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  • CYTOKONES PROFILE IN LONG-TERM USE OF CORTICOSTEROID INHALATION IN CHILDHOOD ASTHMA RECEIVING IMMUNOTHERAPY
  • DR.Dr.Ariyanto Harsono SpAK
  • DR.Dr.Ariyanto Harsono SpAK
  • DR.Dr.Ariyanto Harsono SpAK
  • DR.Dr.Ariyanto Harsono SpAK

Food allergy, the beginning of allergic march1. Food allergy, the beginning of allergic march1. Presentation Transcript

  • Prof Dr Ariyanto Harsono dr SpAKCURICULUMVITAETempat /tgl lahir : Kediri, 3- JuliAgama : IslamStatus Perkawinan: MenikahPendidikanS-1: Lulus Dokter : FK UNAIR, 1972S-2: Spesialis Anak : FK UNAIR, 1982S-3: Program Pascasarjana UNAIR, 2004Pendidikan tambahan : Sertifikat “Fellowship on Food Allergy”,Academisch Ziekenhuis Utrecht, Nederland, 1990-1991Jabatan sekarang : Guru Besar Ilmu Kesehatan Anak,Dep IKA FK UNAIR/RSU Dr.Soetomo, Surabaya.Konsultan Alergi/Imunologi: 19921
  • FOOD ALLERGY:The beginning of Allergic MarchProf DR Dr Ariyanto Harsono SpA(K)
  • Pendahuluan1. Proses akan berlanjut dalam kehidupan bayi2. Sensitisasi terhadap protein makanan yanglain akan terjadiUmumnya Susu sapi adalah alergenpertama pada bayisekali respons IgE terhadap susu sapi terjadiProf DR Dr Ariyanto Harsono SpA(K)
  • Alergen Makanan• Buah• Susu• Telur• Ikan• Kacang4Prof DR Dr Ariyanto Harsono SpA(K)
  • 4 Macam alergen5Prof DR Dr Ariyanto Harsono SpA(K)
  • Cross reactivity• Terdapat Cross-reactivity antara alergenmakanan apabila ada kesamaan struktur,yang kemudian mencetuskan reaksisimpang yang sama dengan alergenmakanan yang asli.• Contoh: antara beberapa shellfish,kacang-kacangan, ketimun, dan tree nuts.J Allergy Clin Immunol. 2010;126:S1-58Prof DR Dr Ariyanto Harsono SpA(K)
  • Alergi Makanan• Beberapa factor yang berpengaruhterhadap terjadinya alergi makanan:– Genetik– Lingkungan– Disfungsi Mucosa– Tipe dan dosis alergen makanan– UsiaProf DR Dr Ariyanto Harsono SpA(K)
  • GENETICIf both parents had sameallergy, risk of allergy in theirchild will be increased up to 60-80%Father Mother Father Mother Father Mother Father MotherSiblingsChildRisk ofallergy5-15%ChildRisk ofallergy25-30%ChildRisk ofallergy40%ChildRisk ofallergy40-60%Prof DR Dr Ariyanto Harsono SpA(K)
  • Uptake Alergen di Usus1. Alergen di uptake oleh subepithelial dendritic cells (DCs) melalui 2 jalur:DCs dapat meraih diantara enterocytes.sAlergen yang larut air dapat di uptake oleh fase cair endocytosis oleh enterocytedan dideposisi di lamina propria kemudian difagosit DCs. DCs bermigrasi darilamina propria ke mesenteric lymph node (MLN), dimana alergen bisa dipresentasikan pada naïve T cells.2. Di Peyers patch, M cells mempunyai spesifikasi uptake alergen tertentu, kemudiandiserahkan pada DCs di ruang subepithelial. DCs ini bisa bergerak ke areainterfollicular Peyers patch untuk dipresentasikan ke T cells (hijau) atau interaksidengan sel B (merah).Pediatric allergy: principlesand practice. 2ndeditionProf DR Dr Ariyanto Harsono SpA(K)
