Feb 2014 allergy a physiology

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  • This disease affects nearly 1% of the population.
  • Timothy grass (Phleum pratense) pollen allergens are an important cause of allergic symptoms. However, pollen grains are too large to penetrate the deeper airways. Grass pollen is known to release allergen-bearing starch granules (SG) upon contact with water. These granules can create an inhalable allergenic aerosol capable of triggering an early asthmatic response and are implicated in thunderstorm-associated asthma.
  • Timothy grass (Phleum pratense) pollen allergens are an important cause of allergic symptoms. However, pollen grains are too large to penetrate the deeper airways. Grass pollen is known to release allergen-bearing starch granules (SG) upon contact with water. These granules can create an inhalable allergenic aerosol capable of triggering an early asthmatic response and are implicated in thunderstorm-associated asthma.
  • Timothy grass (Phleum pratense) pollen allergens are an important cause of allergic symptoms. However, pollen grains are too large to penetrate the deeper airways. Grass pollen is known to release allergen-bearing starch granules (SG) upon contact with water. These granules can create an inhalable allergenic aerosol capable of triggering an early asthmatic response and are implicated in thunderstorm-associated asthma.
  • Timothy grass (Phleum pratense) pollen allergens are an important cause of allergic symptoms. However, pollen grains are too large to penetrate the deeper airways. Grass pollen is known to release allergen-bearing starch granules (SG) upon contact with water. These granules can create an inhalable allergenic aerosol capable of triggering an early asthmatic response and are implicated in thunderstorm-associated asthma.
  • Timothy grass (Phleum pratense) pollen allergens are an important cause of allergic symptoms. However, pollen grains are too large to penetrate the deeper airways. Grass pollen is known to release allergen-bearing starch granules (SG) upon contact with water. These granules can create an inhalable allergenic aerosol capable of triggering an early asthmatic response and are implicated in thunderstorm-associated asthma.
  • Timothy grass (Phleum pratense) pollen allergens are an important cause of allergic symptoms. However, pollen grains are too large to penetrate the deeper airways. Grass pollen is known to release allergen-bearing starch granules (SG) upon contact with water. These granules can create an inhalable allergenic aerosol capable of triggering an early asthmatic response and are implicated in thunderstorm-associated asthma.
  • Timothy grass (Phleum pratense) pollen allergens are an important cause of allergic symptoms. However, pollen grains are too large to penetrate the deeper airways. Grass pollen is known to release allergen-bearing starch granules (SG) upon contact with water. These granules can create an inhalable allergenic aerosol capable of triggering an early asthmatic response and are implicated in thunderstorm-associated asthma.
  • Timothy grass (Phleum pratense) pollen allergens are an important cause of allergic symptoms. However, pollen grains are too large to penetrate the deeper airways. Grass pollen is known to release allergen-bearing starch granules (SG) upon contact with water. These granules can create an inhalable allergenic aerosol capable of triggering an early asthmatic response and are implicated in thunderstorm-associated asthma.
  • Timothy grass (Phleum pratense) pollen allergens are an important cause of allergic symptoms. However, pollen grains are too large to penetrate the deeper airways. Grass pollen is known to release allergen-bearing starch granules (SG) upon contact with water. These granules can create an inhalable allergenic aerosol capable of triggering an early asthmatic response and are implicated in thunderstorm-associated asthma.
  • Timothy grass (Phleum pratense) pollen allergens are an important cause of allergic symptoms. However, pollen grains are too large to penetrate the deeper airways. Grass pollen is known to release allergen-bearing starch granules (SG) upon contact with water. These granules can create an inhalable allergenic aerosol capable of triggering an early asthmatic response and are implicated in thunderstorm-associated asthma.
  • Timothy grass (Phleum pratense) pollen allergens are an important cause of allergic symptoms. However, pollen grains are too large to penetrate the deeper airways. Grass pollen is known to release allergen-bearing starch granules (SG) upon contact with water. These granules can create an inhalable allergenic aerosol capable of triggering an early asthmatic response and are implicated in thunderstorm-associated asthma.
  • Timothy grass (Phleum pratense) pollen allergens are an important cause of allergic symptoms. However, pollen grains are too large to penetrate the deeper airways. Grass pollen is known to release allergen-bearing starch granules (SG) upon contact with water. These granules can create an inhalable allergenic aerosol capable of triggering an early asthmatic response and are implicated in thunderstorm-associated asthma.
