Fadel Muhammad Garishah
Faculty of Medicine Universitas Diponegoro
Review on Clinical Immunology
A 10 years old boy came to the Physician
with his mother, complaining about his
endless-influenza-like illness in the summer.
The boy has to stay in his Granny’s house
during the summer, and that diseases always
come. He gets better when he comes home.
His Granny’s house is located near by
flower-garden as his Grandfather is a gardener
and flowers distributor.
• Sneezing and
• Mucosal edema
• Rhinitis is an inflammation of the nasal
• Allergic rhinitis/hay fever is initiated by
hypersensitivity reactions to one of a large
group of allergens, most commonly plant
pollen, fungi, animal allergens and dust mites.
• Affects 20% US Population
• IgE mediated (early- and late-phase)
immediate hypersensitivity (type I)
• Seasonal allergic rhinitis (SAR): happening at
the same time each year, (Spring/Summer
where pollen spreaded all the air)
• Perrenial allergic rhinitis (PAR): happening
everytime in a year, (mainly caused by dust,
animal allergen, fungi, cockroach)
• Occupational allergic rhinitis: related to
• Allergen bind to B-Cell as
APC, transformed into
Plasma cell secreting IgE
• IgE bind to FcεRI of Mast
• This will be a memoryfuction to allergen
• Th2 Mediated the
spreading of allergen
2. Allergic Response
• Repeat exposure to
• Activation of mast
cells/basophils in large
number in nasal mucosa.
• Degranulation and
releasing many allergicresponse mediators
Effects of Allergic
Response in Rhinitis
• Vasoactive amines.
The most important
amine is histamine.
secretion by nasal
• Histamine, PAF, Leukotrienes C4, D4, E4 Neutral
proteases that activate complement and kinins,
Prostaglandin D2 : Vasodilation, increased
• Edema of the nasal mucous
• Redness around the nose, the mediator of
inflammatory cause itchy
• Increasing of mucous secret worse the breathing
• Stimulation of the sneezing mechanism
repeatedly by p-substances? Neuropeptides?
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