Allergy
cause of allergy Food allergens Non-food protein allergens Toxins interacting with proteins Genetic basis Allergens in the air Insect bits
food allergens One of the most food allergens is against nuts Paenuts, Tree nuts, including pecans, pistachios,
pine nuts, and walnuts They are contain oils where protein is present,
which may elicit an allergic reaction Egg allergies affect about one in fifty children Lactose intolerance Other foods containing allergenic proteins include
soy, wheat, fish, shellfish, fruits, vegetables, spices, synthetic and natural colors, chicken and chemical additives.
non-food protein allergens
Latex can trigger a body, brathing or systemic allergy(less then 1%)
Latex and banana sensitivity may cross-react; furthermore, patients with latex allergy may also have sensitivities to avocado, kiwi and chestnut
toxins interacting with proteins
Another non-food protein reactionare urushiol-induced contact dermatitis, originates after contact with poison ivy, eastern poison oak, western
poison oak or poison sumac. on the percent of the population that will have an
immune system response. Approximately 25 percent of the population will
have a strong allergic response. 80 percent to 90 percent of adults will develop an
allergy
genetic basis identical twins are likely to have the same allergic
diseases about 70% non identical twins are likely to have the same
allergic diseases about 40% Allergic parents are more likely to have allergic
children
allergens in the air
Grass Pollen of the flowers and the trees
insect bits
With people with bees or wasp's poison allergy it comes to additional reactions.
These can be:
nettle rash-like skin rash,
Swells in the face and in the neck,
Breathlessness,
Circulatory failure.
a insect bit
common symptoms of allergy
Nose: swelling of the nasal mucosa (allergic rhinitis)
Eyes: redness and itching of the conjunctiva Sinuses: allergic sinusitis Airways: Sneezing, coughing, bronchoconstriction,
attacks of asthma Ears: feeling of fullness, possibly pain, and
impaired hearing Skin and body: laryngeal edema,eczema
allergic eczema
diagnosis
skin testing blood testing challenge testing
skin test Skin tests: Skin testing is also known as "puncture testing" and
"prick testing" In the forearm or in the back due to the series of tiny puncture or pricks made into
the patient's skin Small amounts of suspected allergens and/or their
extracts (pollen, grass, mite proteins, peanut extract, etc.) are introduced to sites on the skin marked with pen or dye
Is the patient allergic to the substance, then a visible inflammatory reaction will usually occur within 30 minutes
The reaction is like a insect bit
skin test
blood testing
Number of antibodies in the body A low number of antibodies= high risk to
become an allergy
blood testing
challenge testing
small amounts of a suspected allergen are introduced to the body orally
through inhalation or other routes
inhalation
treatment/therapy
Pharmacotherapy Immunotherapy Unproven and ineffective treatments
pharmacotherapy
Several antagonistic drugs are used to block the action of allergic mediators or to prevent activation of cells and degranulation processes
include antihistamines, glucocorticoids, epinephrine (adrenaline), theophylline and cromolyn sodium. Anti-leukotrienes, such as Montelukast (Singulair) or Zafirlukast (Accolate),
Anti-cholinergics, decongestants, mast cell stabilizers, and other compounds thought to impair eosinophil chemotaxis, are also commonly used.
These drugs help to alleviate the symptoms of allergy, and are imperative in the recovery of acute anaphylaxis
immunotherapy
Long term treatment Desensitization or hyposensitization treatment in which the patient is gradually vaccinated with
progressively larger doses of the allergen in question This can either reduce the severity or eliminate
hypersensitivity altogether A second form is to involves the intravenous injection of
monoclonal antibodies ->e.g food allergens Sublingual immunotherapy an orally-administered therapy which takes advantage
of oral immune tolerance to non-pathogenic antigens such as foods and resident bacteria.
This therapy currently accounts for 40 percent of allergy treatment in Europe.
unproven and ineffective treatments
In alternative medicine, a number of allergy treatments are:
practitioners,
particularly naturopathic,
herbal medicine,
homeopathy,
traditional Chinese medicine
kinesiology
epidemiology statistics in the USA allergic rhinitis->35.9 million (about 11% of the
population Asthma-> 9% of the population food allergies-> 1.1% of the population insect venoms-> Around 15% of adults have mild,
localized allergic reactions. systemic reactions occur in 3% of adults and less
than 1% of children
history The concept of "allergy" was originally introduced
in 1906 by the Viennese pediatrician Clemens von Pirquet
In 1963, a new classification scheme was designed by Philip Gell and Robin Coombs
that described four types of hypersensitivity reactions, known as Type I to Type IV hypersensitivity
type 1 The reaction occurs in the second contact within seconds
till few minutes. Antigens are in the pathological allergy case free / relaxed molecules which are evaluated by the immune system erroneously as menacing or foreign to body
The reaction can fall out from relatively mildly up to life-menacing.