  • Timothy grass (Phleum pratense) pollen allergens are an important cause of allergic symptoms. However, pollen grains are too large to penetrate the deeper airways. Grass pollen is known to release allergen-bearing starch granules (SG) upon contact with water. These granules can create an inhalable allergenic aerosol capable of triggering an early asthmatic response and are implicated in thunderstorm-associated asthma.
  • Timothy grass (Phleum pratense) pollen allergens are an important cause of allergic symptoms. However, pollen grains are too large to penetrate the deeper airways. Grass pollen is known to release allergen-bearing starch granules (SG) upon contact with water. These granules can create an inhalable allergenic aerosol capable of triggering an early asthmatic response and are implicated in thunderstorm-associated asthma.
  • a | Sensitization and memory. Initial contact with minute amounts of intact, soluble allergen at mucosal surfaces, particularly of the respiratory tract, might favour allergen uptake by potent antigen-presenting cells (for example, dendritic cells) and/or immunoglobulin-mediated capture by specific B cells. If T helper 2 (TH2)-cell help is acquired, cytokines such as interleukin-4 (IL-4) and IL-13 will be produced that favour immunoglobulin-class switching of specific B cells to immunoglobulin E (that is, sensitization). Sensitization leads to the establishment of IgE+ memory B cells and allergen-specific memory T cells. Subsequent repeated allergen contact will boost IgE+ memory B cells that receive T-cell help to produce increased levels of allergen-specific IgE antibodies. These are loaded by means of specific receptors (FcRI, high-affinity IgE receptor; FcRII, low-affinity IgE receptor) onto mast cells, basophils, monocytes, dendritic cells and B cells. b | Immediate reaction. The crosslinking of effector-cell-bound IgE by allergens leads to the release of biologically active mediators (histamine, leukotrienes) by means of degranulation and, so, to the immediate symptoms of allergy. c | Late reaction. This is caused by the presentation of allergens to T cells, which become activated, proliferate and release proinflammatory cytokines (for example, IL-4, IL-5 and IL-13). This process might be enhanced by the IgE-mediated presentation of allergens to T cells. TH2 cytokines (for example, IL-5) induce tissue eosinophilia and the release of inflammatory mediators from eosinophils. APC, antigen-presenting cell; DC, dendritic cell; TCR, T-cell receptor
  • Timothy grass (Phleum pratense) pollen allergens are an important cause of allergic symptoms. However, pollen grains are too large to penetrate the deeper airways. Grass pollen is known to release allergen-bearing starch granules (SG) upon contact with water. These granules can create an inhalable allergenic aerosol capable of triggering an early asthmatic response and are implicated in thunderstorm-associated asthma.
  • Timothy grass (Phleum pratense) pollen allergens are an important cause of allergic symptoms. However, pollen grains are too large to penetrate the deeper airways. Grass pollen is known to release allergen-bearing starch granules (SG) upon contact with water. These granules can create an inhalable allergenic aerosol capable of triggering an early asthmatic response and are implicated in thunderstorm-associated asthma.
