The document provides an extensive overview of allergic diseases, defining conditions such as allergic rhinitis, asthma, and anaphylaxis, along with their symptoms, diagnosis, and management options. Key points highlight the roles of cytokines in exaggerated immune responses, differentiation between allergic and non-allergic conditions, and various treatment strategies including medications and immunotherapy. Emphasis is placed on the importance of rapid diagnosis and intervention, particularly in cases of anaphylaxis, where epinephrine administration is critical.

1. Allergy
MD SALOME TCHELIDZE
EUROPEAN UNIVERSITY

2. Introduction to Allergic Diseases
 Definition: Allergic diseases result from an immune response to harmless
substances (allergens).
 Examples: Allergic rhinitis, allergic asthma, and anaphylaxis.
 Key Point: Allergic reactions involve abnormal immune responses often
driven by cytokine production.
 Cytokines: Proteins involved in cell signaling, crucial for immune responses.
 Role in Allergies: Abnormal cytokine production drives exaggerated
immune responses in allergic individuals.
 Result: Symptoms such as inflammation, sneezing, itching, and airway
restriction.

3. Differences Between Allergic and Nonallergic Diseases
 Allergic vs. Nonallergic Diseases:
 Allergic asthma vs. intrinsic (nonallergic) asthma
 Allergic rhinitis vs. nonallergic rhinitis
 IgE-mediated vs. non–IgE-mediated anaphylaxis
 Importance: Distinction influences treatment approach and prognosis.

4. Diagnosis of Allergic Diseases
Key Points for Treatment
 Patient History: Essential first step for identifying allergic conditions.
 Allergy Testing:
 Skin Test: Sensitive and cost-effective.
 In Vitro Testing: Used as a screening tool.
 Purpose: Differentiate between allergic and nonallergic forms.
 Importance of Identifying Mechanism: Determines the appropriate treatment and
prognosis.
 For Allergic Patients:
 Environmental controls
 Medications (e.g., antihistamines, corticosteroids)
 Immunotherapy for specific allergens
 Management Differences: Vary between allergic and nonallergic conditions

5. Allergic Rhinitis
 Definition: Allergic rhinitis is an inflammation of the nasal passages caused by
airborne antigens, leading to various respiratory symptoms.
 Types:
 Seasonal Allergic Rhinitis (Hay Fever): Triggered by high pollen concentrations.
 Perennial Allergic Rhinitis: Persistent, year-round symptoms without seasonal variation.
 Common Symptoms:
 Physical Signs: Allergic shiners, nasal salute, pale nasal mucosa.
 Sensory Loss: Diminished taste and smell.
 Sleep Disruption: Snoring, nighttime coughing, mouth breathing.
 Others: Eustachian tube dysfunction, nasal speech, possible appetite loss due to
loss of smell.

6. Diagnosis of Allergic Rhinitis
 Clinical History: Detailed seasonal or environmental triggers.
 Testing Options:
 Skin Prick Test: Measures wheal response to allergens.
 IgE Assays: Quantifies allergen-specific IgE levels.
 Peripheral Eosinophil Count: Elevated counts support diagnosis but are not
definitive.
 Observation: Changes in symptoms with environmental changes (e.g.,
vacations) suggest allergen involvement.

7. Manifestations of Allergic Rhinitis
 Seasonal Allergic Rhinitis:
 Symptoms: Paroxysmal sneezing, watery nasal discharge, nasal congestion.
 Additional Symptoms: Itchy eyes, throat irritation, nasal obstruction.
 Perennial Allergic Rhinitis:
 Symptoms: Persistent congestion, itching, loss of smell/taste, eustachian tube
dysfunction.

8. Environmental Control Measures
 Indoor Adjustments:
 Use air conditioning and replace filters regularly.
 HEPA filters for dust and animal dander control.
 Hot water washing for linens and using impermeable encasings.
 Remove carpets and avoid fans or cool-mist vaporizers.
 Minimize clutter to reduce dust accumulation.

9. Medication Options
 Antihistamines:
 Second-Generation: Fexofenadine, loratadine, cetirizine – less sedative, effective
for daily use.
 Combination Therapy: Antihistamines with α-adrenergic decongestants for
increased effectiveness.
 Intranasal Steroids: Beclomethasone, fluticasone – the most effective for
controlling nasal symptoms.
 Leukotriene Receptor Antagonists: Montelukast for both seasonal and
perennial symptoms.
 Herbal Options: Butterbur, shown effective with minimal side effects.

10. Specific Immunotherapy
 Allergen-Specific Immunotherapy:
 Recommended when skin testing identifies unavoidable allergen sensitivities.
 More effective for seasonal than perennial symptoms.
 Goal: Possible resolution of allergies and prevention of asthma development in
children.
 Management of Allergy-Related Eye Symptoms
 Eye Symptom Relief:
 Oral antihistamines alleviate eye-related symptoms and improve quality of life.
 Topical treatments and intranasal steroids can help reduce nasal and ocular
symptoms.

11. Asthma
 Asthma is a chronic inflammatory disorder of the airways, diagnosed
primarily based on three criteria: reversible airway obstruction, airway
inflammation, and heightened airway responsiveness to various stimuli

12. Key Points in Asthma Diagnosis and Management
 Reversible Airway Obstruction: Asthma typically involves a reversible
reduction in airflow, which improves with treatment or sometimes on its
own.
 Airway Inflammation and Responsiveness: The airways in asthma patients
are highly sensitive, reacting to triggers that would not affect non-asthmatic
individuals.
 Symptom Control: Identifying and avoiding allergens and irritants (e.g.,
pollen, dust mites, smoke, certain medications) are crucial to prevent
asthma attacks.
 Asthma Action Plan: Patients should have an action plan to recognize early
signs of an exacerbation and take appropriate steps to prevent worsening.

