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  • ALLERGY
    DR. MA. TERESA S. FAJARDO
    PEDIATRICS
    HEMATOLOGY / ONCOLOGY
  • IMMUNOLOGIC BASISOF ALLERGIC DISEASE
    TO DETECT AND ELIMINATE ANYTHING FOREIGN
    TO THE BODY
    BENEFICIAL (IMMUNITY) OR HARMFUL (ALLERGY)
  • COMPONENTS IN HOST'S RESPONSE TO THE ALLERGEN
    ENVIRONMENT
    TARGET CELLS
    B AND T LYMPHOCYTES
  • IMMUNOLOGIC CAPABILITIES OF THE HOST
    PRIMARY ( NON- SPECIFIC )
    SECONDARY (SPECIFIC)
    TERTIARY ( TISSUE DAMAGING
    RESPONSE)
  • PRIMARY RESPONSE
    MOST PRIMITIVE
    PHAGOCYTOSIS / INFLAMMATION
  • SECONDARY RESPONSE
    SPECIFIC RESPONSE
    MECHANISMS :
    B CELL / T CELL RESPONSE
    COMPLEMENT SYSTEM
    COAGULATIPON SYSTEM
  • TERTIARY RESPONSE
    TISSUE – DAMAGING RESPONSES
    ( TYPES I, II, III, IV )
    PROPOSED BY GELL AND COOMBS
  • MEDIATORS OF ALLERGY
    PREFORMED MAST CELL MEDIATORS
    RAPIDLY FORMED MAST CELL MEDIATORS
  • PREFORMED MAST CELLMEDIATORS
    VASOACTIVE MEDIATORS
    CHEMOTACTIC MEDIATORS
    ENZYMES
    PROTEOGLYCANS
  • PREFORMED MAST CELLMEDIATORS ( VASOACTIVE MEDIATORS)
    HISTAMINE
    BRONCHOSPASM AND VASCULAR PERMEABILITY
    ADENOSINE
    INHIBIT PLATELET AGGREGATION
    STIMULATE IRRITANT RECEPTORS
  • PREFORMED MAST CELLMEDIATOR (CHEMOTACTIC MEDIATORS )
    1. NEUTROPHIL FACTOR
    RECRUITMENT / ACTIVATION OF NEUTROPHIL
    2. EOSINOPHIL FACTOR
    RECRUITMENT /ACTIVATION OF EOSINOPHIL
  • PREFORMED MAST CELLMEDIATOR ( ENZYMES)
    1. NEUTRAL PROTEASES ( TRYPTASE , CHYMASE )
    COMPLEMENT/ KININ ACTIVATION
    2. ACID HYDROLASES ( BETA- GLUCORONIDASE)
    INFLAMMATION
  • PREFORMED MAST CELLMEDIATOR (PROTEOGLYCANS)
    HEPARIN
    ANTICOAGULANT
    ANTICOMPLEMENT ACTIVITY
  • RAPIDLY FORMED MAST CELL MEDIATORS
    PLATELET- ACTIVATING FACTOR
    PROSTAGLANDIN
    LEUKOTRIENES
  • RAPIDLY FORMED MASTCELL MEDIATORS
    BIOLOGIC ACTIVITY :
    VASODILATATION
    VASCULAR LEAKAGE
    SMOOTH MUSCLE CONTRACTION
    GLANDULAR SECRETION
    STIMULATION OF THE IRRITANT ( ITCH / SNEEZE )
    RECEPTORS
    PRO –ANTI-INFLAMMATORY MEDIATOR
  • CYTOKINES
    NEWLY SYNTHESIZED PROTEINS THAT REGULATE
    IMMUNE RESPONSE
    POTENT PRO- INFLAMMATORY MEDIATORS
    GROWTH / DIFFERENTIATION OF EOSINOPHILS
    AND MAST CELLS