  • a | Sensitization and memory. Initial contact with minute amounts of intact, soluble allergen at mucosal surfaces, particularly of the respiratory tract, might favour allergen uptake by potent antigen-presenting cells (for example, dendritic cells) and/or immunoglobulin-mediated capture by specific B cells. If T helper 2 (TH2)-cell help is acquired, cytokines such as interleukin-4 (IL-4) and IL-13 will be produced that favour immunoglobulin-class switching of specific B cells to immunoglobulin E (that is, sensitization). Sensitization leads to the establishment of IgE+ memory B cells and allergen-specific memory T cells. Subsequent repeated allergen contact will boost IgE+ memory B cells that receive T-cell help to produce increased levels of allergen-specific IgE antibodies. These are loaded by means of specific receptors (FcRI, high-affinity IgE receptor; FcRII, low-affinity IgE receptor) onto mast cells, basophils, monocytes, dendritic cells and B cells. b | Immediate reaction. The crosslinking of effector-cell-bound IgE by allergens leads to the release of biologically active mediators (histamine, leukotrienes) by means of degranulation and, so, to the immediate symptoms of allergy. c | Late reaction. This is caused by the presentation of allergens to T cells, which become activated, proliferate and release proinflammatory cytokines (for example, IL-4, IL-5 and IL-13). This process might be enhanced by the IgE-mediated presentation of allergens to T cells. TH2 cytokines (for example, IL-5) induce tissue eosinophilia and the release of inflammatory mediators from eosinophils. APC, antigen-presenting cell; DC, dendritic cell; TCR, T-cell receptor
  • a | Sensitization and memory. Initial contact with minute amounts of intact, soluble allergen at mucosal surfaces, particularly of the respiratory tract, might favour allergen uptake by potent antigen-presenting cells (for example, dendritic cells) and/or immunoglobulin-mediated capture by specific B cells. If T helper 2 (TH2)-cell help is acquired, cytokines such as interleukin-4 (IL-4) and IL-13 will be produced that favour immunoglobulin-class switching of specific B cells to immunoglobulin E (that is, sensitization). Sensitization leads to the establishment of IgE+ memory B cells and allergen-specific memory T cells. Subsequent repeated allergen contact will boost IgE+ memory B cells that receive T-cell help to produce increased levels of allergen-specific IgE antibodies. These are loaded by means of specific receptors (FcRI, high-affinity IgE receptor; FcRII, low-affinity IgE receptor) onto mast cells, basophils, monocytes, dendritic cells and B cells. b | Immediate reaction. The crosslinking of effector-cell-bound IgE by allergens leads to the release of biologically active mediators (histamine, leukotrienes) by means of degranulation and, so, to the immediate symptoms of allergy. c | Late reaction. This is caused by the presentation of allergens to T cells, which become activated, proliferate and release proinflammatory cytokines (for example, IL-4, IL-5 and IL-13). This process might be enhanced by the IgE-mediated presentation of allergens to T cells. TH2 cytokines (for example, IL-5) induce tissue eosinophilia and the release of inflammatory mediators from eosinophils. APC, antigen-presenting cell; DC, dendritic cell; TCR, T-cell receptor
  • a | Sensitization and memory. Initial contact with minute amounts of intact, soluble allergen at mucosal surfaces, particularly of the respiratory tract, might favour allergen uptake by potent antigen-presenting cells (for example, dendritic cells) and/or immunoglobulin-mediated capture by specific B cells. If T helper 2 (TH2)-cell help is acquired, cytokines such as interleukin-4 (IL-4) and IL-13 will be produced that favour immunoglobulin-class switching of specific B cells to immunoglobulin E (that is, sensitization). Sensitization leads to the establishment of IgE+ memory B cells and allergen-specific memory T cells. Subsequent repeated allergen contact will boost IgE+ memory B cells that receive T-cell help to produce increased levels of allergen-specific IgE antibodies. These are loaded by means of specific receptors (FcRI, high-affinity IgE receptor; FcRII, low-affinity IgE receptor) onto mast cells, basophils, monocytes, dendritic cells and B cells. b | Immediate reaction. The crosslinking of effector-cell-bound IgE by allergens leads to the release of biologically active mediators (histamine, leukotrienes) by means of degranulation and, so, to the immediate symptoms of allergy. c | Late reaction. This is caused by the presentation of allergens to T cells, which become activated, proliferate and release proinflammatory cytokines (for example, IL-4, IL-5 and IL-13). This process might be enhanced by the IgE-mediated presentation of allergens to T cells. TH2 cytokines (for example, IL-5) induce tissue eosinophilia and the release of inflammatory mediators from eosinophils. APC, antigen-presenting cell; DC, dendritic cell; TCR, T-cell receptor
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  • Feb 2014 allergy a physiology

    1. 1. Allergy A: Introduction & Physiology Gimli Glider Pilot School/FMPE Abbotsford/Mission & Langley/Aldergrove 19 February & 25 February 2014
    2. 2. 1. You can't be allergic to organic food ? Organic foods may be free of harmful pesticides, but they aren’t free of the proteins that cause allergic reactions. http://www.mnn.com/health/allergies/photos/10-common-allergy-myths/you-cant-be-allergic-to-organic-food
    3. 3. 2. Food allergies are extremely common ? Although 25 % of people think they're allergic to certain foods, studies show that about only 6 % of children and 1 to 2 % of adults have a food allergy. Food Allergies—Just the Facts Am Fam Physician. 1999 Jan 15;59(2):429-430.