  • Fireman P, Slavin RG. Atlas of Allergies, 1991.Mekanisme AlergiSENSITIZATION ENHANCEMENT TRIGGERINGProf DR Dr Ariyanto Harsono SpA(K)
  • Aktivasisel-selImuno-kompeten•Sel T•Sel B•Sel Mast•SelLanger-hansAktivasisel-selstruk-tural•Selendotel•SelepitelAktivasi danRekruitmen•Sel Mast•Eosinofil•Neutrofil•BasofilPelepasanmediatorKerusakanepitelStimulasineuralDilatasi &peningkatanpermeabilitasvaskulerlBronkokonstriksiPerbaikanepitel•Proliferasifibroblast•Deposisikolagen•Hipertropi/hiperplasia otot polos•EkspansivaskulerPenyempitansaluran nafasbawahSymptomalergiBronkushiper-reaktifALERGENA B C D EImunopatologi alergiAirwayremodelling11Prof DR Dr Ariyanto HarsonoSpA(K)Trigger
  • Prof DR Dr Ariyanto Harsono SpA(K)
  • SususapiAPC MHC-II Th0IL-1Th-2Th.1IL-12 IL-2, IFN-γB-CellIL-4IL-5SEL PLASMASEL MEMORIIL-6IL-10AMemory Cells13Prof DR Dr Ariyanto Harsono SpA(K)AKTIVASI SEL-SEL IMUNOKOMPETEN OLEHANTIGEN
  • Prof DR.dr. Ariyanto Harsono SpAK14(J Allergy Clin Immunol 1999;118:124-6)Th1Dendritic cellEosinophileNeutrophile
  • Prof DR Dr Ariyanto Harsono SpA(K)
  • Ariyanto Harsono MD PhD 1611Ariyanto Harsono MD PhDProf DR.dr. Ariyanto Harsono SpAK
  • VACCINATIONACTIVATIONANTIGENSPECIFICB CELLGENERATION OFMEMORYACTIVATEDCD4+Th-2 CELL IL-4DIFFERENTIATION& AFFINITYMATURATIONANTIBODY SECRETINGPLASMA CELLSANTIGENPROCESSING &PRESENTATIONMHC Class II B CELL IMMUNOGLOBULINET CELL RECEPTOR ANTIGENB CELLIL-5,IL-13Cow’s Milk ProteinCow’s Milk epitopeIgE mediated: Asthma, Rhinitis, Dermatitis Atopic, Urticaria, Abdominal colic
  • Mast Cells and basophiles involve in allergicreaction in the context of antigen-IgE Prof DR.dr. Ariyanto Harsono SpAK
  • IgGIgG mediated: Protein loosing enteropathy, Gastro-intestinal haemorrhageProf DR Dr Ariyanto Harsono SpA(K)1
  • IgMIgM mediated: Protein loosing enteropathy, Gastro-intestinal haemorrhageProf DR Dr Ariyanto Harsono SpA(K)1
  • SensitiSensitisasi didalam kandungansasi didalam kandungan• SelSelTT telah berespons pada janin umur 22telah berespons pada janin umur 22minggu.minggu.• SelSel TT pusar telah berespons pada waktupusar telah berespons pada waktulahirlahir– mite ~ 47 %– telur, susu sapi ~ 75 %– Sedikit IFN dan banyak IL-4 & 10• IgEIgE waktu lahirwaktu lahir– Susu sapi, gandum, telur.Prof DR Dr Ariyanto Harsono SpA(K)
  • BAKTIVASI SEL-SEL STRUKTURALNature Rev Immunol 2003; 3: 867-78NeutrophilEosinophil22Prof DR Dr Ariyanto Harsono SpA(K)
  • 23Prof.DR.dr. Ariyanto Harsono SpAK
  • Chemotactic24Prof.DR.dr. Ariyanto Harsono SpAK
  • 25Prof.DR.dr. Ariyanto Harsono SpAK
  • Chemotactic…26Prof.DR.dr. Ariyanto Harsono SpAK
  • Chemotactic…27Prof.DR.dr. Ariyanto Harsono SpAK
  • CPELEPASAN MEDIATOR28Prof DR Dr Ariyanto HarsonoSpA(K)
  • Granule contents:Histamine,TNF-α,Proteases,Heparin, ECF, NCFLipid mediators:ProstaglandinsLeukotrienesCytokine production:Specifically IL-4, IL-1329Prof DR Dr Ariyanto Harsono SpA(K)
  • D EFEK PELEPASAN MEDIATOR PADA TARGET ORGANNature Rev Immunol 2004: 3:234-23730Prof DR Dr Ariyanto HarsonoSpA(K)