  • CYTOKINES AND ALLERGY
    IgE REGULATION
    EOSINOPHILIA
    MAST CELL DEV ‘T AND ACTIVATION
    INFLAMMATION
  • IMMUNOLOGIC MECHANISM IN ALLERGIC INFLAMMATION
    ALLERGEN EXPOSURE ----MAST CELL ACTIVATION----
    VASOACTIVE AMINE ACTIVATION ---- IMMEDIATE
    REACTIONS ( VASODILATATION, EDEMA, SM CONTRACTION, MUCUS SECRETION) ------------ 3 -8 HRS
    LATE PHASE RESPONSE (INFILTRATION OF EOSINOPHILS
    MONONUCLEARS AND NEUTROPHILS) ----------- AFTER 24 -48 HRS ------
    T- CELL ACTIVATION --------- CHEMOTACTIC MEDIATORS -------- CELLULAR INFILTRATION ------
    INFLAMMATORY MEDIATORS ------------ EDEMA, DESQUAMATION, CELLULAR INFI;LTRATION AND MUCUS
    SECRETION
  • ALLERGIC RHINITIS
    SYMPTOMS:
    “ SNEEZERS AND RUNNERS”
    -- PAROXYSMAL SNEEZING
    -- WATERY RHINORRHEA
    -- ITCHY NOSE
    ---NASAL BLOCKAGE (VARIABLE)
    -- DIURNAL RHYTHM (WORST DAYTIME IMPROVES
    AT NIGHT
    -- OFTEN ASSOCIATED WITHJ CONJUNCTIVITIS
  • ALLERGIC RHINITIS
    SYMPTOMS:
    BLOCKERS
    -- LITTLE OR NO SNEEZING
    -- THICK NASAL MUCUS (CATARRH) MORE OFTEN
    POSTERIOR (POST NASAL DRIP)
    -- NO ITCH
    -- NASAL BLOCKAGE OFTEN SEVERE
    -- CONSTANT BUT MAYBE WORST AT NIGHT
  • RHINITIS DEFINITION
    NASAL DISCHARGE
    BLOCKAGE
    SNEEZE/ ITCH
    TWO OR MORE SYMPTOMS FOR MORE THAN ONE HOUR ON MOST DAYS
  • ALLERGIC RHINITIS
    TREATMENT
    ENVIRONMENTAL CONTROL
    IMMUNOTHERAPY
    PHARMACOTHERAPY
    PARENT/PATIENT EDUCATION
  • ASTHMA
    CHRONIC, RECURRENT , OCCASIONALLY FATAL
    CHRONIC INFLAMMATORY DISORDER OF THE
    AIRWAYS IN WHICH CELLS PLAY A ROLE, INCLUDING M
    MAST CELLS AND EOSINOPHILS
    WIDESPREAD BUT VARIABLE AIRFLOW OBSTRUCTION
    THAT IS OFTEN REVERSIBLE EITHER SPONTANEOUSLY
    OR WITH TREATMENT ASSSOCIATED WITH AIRWAY
    RESPONSIVENESS
  • PRECIPITANT OF ASTHMA
    RESPIRATORY INFECTION (VIRAL)
    ALLERGENS
    FOOD
    HOUSEHOLD INHALANTS
    OUTDOOR INHALANTS
    IRRITANTS
    EXERCISE
    EMOTIONAL FACTORS
  • PATHOPHYSIOLOGY OFASTHMA ,SEVERE
    ASTHMA -- MUCUS SECRETION , BRONCHOSPASM ,EDEMA ---INCREASED RESISTANCE TO AIRFLOW---HYPERINFLATION, ATELECTASIS , CNS DEPRESSION--
    PULMONARY VASOCONSTRICTION--CARDIAC FAILURE AND COMA
  • ASTHMA
    CLINICAL MS:
    WHEEZING , A HIGH- PITCHED OR SQUEAKING