    4. 4. 3. What is celiac disease? • Celiac disease or gluten-sensitive enteropathy is an inherited condition triggered by the consumption of cereal grains containing "gluten“ Health Canada www.hc-sc.gc.ca
    5. 5. 3. Celiac Disease • Celiac disease or gluten-sensitive enteropathy is an inherited condition triggered by the consumption of cereal grains containing "gluten” • Gluten (from Latin gluten, "glue") is a protein composite found in foods processed from wheat and related grain species, including barley and rye • different species of wheat (e.g., durum, spelt, kamut), barley, rye, and their cross-bred hybrids (e.g., triticale, which is a cross between wheat and rye) Health Canada www.hc-sc.gc.ca
    6. 6. 3. Celiac/gluten allergy? http://www.nature.com/scientificamerican/journal/v301/n2/images/scientificamerican0809-54-I5.jpg Anti-TTG APC helper T-Cell Mature B-Cell Gluten protein
    7. 7. 3.How common is it? This disease affects nearly 1% of the population. Health Canada www.hc-sc.gc.ca
    8. 8. • Most people are actually suffering from a food intolerance or sensitivity. • A food sensitivity does not incite an allergic reaction in the body. • Further, most people with food allergies are actually allergic to less than 4 foods. Food Allergies—Just the Facts Am Fam Physician. 1999 Jan 15;59(2):429-430. 3. Food allergy facts
    9. 9. 4. Allergic reactions are rarely serious ? Allergies can sometimes prove fatal. Some people can be so sensitive to some allergens that they go into anaphylactic shock. http://www.mnn.com/health/allergies/photos/10-common-allergy-myths/you-cant-be-allergic-to-organic-food Food Allergies—Just the Facts Am Fam Physician. 1999 Jan 15;59(2):429-430.
    10. 10. 4. anaphylactic shock fact This is a severe, whole-body reaction that can result in nausea, hives, abdominal cramps, and possibly constriction of the airways. Many people prone to these dangerous attacks carry an epinephrine autoinjector, necessary. http://www.mnn.com/health/allergies/photos/10-common-allergy-myths/you-cant-be-allergic-to-organic-food
    11. 11. 5. Pet fur triggers allergies ? Pet allergy, by definition, “is an allergic reaction to proteins found in an animal's skin cells, saliva or urine.” http://www.mnn.com/health/allergies/photos/10-common-allergy-myths/you-cant-be-allergic-to-organic-food
    12. 12. 5.1 Pet allergy facts 1. People are most commonly affected by the dead skin cells, or dander, that an animal sheds. 2. Signs of pet allergy include those common to hay fever, such as sneezing and runny nose. 3. Some people may also experience signs of asthma, such as wheezing and difficulty breathing. http://www.mnn.com/health/allergies/photos/10-common-allergy-myths/you-cant-be-allergic-to-organic-food
    13. 13. 5.5 Pet allergy facts As the Asthma and Allergy Foundation of America reports, “from 15 percent to 30 percent of people with allergies have allergic reactions to cats and dogs Food Allergies—Just the Facts Am Fam Physician. 1999 Jan 15;59(2):429-430.
    14. 14. 6. What is house dust ?
    15. 15. 6. What causes House dust allergy ?
    16. 16. 6. I’m allergic to cotton wood ? Is it cottonwood or is it grass?
