)
 Enzymes (Tryp, CT, Pnc, SK)
 Pollen extracts
 Non-pollen extracts
 Foods (milk, eggs, sea food)
 Antisera
 Occupation related proteins
Hymenopetra venom
2. Polysaccharides
 Dextran
 Thiomerosal (vaccine preservative)
3. Drugs: Protamine
 Antibiotics
 Local anaesthetics
 Muscle relaxants
 Vitamins
 Diagnostic agents
4. Occupation related chemicals
Ethylene oxide
 Mechanism of Allergy
1. Sensitization: Childhood or early
adolescence

2. Activation on re-exposure

Antigen specific
 Activation
Antigen exposure (re)

Sensitized key
effector cells
(Mst cells, basophils)
  IgE fixation
Ag specific activation

Mediator release

Lipids: LTB4 Secretory granule Cytokines

LTC4, PAF, (preformed) IL-3, IL-4, IL-5,
PGD2 Hist, Proteoglycans, IL-6, GM-CSF, IL-1,
tryptase, chymase INFr, TNF 
 Immune Reaction
Immediate Late
1. Onset < Minutes 4-6 hours
2. Immunological IgE dependent Cellular;
Preformed mediators cytokines
3. Allergen Minute Greater
quantity
4. Clinical Pruritis; rhinorrhoea Nasal block;
features bronchospasm; wheal skin erythema &
and flare; bronchorrhoea induration;
 PFT (BHR)
 Sensitization
Antigen exposure

Processing by Ag presenting cells

Presentation via their MHC to
T cell subsets

Recognition & response

IL-4: TH2 response IN Fr : TH1 type


Activation of specific Allergen specific
B cells  Plasma cells  IgE

Sensitization of IgE Fc receptor bearing cells
 Characteristics

 Immediate/Late

 Sudden/Episodic

 Recurrent/Persistent

 Spontaneous remissions/recurrences

 Familial

 Variable
 ANAPHYLAXIS

Life threatening response of a sensitized person, immediately after specific

antigen exposure.
 Respiratory distress

 Vascular collapse
 Predisposing Factors
 Immunogen exposure

 No proven influence:

-Age, sex, race

-Occupation, place

-Atopy (for Penicillin

therapy or insect bites)

 Diagnosis of Allergy

1. Circumstantial : Onset; antecedent admn.

2. Specific history e.g. recurrence

3. Skin tests

4. Specific tests: disease directed/others

 Treatment of Allergy
General: Identifying allergenic agents
 Antihistaminics

 Glucocorticoids:

 Topical

 Oral

 Parenteral

 Specific

 Immunotherapy
 Treatment of Anaphylaxis
 Early recognition

 Epinephrine:

- S/C 0.2 – 0.5 ml of 1:1000 ml

Repeated doses.
- In to the site/tourniquet
- I.V infusion, 2.5 ml of 1:10,000 at
5 to 10 min
 Volume expanders : N. saline

 Vasopressors: dopamine

 Isoproterenol (1:200) 0.5 ml

 Tmt. (contd.)
 Oxygen, Intermittent PPB

 Endotrach. Intubation/tracheostomy

Ancillary agents
 Antihistaminics – diphenyl – hydramine

(50-100 mg) I/M or I/V

 Aminophylline (0.25 – 0.5 gm), I/V

 Glucocorticoids: I/V esp. for later recurrence

 Prevention of Anaphylaxis

1. History of previous episodes

2. Cross reactivity of agents

3. Skin test: scratch/I.D.

Allergenic extracts

Penicillins/other agents

4. Desensitization – slow vs rapid

5. Resuscitation facilities
 Protection against venom induced
anaphylaxis

 Immunotherapy : Use of specific/cross reacting venom

 Modification of outdoor activities; dress and habits

 Informational bracelet

 Epinephrine kit
 Manifestations
 Onset:within seconds

 Laryngeal oedema: “Lump”, hoarseness, stridor

 Bronchospasm

 Cutaneous wheals, ‘giant hives’

 Schimitar syndrome

 Fatal cases: Angio oedema; (skin & upper respir. tract, viscera) shock
 Diagnosis of Anaphylaxis

 Clinical picture

 Prausnitz-Kustner reaction: Passive transfer of cutaneous hypersensitivity

 Passive sensitization of a human leukocyte suspension

 Radioimmunoassay for specific IgE antibodies

 Elevation of beta tryptase levels i.e. mast cell activation

 Antihistaminic agents
1. H1 receptor antagonists:

 Chlorphenirmine
 Diphenyl hydramine
 Astemizole, terfenatine
 Non sedating; cetrizine, loratadine, fexofenadine

2. Both H1 and H2 agents: Doxepin

3. Others: Cyproheptadine, Hydroxyzine

 Alpha adrenergic agents; Phenyl epherine (Topical)
 Mast cell stabilizers: Cromolyn
 Systemic Mastocytosis
“Mast cell hyperplasia”
 Indolent – cutaneous

features, vascular collapse,

ulcer dis, hepatospleno, LN

 Concomitant haematological dis

 Aggressive

 Mastocytic leukaemia