ალერგიული

დაავადებები
dReisaTvis medicinaSi sayovelTaod aRiarebuli
paradoqsia, rom mravali daavadebis
etiopaTogene-zisa da mkurnalobis sakiTxebSi
miRweuli udidesi warmatebebis miuxedavad, am
daavadebaTa ricxvi ar mcirdeba, mkurnalobac
xSir SemTxvevaSi araefeqturia, da ufro metic,
maTi
epidemiologiuri maCveneblebi
sagangaSoa, prognozi ki
arakeTilsaimedo.
 alergia- berZn
«allos» - sxva + «ergon» - moqmedeba

 alergiuli daavadebebi warmoadgenen organizmis

hiperreaqcias garemo faqtorebis zemoqmedebis
sapasuxod , romelsac Rebulobs, rogorc potenciurad
saSiSs (Tundac isini ar warmoad gendnen aseTebs)

termini «alergia» pirvelad mowodebul iqna avstrieli pediatris

pirkes mier (1906)
(Dr. C. von Pirquet)
alergia – sistemuri paTologia!

asTma

alergiuli riniti
urtikaria
alergia -
sistemuri
daavadeba

koniunqtiviti kvebiTi
alergia
atopuri dermatiti
Allergy: Rhinitis, Eczema & Conjunctivitis

Normal nose
alergiul daavadebaTa SemTxvevebis sixSire

16

14

12

10
sixSire
частота

0 6 мес 1 год 3 года 7 лет 1212 лет

weli
6 Tve 1 weli 3 weli 7 weli
возраст

пищевая аллергия
kvebiTi alergia АД
ad астма
asTma ринит
riniti
 alergiuli «marSi» -

- etapuroba sensibilaziis ganviTarebis da alergiis klinikuri

gamovlinebis transformacia asakis mixedviT:

● adreul asakSi –
kvebiTi alergia da atopuri dermatiti;

● mogvianebiT - alergiuli riniti (bavSvTa10-15%) da

● bronquli asTma ( 40-43%)

Aad da ar mZime mimdinareoba – SemdgomSi ba ganviTarebis

riskia
WeSmariti alergiuli reaqciis
ganviTarebis meqanizmebi

 organizmis imunuri sistemis pirveladi kontaqti

alergenTan

 imunuri pasuxisaTvis drois garkveuli monakveTis

arseboba _sensibilizacia, sensibilizirebu li
citotoqsiuri T-limfocitebis warmoqmna
WeSmariti alergiuli reaqciis
ganviTarebis meqanizmebi

 imave (specifiur) alergenTan ganmeorebiTi

kontaqti

 damaxasiaTebeli klinikuri gamovlineba

_WeSmariti alergiuli reaqcia.
alergiuli reaqciebis paTogenezi

1. I faza- imunologiuri_ imunuri sistemis alergenTan

pirveladi kontaqtidan sensi bilizaciis ganviTarebamde.
formirdeba antigen-antisxeulis urTierTmoqmedeba,
specifiuri ant
alergiuli reaqciebis paTogenezi

2. II faza paToqimiuri _ specifiur alergen Tan

ganmeorebiTi kontaqtis Sedegad didi raodenobiT
biologiurad aqtiuri nivTi erebis gamonTavisufleba.
degranulacia, alergiuli anTebis mediatorebis gadmos
rola samizne ujredebSi
 alergiuli reaqciebis paTogenezi

3. III faza paTofiziulogiuri _ biologiu rad aqtiuri

nivTierebis gamonTavisuf lebis Sedegad ujredebisa da
qsovile bis funqcionirebis darRveva, dazianebac ki.
anTebis mediatorebis moqmedeba orga nizmze
4. klinikuri _ klinikuri gamovlineba
hipermgrZnobelobis tipebi
(Gell & Cumbs, 1964)

 anafilaqsiuri, swrafi tipis alergiu li reaqcia - viTardeba 15-20 wT-

Si/ufro adre, gansakuTrebuli tipis antisxeulis, IgE-s warmoqmna;

 citotoqsiuri tipi, 4-6 sT-Si, I tipis analogiurad realizdeba, mxolod

IgE-s nacvlad IgG (IgG4-is garda) da IgM.
hipermgrZnobelobis tipebi
(Gell & Cumbs, 1964)

 imunokompleqsuri, realizdeba rogorc IItipi, mxolod aq antisxeuli

urTierTqmedebs xsnad antigenTan (ara ujredis zedapirze).

 Senebuli tipis, ujred-ganpirobebili, tuberkuli nuri, 48-72 sT;

 alergiuli pasuxi

dauyovnebeli, an mogvianebiTi,
adreuli faza an LPR- faza

... 6-48 sT Semdeg

xanmokle, SezRuduli kontaqti alergenTan – umetesad

iwvevs adreuli fazis izolirebul pasuxs
gaxangrZlivebuli, intensiuri kontaqti – adreu li, Semdeg
mogvianebiTi fazebi an, iSviaTad – izoli rebuli LPR- faza
 dauyovnebeli, an adreuli faza
histamindamokidebulia

alergeni aaqtiurebs poxier ujredebs jvaredini kavSiris gziT IgE-

Tan

alergiuli anTebis mediatorebis gadmosrola poxieri ujredebis

sekretoruli granulebidan:
histamini,
triptaza, qimaza da karboqsipeptidaza
 mogvianebiTi, dayovnebuli faza LPR

dakavSirebulia eozinofilebis, bazobilebis, da limfocitebis

modinebasTan alergiuli anTebis keraSi

Eozinofilebi pirveladi ujredebia, romlebic erTvebian procesSi,

isini granulebidan anTavisufleben proteins, neirotoqsins,
leikotrienebs da sxva

LPR-fazisaTvis poxieri ujredebi nakleb mniSvnelovania

hitaminis roli adreul fazaSi gacilebiT mniSvnelovania, vidre,

LPR-gvianSi
 alergia da histamini
 alergiis dros sxva mediatorebTan erTad izrdeba Tavisufali histaminis
raodenoba, rac warmoadgens alergiuli reaqciebis adreuli klinikuri
simptomebis mizezs:

- kanis (atopiuri dermatiti, urtikaria)

- sasunTqi gzebis (alergiuli riniti, ba) da

- sms (kvebiTi alergia, gastrointestinaluri) mxriv

 ალერგიული დარღვევების
პათოფიზიოლოგია

• histaminuri
• alergiuli
• anTebiTi
 alergiuli procesis paTofiziologia
adreuli faza gviani faza
poyieri ujredi ujredovani infiltracia/anTeba

Allergen
Histamine Eosinophil

Other Inflammatory Mediators

Proteases
ion
ulat
n
gra
De
Basophil
Chemotactic
factors
Ne
os
y nth
es
is Monocyte
Mast cell
Other
Inflam.
mediators Lymphocyte

nazaluri sekreti pacientebSi

persistirebuli alergiuli rinitiT
Pearlman. J Allergy Clin Immunol. 1999;104:S132. Bascom et al. Am Rev Respir Dis. 1988;138:406. Bascom et al. J
Allergy Clin Immunol. 1988;81:580. Quraishi et al. J Am Osteopath Assoc. 2004;104(suppl 5):S7. Minshall et al.
Otolaryngol Head Neck Surg. 1998;118:648.
poxieri ujredi warmoadgens pirvelad imuno-efeqtorul
ujreds alergiuli rinitis dros

 poxieri ujredebi warmoadgens mediatorebis ZiriTad wyaros

- histamini
- citokini
- prostaglandini/leikotrieni

Kovarova and Rivera. Curr Med Chem. 2004;11:2083.

 poxieri ujredi iwvevs alergiul reaqciebs

IgE + FceRI

p.u. alergiuli
histamini reaqcia

Graphics courtesy of Prof. M. Maurer.

IgEE-damokidebuli anTebiTi madiatorebis
gamonTavisufleba
IgE
momentaluri ganTavisufleba
granuli Semcveloba:
histamini, TNF-,
proteaza, heparini
cemineba, cxviris
obstruqcia,
qavili, rinorea,
cremliani Tvalebi
alergenebi
FceRI
Over hours
Over minutes citokinebis gamomuSaveba:
lipiduri mediatorebi: gnasakuTrebulad IL-4, IL-13
prostaglandini
leikotrienebi
lorwos gamomuSaveba
eozinofilebis arseboba
xixini (Wheezing)
bronxokonstruqcia
histamini
 histamini biogenuri naerTia, romelic organizmSi warmoiqmneba aminomJava
histidinis dekarboqsilirebiT
 foxier ujredebSi Tavdapirvelad Senaxul da Semdgom gadamuSavbeul
vezikulebs ewodeba granulebi

 foxieri ujredebi aris pirveladi wyaro

 aseve bazofilebi, histaminerguli nervuli ujredebi da ECL ujredebi nawlavebSi

ECL=enterochromaffin-like
 histaminis ZiriTadi fiziologiuri roli: alergiuli
reaqcia

Aalergeni
histamini eozinofili

nakrebi
bazofili
foxieri ujredebi
monociti

qemotaqsisi
limfociti
anTeba
kuWis wvenis sekrecia
neirotransmisia aqtivacia
proliferacia
vazodilatacia
citokinebis
gamonTavisufleba
Pearlman DS. J Allergy Clin Immunol. 1999;104:S132.
qemotaqsisi
foxier ujredebs SeuZliaT gaaZlieron sakuTari aqtivacia da histaminis
gamonTavisufleba

B ujredi
↑IgE produqcia
antigeni

H1 receptorebi
Ffoyieri ujredebi
T
ujredi
Th2 polarizacia
Autocrine Paracrine
histamini

dendrituli ujredi
H1 / H4 receptorebi H2 receptorebi
 ***
 IgE-s fiqsacia poxier ujredebze (mast cells) da
bazofilebze _ procesi warmoadgens sensibilizacias, ris
Sedegadac es ujredebi iZenen antigen-specifikur
aqtivobas

 IgE-s maRali afinurobis receptorebis (FcR1)

agregaciis Sedegad warmoiqmneba polimeruli
antigenis tetrameruli receptorebi
***

 agregacia iwvevs genetikuri (ojaxuri)

tirozinkinazis (Lyn) aqtivacias, egzocitozi,
kalciumis arxebi
 alergiuli paTologiis menejmenti

alergenTan kontaqtis gamoricxva

(SesaZleblobis mixedviT)

farmakoTerapia imunoTerapia
usafrTxoeba efeqturoba
efeqturoba iniSneba specialis tis mier
advilad marTvadoba SeiZleba Secvalos
daavadebis bunebrivi
mimdinareoba

pacientis ganaTleba
naCvenebia yovelTvis

Bousquet et al. J Allergy Clin Immunol. 2001;108 (5 suppl):S147.