    EXPIRATORY SOUND
    ONSET , ACUTE /INSIDIOUS
    COUGH , TACHYPNEA , DYSPNEA
    HYPERINFLATION OF THE CHEST, TACHYCARDIS
    ABDOMINAL PAIN WITH VOMITING
    LOW GRADE FEVER
    HUNCHED- OVER SITTING POSITIUON
  • MANAGEMENT OFASTHMA
    ACHIEVE AND MAINTAIN CONTROL OF SYMPTOMS
    PREVENT ASTHMA EXACERBATIONS
    MAINTAIN PULMONARY FUNCTIONS AS CLOSE
    TO NORMAL LEVELS
    AVOID ADVERSE EFFECTS FROM ASTHMA MEDICATIONS
    PREVENT IRREVERSIBLE AIRWAY OBSTRUCTION
    PREVENT ASTHMA MORBIDITY
  • MANAGEMENT PROGRAMS FOR ASTHMA
    EDUCATE PATIENTS/PARENTS
    ASSESS AND MONITOR SEVERITY
    AVOID OR CONTROL TRIGGERS
    MEDICATION PLANS FOR CHRONIC ASTHMA
    PLANS FOR EXACERBATIONS
    PROVIDE REGULAR FOLLOW-UP
  • STATUS ASTHMATICUS
    SEVERE ACUTE ASTHMA
    LIFE-THREATENING EPISODE
    UNRESPONSIVE TO THE USUAL APPROPRIATE THERAPY
    WITH ADRENERGIC AGENT AND THEOPHYLINE
    LEADS TO ACUTE RESPIRATORY INSUFFICIENCY
  • ATOPIC DERMATITIS
    CHRONIC ,HERITABLE, DISTINCTIVE CUTANEOUS INFLAMMATORY DISEASE CHARACTERIZED BY
    EARLY AGE OF ONSET AND INTENSE PRURITUS
    SKIN LESION: DRY, IRRITATED, WEEPING, EXCORIATED
    LICHENIFIED LESIONS ON THE FLEXURAL AREAS
    IN LATE CHILDHOOD AND ADOLESCENSE
    WIIH GENETIC PREDISPOSITION
    RELAPSING
    CAN DEVELOP ALLERGIC RHINITIS AND ASTHMA
  • STAGES OF ATOPIC DERMATITIS
    INFANTILE STAGE
    4TH -6TH MONTH OF AGE
    ERYTHEMATOUS, PRURITIC, WEEPING DERMATITIS
    IN THE CHEEKS WHICH SPREADS TO THE FOREHEAD
    AND EXTENSOR SURFACES OF THE ARMS AND LEGS
    CIRCUMORAL AREA AND EYELIDS ARE USUALLY SPARED
  • STAGES OF ATOPIC DERMATITIS
    CHILDHOOD STAGE:
    2-4 YRS OF AGE
    PRURITIC, EXCORIATED PAPULESON THE FLEXURAL
    SURFACES OF EXTREMITIES AND FACE
    LICHENIFICATION IN THE POPLITEAL AND ANTECUBITAL FOSSAE
    AND ANKLES
    MAY DISAPPEAR BEFORE 10 YRS
  • STAGES OF ATOPIC DERMATITIS
    ADULT STAGE :
    HIGHLY PRURITIC , CONFLUENT PAPULES ON THE
    DORSAL ASPECT OF THE HANDS, UPPER EYELIDS AND
    FLEXURAL AREAS OF THE EXTREMITIES
  • STIGMAS OF ATOPICDERMATITIS
    LICHENIFICATION
    DENNIE ‘S LINE
    ATOPIC PALMS
    BUFFED NAILS
    WHITE DERMOGRAPHISM
    DELAYED BLANCHED PHENOMENON
    DRYNESS XEROSIS
    ATOPIC PERSONALITY
    HOUSEWIFE’S ECZEMA