    17. 17. http://en.wikipedia.org/wiki/File:Timothy_grass.jpg Timothy Grass Pollen Allergy ? Phleum pratense
    18. 18. Definition: Allergy “allergy is characterized by an overreaction of the human immune system to a foreign protein substance ('allergen') that is eaten, breathed into the lungs, injected or touched. This immune overreaction can result in symptoms such as coughing, sneezing, itchy eyes, runny nose and scratchy throat.” More severe symptoms include rash, hives, asthma and even death. http://aafa.org/
    19. 19. Allergy History The term "allergy" was first coined by Clemens von Pirquet in 1906 to describe an altered or changed reactivity of the immune system to foreign proteins,[7] irrespective of whether this resulted in immunity or a harmful effect. However, today most clinicians restrict the use of the term to situations where an exaggerated sensitivity (hypersensitivity) results from a heightened or altered reactivity of the immune system in response to external substances. Allergy: the unmet need A blueprint for better patient care. A report of the Royal College of Physicians Working Party on the provision of allergy services in the UK. Royal College of Physicians June 2003. http://www.bsaci.org/pdf/allergy_the_unmet_need.pdf
    20. 20. Allergy History The foreign substances that provoke allergies are called allergens and enter the body either by inhalation, swallowing, injection, or contact with the skin, eye or airways. The Royal College of Physicians reported that common allergens include "grass, weed and tree pollens, substances present in house dust … [particularly the faeces of housedust mites], fungal spores, animal products, certain foods, and various chemical agents found in the home and at work."[8] Allergy: the unmet need A blueprint for better patient care. A report of the Royal College of Physicians Working Party on the provision of allergy services in the UK. Royal College of Physicians June 2003. http://www.bsaci.org/pdf/allergy_the_unmet_need.pdf
    21. 21. Timothy grass http://en.wikipedia.org/wiki/File:Timothy_grass.jpg
    22. 22. Timothy-grass (Phleum pratense) An abundant perennial grass. It is a major source of hay and cattle fodder. http://en.wikipedia.org/wiki/File:Timothy_grass.jpg
    23. 23. http://agronomator.files.wordpress.com/2013/06/img_0098.jpg Timothy Grass: meadow cat's-tail
    24. 24. http://en.wikipedia.org/wiki/File:Timothy_grass.jpg Timothy grass Phleum pratense
    25. 25. http://en.wikipedia.org/wiki/File:Timothy_grass.jpg Timothy grass Phleum pratense
    26. 26. http://en.wikipedia.org/wiki/File:Timothy_grass.jpg Timothy grass Phleum pratense
    27. 27. http://en.wikipedia.org/wiki/File:Timothy_grass.jpg Timothy grass Phleum pratense
    28. 28. http://agronomator.files.wordpress.com/2013/06/img_0098.jpg Timothy grass
    29. 29. http://en.wikipedia.org/wiki/File:Timothy_grass.jpg Timothy grass When do people report problems with grass allergy ?
    30. 30. http://en.wikipedia.org/wiki/File:Timothy_grass.jpg Timothy grass Pollen grains
    31. 31. http://en.wikipedia.org/wiki/File:Timothy_grass.jpg Timothy grass Do pollen grains trigger the allergic response ?
    32. 32. http://en.wikipedia.org/wiki/File:Timothy_grass.jpg Timothy grass What events are often reported in association with grass allergy ?
    33. 33. http://en.wikipedia.org/wiki/File:Timothy_grass.jpg Timothy grass Anything special about cut grass ?
    34. 34. Timothy grass (Phleum pratense) release allergen-bearing starch granules (SG) upon contact with water Motta et al. Phleum pratense pollen starch granules induce humoral and cell-mediated immune responses in a rat model of allergy. Clin Exp Allergy. 2004 Feb;34(2):310-4.
    35. 35. Timothy grass (Phleum pratense) release allergen-bearing starch granules (SG) upon contact with water Motta et al. Phleum pratense pollen starch granules induce humoral and cell-mediated immune responses in a rat model of allergy. Clin Exp Allergy. 2004 Feb;34(2):310-4.
    36. 36. Timothy grass (Phleum pratense) allergen-bearing starch granules (SG) Motta et al. Phleum pratense pollen starch granules induce humoral and cell-mediated immune responses in a rat model of allergy. Clin Exp Allergy. 2004 Feb;34(2):310-4. allergen.
    37. 37. Motta et al. Phleum pratense pollen starch granules induce humoral and cell-mediated immune responses in a rat model of allergy. Clin Exp Allergy. 2004 Feb;34(2):310-4. 1st Antigen Contact: Antigen Processing Cell Dentritic cell Antigen processing allergen.