13. Differential Diagnosis
 Asthma can sometimes be mistaken for other conditions, with differential diagnoses varying
between age groups:
 Children: Conditions like allergic rhinitis, cystic fibrosis, and viral bronchiolitis should be
considered.
 Adults: COPD, congestive heart failure, and pulmonary embolism are among other conditions
that may mimic asthma
 Precipitating Factors
 Common triggers that may lead to asthma symptoms or exacerbations include:
 Environmental allergens: Dust mites, molds, animal dander, pollen.
 Environmental irritants: Tobacco smoke, air pollutants, strong odors.
 Other factors: GERD, respiratory infections, exercise, strong emotions, certain medications (e.g.,
NSAIDs, beta-blockers).

14. Diagnostic Testing
 Pulmonary Function Testing (PFT): Spirometry is the gold standard for asthma
diagnosis and includes:
 FEV1 (Forced Expiratory Volume in 1 second): Measures airway obstruction.
 FVC (Forced Vital Capacity): Total air exhaled in a forceful breath.
 Reversibility Testing: Improvement in FEV1 by 12% or 200 mL after a
bronchodilator indicates reversible obstruction, a hallmark of asthma.
 Peak Flow Monitoring: Helpful in self-management but not a diagnostic
tool. It provides insight into daily fluctuations and exacerbations.

15. Treatment and Classification
 Asthma is categorized into four classifications—intermittent, mild persistent,
moderate persistent, and severe persistent—based on symptom frequency
and spirometric values. Key treatment principles include:
 Stepwise Therapy: Adjusting medication levels based on symptom severity.
 Inhaled Corticosteroids (ICS): First-line treatment for persistent asthma, with
inhaled β2-agonists used for acute relief.
 Exacerbation Management: Short-acting β2-agonists and oral
corticosteroids are recommended for exacerbations. Nebulized ipratropium
can be used in emergency settings but not during hospitalization

17. Monitoring and Prevention
 Self-Monitoring: Patients with moderate to severe asthma or frequent
exacerbations should monitor their peak flow daily.
 Reducing Medication Reliance: Frequent need for short-acting β2-agonists
indicates poor asthma control and may necessitate higher maintenance
therapy.
 Education and Prevention: Teaching patients to manage their triggers,
recognize early symptoms, and respond quickly to changes in their
condition.

18. Anaphylaxis
 Definition:
 "Acute, systemic hypersensitivity reaction due to IgE-mediated degranulation of mast cells and basophils."
 Comparison: Immunologic vs. Non-immunologic reactions.
 Key Terms:
 Anaphylaxis, IgE-mediated, Mast Cells, Basophils
 Pathophysiology
 Immunologic Pathway:
 IgE triggers mast cells and basophils to release histamines and other mediators.
 Non-immunologic Pathway:
 Direct degranulation (e.g., reactions to radiocontrast media).
 Mediator Effects:
 Vasodilation, increased vascular permeability, smooth muscle contraction.

19. Classification
 Immunologic Anaphylaxis:
 IgE-mediated (e.g., food allergies).
 Non-IgE-mediated (e.g., blood transfusion reactions).
 Non-immunologic Anaphylaxis:
 Direct mast cell/basophil degranulation (e.g., RCM).
 Common Triggers of Anaphylaxis
 Foods:
 Shellfish (adults), peanuts (children), milk (infants).
 Medications:
 Antibiotics, NSAIDs, radiocontrast media.
 Other Triggers:
 Insect stings, exercise, idiopathic (no known cause).

20. Signs and Symptoms
 Cutaneous Symptoms:
 Urticaria (hives), angioedema.
 Systemic Symptoms:
 Respiratory: Shortness of breath, wheezing.
 Cardiovascular: Hypotension, shock.
 Gastrointestinal: Nausea, vomiting, diarrhea.
 Syncope:
 Rapid loss of consciousness due to hypotension.

21. Diagnostic Criteria
 Multi-system Involvement:
 Usually requires skin plus respiratory, cardiovascular, or GI symptoms.
 Single-System Diagnosis:
 Possible in high-risk exposures (e.g., urticaria within 30 minutes of known allergen).
 Importance of Rapid Diagnosis:
 Early epinephrine can prevent further progression.

22. Management Protocol
 Initial Response:
 Epinephrine administration is primary.
 Place patient in recumbent position with elevated legs.
 Epinephrine Administration:
 Adults: 0.2-0.5 mL of 1:1000 IM in lateral thigh.
 Children: 0.01 mg/kg, max 0.3 mg.
 Re-dosing:
 Every 5 minutes if necessary, or switch to IV infusion if unresponsive.

23. Additional Treatments
 After Epinephrine:
 Antihistamines (H1 and H2): Diphenhydramine, Ranitidine.
 Corticosteroids: Methylprednisolone for prolonged reactions.
 Fluid Resuscitation:
 IV normal saline for persistent hypotension.
 Observation and Follow-up
 Observation Time:
 6-24 hours depending on severity (risk of biphasic reactions).
 Patient Education:
 Prescribe epinephrine autoinjector.
 Training on autoinjector use and avoidance of known allergens.
 Medical alert bracelets recommended for at-risk individuals.

24. Key Takeaways
 Quick Action Saves Lives:
 Epinephrine is the first-line treatment and should not be delayed.
 Multi-faceted Approach:
 Epinephrine, positioning, oxygen, and IV fluids as primary treatments.
 Preventative Measures:
 Autoinjector prescription and training, allergy identification, and lifestyle
modifications.