    ATOPIC FOOT
    ALLERGIC SHINERS
  • CRITERIA FOR THE DIAGNOSISOF ATOPIC DERMATITIS
    MUST HAVE 3 OR MORE BASIC FEATURES :
    1.PRURITUS
    2.TYPICAL MORPHOLOGY /DISTRIBUTION
    3.TENDENCY TO RECURRENCES
    4.PERSONAL OR FAMILY HISTORY
  • CRITERIA FOR THE DIAGNOSIS OF ATOPIC DERMATITIS
    PLUS ANY THREE OR MORE OF THE FF FEATURES:
    ICHTHYOSIS, ELEVATED SERUM IgE , EARLY AGE ONSET
    CUTANEOUS INFECTION, IMPAIRED T- CELL IMMUNITY
    HAND/FOOT DERMATITIS , NIPPLE ECZEMA, , CHEILITIS,
    RECURRENT CONJUNCTIVITIS, DENNIE MORGAN INFRAORBITAL FOLD
    CATARACT, ORBITAL DARKENING, PITYRIASIS ALBA
    FOOD HYPERSENSITIVITY
  • ATOPIC DERMATITIS
    TREATMENT
    AVOID ENVIRONMENTAL FACTORS
    GOOD HYDRATION OF THE AFFECTED AREAS
    MOISTURIZERS
    CORTICOSTEROIDS IN THE SUBACUTE PHASE
  • URTICARIA ( HIVES)
    RAISED ERYTHEMATOUS SKIN LESIONS ASSOCIATED
    WITH MARKED PRURITUS
    DUE TO VASODILATATION OF SMALL VENULES
    AND CAPILLARIES AND EXUDATION OF FLUID
    INTO THE SUPERFICIAL DERMIS
    ANGIOEDEMA IS URTICARIA INVOLVING THE DEEPER SUBCUTANEOUS TISSUES
  • CLASSIFICATION OF URTICARIA
    IMMUNOLOGIC
    ANAPHYLACTIC / CYTOTOXIC/ IMMUNE COMPLEX
    ANAPHYLACTOID
    HEREDITARY ANGIOEDEMA/ CHEMICAL/ ASPIRIN SENSITIVITY
    PHYSICAL
    DERMATODRAPHIA/ COLD/ CHOLINERGIC/ SOLAR/PRESSURE
    MISC
    INFECTION/ PIGMENTOSA/ PSYCHOGENIC/IDIOPATHIC
  • URTICARIA
    TREATMENT
    SYMPATHOMIMETIC AGENTS : EPINEPHRINE
    ANTIHISTAMINICS
    CORTICOSTEROIDS
  • ALLERGIC CONTACT DERMATITIS
    COMMON DISORDER IN CHILDHOOD
    ERYTHEMA, PAPULES, VESICLES, SWELLING
    WEEPING ANG ITCHING
    24 -48 HRS AFTER EXPOSURE
    TYPE IV
  • CAUSES OF CONTACTDERMATITIS
    IRRITANTS ANIMALS
    PLANTS CLOTHING
    NICKEL DRUGS
    CHROMATE
    MERCURY
    COSMETICS
  • ADVERSE FOOD REACTION
    IMMUNOLOGIC REACTION RESULTING FROM INGESTION OF FOOD PRODUCTS
    AND ADDITIVES
    I
  • FOOD ALLERGY(HYPERSENSITIVITY)
    IMMUNOLOGIC REACTION RESULTING FROM
    INGESTION OF FOOD ADDITIVE , IgE MEDIATED
  • FOOD ANAPHYLAXIS
    CLASSIC ALLERGIC HYPERSENSITIVITY REACTION
    TO FOOD OR FOOD ADDITIVES INVOLVING IgE AND THE
    RELEASE OF CHEMICAL MEDIATORS
  • FOOD INTOLERANCE
    ABNORMAL NON-IMMUNOLOGIC PHYSIOLOGIC RESPONSE TO FOOD OR FOOD ADDITIVES