    38. 38. FIGURE 1 | How allergens induce and maintain allergy. The future of antigen-specific immunotherapy of allergy Rudolf Valenta; Nature Reviews Immunology 2, 446-453 (June 2002); http://www.nature.com/nri/journal/v2/n6/fig_tab/nri824_F1.html Sensitization
    39. 39. • IgE is a Y-shaped molecule. • The long arm of the Y is the part that binds avidly to the surface of the mast cell. • The short arm links with the allergen in a ‘lock and key’ fashion. Basic Mechanisms: Common Atopic Allergic Diseases Allergy: the unmet need A blueprint for better patient care. A report of the Royal College of Physicians Working Party on the provision of allergy services in the UK. Royal College of Physicians June 2003. http://www.bsaci.org/pdf/allergy_the_unmet_need.pdf
    40. 40. Allergy: the unmet need A blueprint for better patient care. A report of the Royal College of Physicians Working Party on the provision of allergy services in the UK. Royal College of Physicians June 2003. http://www.bsaci.org/pdf/allergy_the_unmet_need.pdf IgE Basic Mechanisms: Atopic Allergic Diseases IgE is a Y-shaped molecule. The long arm of the Y is the part that binds avidly to the surface of the mast cell. The short arm links with the allergen in a ‘lock and key’ fashion. long arm short arm
    41. 41. Allergy: the unmet need A blueprint for better patient care. A report of the Royal College of Physicians Working Party on the provision of allergy services in the UK. Royal College of Physicians June 2003. http://www.bsaci.org/pdf/allergy_the_unmet_need.pdf IgE Basic Mechanisms: Atopic Allergic Diseases Short arm links with the allergen in a ‘lock and key’ fashion
    42. 42. Allergy: the unmet need A blueprint for better patient care. A report of the Royal College of Physicians Working Party on the provision of allergy services in the UK. Royal College of Physicians June 2003. http://www.bsaci.org/pdf/allergy_the_unmet_need.pdf IgE Basic Mechanisms: Atopic Allergic Diseases Short arm links with the allergen in a ‘lock and key’ fashion Long arm of the ‘Y’ binds avidly to the surface of the mast cell
    43. 43. Mast Cell Mast Cell Activated and Primed for Release
    44. 44. 2nd Antigen Contact: Mast Cell Activation & Release Allergen interacts with IgE bound to mast cells to cause the acute symptoms of allergy through the release of histamine and other mediators (eg leukotrienes).
    45. 45. FIGURE 1 | How allergens induce and maintain allergy. The future of antigen-specific immunotherapy of allergy Rudolf Valenta; Nature Reviews Immunology 2, 446-453 (June 2002); http://www.nature.com/nri/journal/v2/n6/fig_tab/nri824_F1.html Immediate Reaction This process is sometimes called ‘mast cell degranulation’ because the granules, which contain the histamine, are released outside the cell.
    46. 46. FIGURE 1 | How allergens induce and maintain allergy. The future of antigen-specific immunotherapy of allergy Rudolf Valenta; Nature Reviews Immunology 2, 446-453 (June 2002); http://www.nature.com/nri/journal/v2/n6/fig_tab/nri824_F1.html Late Reaction
    47. 47. Allergy: the unmet need A blueprint for better patient care. A report of the Royal College of Physicians Working Party on the provision of allergy services in the UK. Royal College of Physicians June 2003. http://www.bsaci.org/pdf/allergy_the_unmet_need.pdf Basic Mechanisms: Common Atopic Allergic Diseases
    48. 48. Allergy: the unmet need A blueprint for better patient care. A report of the Royal College of Physicians Working Party on the provision of allergy services in the UK. Royal College of Physicians June 2003. http://www.bsaci.org/pdf/allergy_the_unmet_need.pdf Basic Mechanisms: Common Atopic Allergic Diseases
    49. 49. • The Th2 cell is believed to play a central role in ongoing chronic symptoms by synthesising inflammatory proteins called cytokines and chemokines Basic Mechanisms: Common Atopic Allergic Diseases Allergy: the unmet need A blueprint for better patient care. A report of the Royal College of Physicians Working Party on the provision of allergy services in the UK. Royal College of Physicians June 2003. http://www.bsaci.org/pdf/allergy_the_unmet_need.pdf
