Allergy new

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Allergy new

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

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