  • FOOD IDIOSYNCRASY
    HYPERSENSITIVITY WITHOUT IMMUNE RESPONSE
  • FOOD TOXICITY
    ADVERSE REACTION CAUSED BY DIRECT ACTION
    OF FOOD ADDITIVE/ FOOD ON THE HOST RECIPIENT
    WITHOUT IMMUNE MECHANISM FOUND NATURALLY
    IN FOOD OR SECONDARY TO CONTAMINATION BY MICROORGANISM OR PARASITES
  • RISK OF MANIFESTINGATOPY BASED ON FAMILYHISTORY OF ATOPY
    FAMILY HISTORY OF ATOPY RISK OF
    ATOPY
    BIPARENTAL( SAME ALLERGY) 50-80 %
    BIPARENTAL OR UNIPARENTAL 40-60%
    PLUS ONE SIBLING
    UNIPARENTAL OR SIBLING 20-49%
    NEGATIVE 5-15 %
  • MANIFESTATIONS OFFOOD ALLERGY
    GASTROINTESTINAL:: VOMITING, ENTEROCOLITIS,MALABSORPTION, BLEEDING
    RESPIRATORY : RHINITIS, ASTHMA, OTITIS MEDIA
    DERMATOLOGY : URTICARIA, ATOPIC DERMATITIS,
    ALOPECIA
    NEUROLOGIC : SEIZURE, LETHARGY
    HEMATOLOGY : ANEMIA
    ANAPHYLACTIC SHOCK
  • ADVERSE DRUG REACTION
    “ AN EFFECT WHICH IS UNINTENDED AND OCCURS
    AT DOSES NORMALLY USED IN MAN FOR PROPHYLAXIS
    DIAGNOSIS AND THERAPY “
    OCCURS WITHIN A REASONABLE TIME FOLLOWING ADMINISTRATION OF THE DRUG
    REACTIONS : INTOLERANCE, IDIOSYNCRASY, HYPERSENSITIVITY ,PSYCHOGENIC
  • CLASSIC ANTIHISTAMINICS
    ETHANOLAMINES
    EXAMPLES : DIPHENHYDRAMINE , CARBINOXAMINE
    CLEMASTINE, DIMENHYDRINATE
    GENERAL COMMENTS: SEDATIVE EFFECT HIGH,
    MODERATE ANTICHOLINERGIC EFFECTS, RELATIVE LOW
    GIT EFFECTS
  • CLASSIC ANTIHISTAMINICS
    ALKYLAMINES : CHLORPHENIRAMINE , TRIPROLIDINE,
    BROMPHENIRAMINE, PHENIRAMINE
    GENERAL COMMENTS : LOW SEDATIVE , ANTICHOLINERGIC AND GI EFFECTS , BEST GROUP
    FOR DAYTIME USE
  • CLASSIC ANTIHISTAMINICS
    ETHYLENEDIAMINES: ANTAZOLINE TRIPELENNAMINE
    GENERAL COMMENTS :LOW SEDATIVE , ANTICHOLINERGIC EFFECTS , GI EFFECTS COMMON
  • CLASSIC ANTIHISTAMINICS
    PIPERAZINES : HYDROXYZINE , MECLIZINE , CHLORCYCLIZINE
    GENERAL COMMENTS : DROWSINESS IS FREQUENT ,DRY
    MOUTH A USUAL CHOLINERGIC EFFECT
  • CLASSIC ANTIHISTAMINICS
    PHENOTHAZINE : METHDILAZINE , PROMETHAZINE
    TRIMEPRAZINE
    GENERAL COMMENTS : MARKED SEDATIVE EFFECT
    ( USEFUL TREATMENT OF PRURITUS )
  • CLASSIC ANTIHISTAMINICS
    PIPERIDINES : CYPROHEPTADINE , BENZOCYCLOHEPTATHIPINE
    AZATADINE
    GENERAL COMMENTS : DROWSINESS IS COMMON
    USEFUL IN THE TREATMENT OF URTICARIA