  • TargetOrganIgE-mediated disorder Non IgE-mediateddisorderSkinGastro-intestinalRespiratoryTractMulti-systemUrticaria and angioedemaAtopic DermatitisOral Allergy SyndromeGastrointestinal anaphylaxisAllergic eosinophilic gastroenteritisAsthma; Allergic RhinitisFood-induced anaphylaxisFood associated, exercise-inducedanaphylaxisAtopic DrmatitisDermatitis HerpetiformisProctocolitisEnterocolitisAllergic eosinophilic-gastroenteritisEnteropathy syndromeCeliac DiseaseHeiner SyndromeClinical ManifestationE SymptomsProf DR.dr. Ariyanto Harsono SpAK
  • 32Prof DR Dr Ariyanto HarsonoSpA(K)Prof DR Dr Ariyanto Harsono SpA(K)
  • Prof DR Dr Ariyanto HarsonoSpA(K)33Prof DR Dr Ariyanto Harsono SpA(K)
  • Prof DR.dr. Ariyanto Harsono SpAK
  • Prof DR.dr. Ariyanto Harsono SpAK
  • 36Prof DR Dr Ariyanto Harsono SpA(K)
  • Prof DR.dr. Ariyanto Harsono SpAK
  • Prof DR.dr. Ariyanto Harsono SpAK
  • Target organ Unusual Clinical manifestation•Skin•ENT•Respiratory•Gastrointestinal•Multi systemVasculitis; Fixed Skin EruptionChronic Serous Otitis MediaChronic Pulmonary disease (Heiner Syndrome)Hypersensitivity pneumonitisConstipation; Gastroesophageal refluxIrritability/Sleeplessness in infants; colic, Arthropathy;Nephropathy; ThrombocytopeniaUnusual Clinical ManifestationProf DR.dr. Ariyanto Harsono SpAK
  • Unusual ManifestationProf DR.dr. Ariyanto Harsono SpAK
  • Unusual ManifestationProf DR.dr. Ariyanto Harsono SpAK
  • Unusual ManifestationProf DR.dr. Ariyanto Harsono SpAK
  • CEProf DR Dr Ariyanto HarsonoSpA(K)43Unusual Manifestation
  • Prof DR.dr. Ariyanto Harsono SpAKUnusual Manifestation
  • Prof DR Dr Ariyanto HarsonoSpA(K)45
  • Prof DR Dr Ariyanto Harsono SpA(K) 46
  • Prof DR Dr Ariyanto Harsono SpA(K) 47
  • Natural History of Food Allergy• Kebanyakan anak alergi menjadi toleranterhadap susu sapi, kedelai, dan telur dalambeberapa tahun.• Anak yang lebih besar (15 tahun) dan dewasaumumnya tidak mengalami toleransi imun.• Alergi kacang, ikan, dan kerang lebih persisten.• Food hypersensitivity di usia dini (i.e. Susu sapi,telur, kacang) adalah faktor resiko menjadi alergimakanan tambahan, Atopik Dermatitis, danasma.Prof DR Dr Ariyanto Harsono SpA(K)
  • Induksi Toleransi OralT-cells regulation:1. Intra Epithelial Lymphocytes: berasal dari ekstrathymus, TCR terbatas, dapat mengenali alergen, mempunyaifungsi sitolitik.2. Lamina Propria Lymphocytes: berasal dari thymus,TCR/CD3 terbatas-memediasi signal di mukosa..Prof DR Dr Ariyanto Harsono SpA(K)
  • IELLPLCD23Anergy/Tolerance: Formula HA: Imunoterapi: ProbiotikProf DR Dr Ariyanto Harsono SpA(K)
  • IgATRegTGF-βProf DR Dr Ariyanto Harsono SpA(K)
  • Prof DR Dr Ariyanto Harsono SpA(K) 52
  • Prof DR Dr Ariyanto HarsonoSpA(K)53Prof DR Dr Ariyanto Harsono SpA(K)
  • KesimpulanAlergi adalah hipersensitifitas tipe ISensitisasi pertama biasanya Susu Sapikemudian makanan lain.Kaskade inflamasi alergi melibatkan interaksisel dendritik, limfosit, sel Mast, esinofil,neutrofil beserta mediatornya54Prof DR Dr Ariyanto Harsono SpA(K)
  • Thank You55Prof DR Dr Ariyanto HarsonoSpA(K)