    50. 50. FIGURE 1 | How allergens induce and maintain allergy. The future of antigen-specific immunotherapy of allergy Rudolf Valenta; Nature Reviews Immunology 2, 446-453 (June 2002); http://www.nature.com/nri/journal/v2/n6/fig_tab/nri824_F1.html Sensitization memory Immediate reaction late reaction
    51. 51. Early Signs of Childhood Allergy The “Allergic March” is the predictable progression of allergic symptoms frequently observed in growing children, beginning with http://enhs.umn.edu/current/5100/asthma/allergens.html
    52. 52. Early Signs of Childhood Allergy The “Allergic March” is the predictable progression of allergic symptoms frequently observed in growing children, beginning with atopic dermatitis, http://enhs.umn.edu/current/5100/asthma/allergens.html
    53. 53. Early Signs of Childhood Allergy http://enhs.umn.edu/current/5100/asthma/allergens.html beginning with atopic dermatitis,
    54. 54. Early Signs of Childhood Allergy The “Allergic March” is the predictable progression of allergic symptoms frequently observed in growing children, beginning with atopic dermatitis, followed by http://enhs.umn.edu/current/5100/asthma/allergens.html
    55. 55. Early Signs of Childhood Allergy The “Allergic March” is the predictable progression of allergic symptoms frequently observed in growing children, beginning with atopic dermatitis, followed by allergic rhinitis. http://enhs.umn.edu/current/5100/asthma/allergens.html
    56. 56. http://enhs.umn.edu/current/5100/asthma/allergens.html Early Signs of Childhood Allergy followed by allergic rhinitis
    57. 57. Early Signs of Childhood Allergy The “Allergic March” is the predictable progression of allergic symptoms frequently observed in growing children, beginning with atopic dermatitis, followed by allergic rhinitis and the development of http://enhs.umn.edu/current/5100/asthma/allergens.html
    58. 58. Early Signs of Childhood Allergy The “Allergic March” is the predictable progression of allergic symptoms frequently observed in growing children, beginning with atopic dermatitis, followed by allergic rhinitis and the development of asthma. http://enhs.umn.edu/current/5100/asthma/allergens.html
    59. 59. The “Allergic March” is the predictable progression of allergic symptoms frequently observed in growing children, beginning with atopic dermatitis, followed by allergic rhinitis and the development of asthma. http://enhs.umn.edu/current/5100/asthma/allergens.html Early Signs of Childhood Allergy development of asthma
    60. 60. From LEAP Study 2011; http://www.leapstudy.co.uk/LEAP.html Allergic March as a series of common allergic conditions that can appear either singularly or together and often track with age. Allergic March
    61. 61. http://www.publications.parliament.uk/pa/ld200607/ldselect/ldsctech/166/16605.htm
    62. 62. http://www.publications.parliament.uk/pa/ld200607/ldselect/ldsctech/166/16605.htm
    63. 63. http://www.publications.parliament.uk/pa/ld200607/ldselect/ldsctech/166/16605.htm
    64. 64. http://www.publications.parliament.uk/pa/ld200607/ldselect/ldsctech/166/16605.htm
    65. 65. http://www.publications.parliament.uk/pa/ld200607/ldselect/ldsctech/166/16605.htm
    66. 66. http://www.publications.parliament.uk/pa/ld200607/ldselect/ldsctech/166/16605.htm
    67. 67. http://www.publications.parliament.uk/pa/ld200607/ldselect/ldsctech/166/16605.htm
    68. 68. 1 2 3 4 5 6 7 8 9 10 + 1 2 3 4 5 6 7 8 9 10 +
    69. 69. http://www.ec.gc.ca/cas-aqhi/default.asp?lang=En&n=9E5D28AD-1 Environment Canada
    70. 70. http://www.bcairquality.ca/readings/index.html
    71. 71. Abelsohn A., Stieb DM; Health effects of outdoor air pollution; Approach to counseling patients using the Air Quality Health Index; Clinical Review; Can Fam Physician 2011;57:881-7 Health effects of outdoor air pollution
    72. 72. Air Quality Health Index (AQHI) Abelsohn A., Stieb DM; Health effects of outdoor air pollution; Approach to counseling patients using the Air Quality Health Index; Clinical Review; Can Fam Physician 2011;57:881-7
    73. 73. Air Quality Health Index (AQHI) Abelsohn A., Stieb DM; Health effects of outdoor air pollution; Approach to counseling patients using the Air Quality Health Index; Clinical Review; Can Fam Physician 2011;57:881-7

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