Typical clinical pictures of the immediate type reaction are the allergic conjunctivitis (conjunctivitis), allergic coryza (hay fever), allergic asthma, nettle rash (Urticaria), larynx cutaneous dropsy, serious to life-menacing forms, how the angioneurotische
cutaneous dropsy (angioedema) , the serum accident
type 2 Type II: Cell-engaged antigens, Antikörper-mediierter, zytotoxischer type Type IIa With hypersensitivity reactions of the type IIa are antibody against bodycelll-
engaged antigens (autoantibody).. Typical ilnesses are: Drug-induced deficiency of coagulation panel (Thrombopenie) Drug-induced deficiency of erythrocyte (hämolytische anaemia) The Goodpasture syndrome with which autoantibodies are formed against
collagen IV in the lung and the kidneys Type II b Stimulatorische immune response / reaction with hormone receptors Type II interaction like with type IIa, leads, however, the connection not to the
cell destruction, but about receptor connection to the activation of specific cell functions. The antibodies work as hochaffine neurotransmitters
Typical examples are the morbus Basedow with which autoantibodies are formed against the TSH
receptor the chronic Urtikaria with which autoantibodies are formed against the IgE
receptor.
Type II b Stimulatorische immune response / reaction with hormone receptors
Type II interaction like with type IIa, leads, however, the connection not to the cell destruction, but about receptor connection to the activation of specific cell functions. The antibodies work as hochaffine neurotransmitters
Typical examples are the morbus Basedow with which autoantibodies are
formed against the TSH receptor the chronic Urtikaria with which autoantibodies are
formed against the IgE receptor.
type 3 Type III: Immune complex Typ/Arthus type dependent on
antibody Type III-hypersensitivity reactions are marked by antibody
education against dissolvable antigens. The formed immune complexes can deposit, on the one hand, in
the blood capillaries (e.g., in the kidney) and thus lead to damages, activate on the other hand, however, also complement what leads to inflammation reactions.
Typical illnesses are:
blood serum disease,
exogenic-allergic Alveolitiden (for example, the occupational diseases farmer's lung, bird's holder's lung, cheese trader's lung and baker's lung
type 4 type IV: late type / delayed type / cell-mediierter type / tuberculin type
independent of type / antibody type IV :Hypersensitivity reactions are brought on by the activation of t
cells specific for allergen. Three subtypes are distinguished. With a positive reaction are found beside erythema and infiltration also Papeln and vesicle. The test reactions (erythema, vesicle, Papeln) can also appear after the test area.
type IVa1 Activation of TH1 cells, the reaction is directed against dissolvable antigens
and leads to the activation of macrophages. Examples for this are the nickel-contact dermatitis and the tuberculin test in what with the latter the tuberculin causes a reaction with sensitised t lymphocytes with the bringing in in the skin which were formed in a possible contact with tuberculosis causes.
type IVa2 Activation of TH2 cells. The reaction is directed against dissolvable
antigens and leads to the activation of eosinocytes. Typical illnesses are an allergic asthma and the atopische dermatitis.
type IVb Activation of zytotoxischen lymphocytes, reaction is directed against
cell-engaged antigens, Lyse of the affected cells.
Typical diseases are:
Contact dermatitis Stevens Johnson syndrome chronic asthma chronic allergic coryza
drugs against allergies Symptomatic therapy The most allergies are treated with drugs which reduce the occurrence of allergic
symptoms or prevent, but can cause no healing of the allergic illness. These Antiallergika are applied according to disease form and gravity of the illness in
different forms (tablets, nasal sprays, asthma sprays, eye drops, creams, ointments and injections) and in different intervals (with acute need, prophylactically, permanently).
Used agents are: Antihistaminika, e.g. Loratadin Mastzellstabilisatoren, e.g. Cromoglicinsäure
Leukotrienrezeptor-Antagonisten by asthma, e.g. Montelukast Theophyllin by asthma Severe acute cases (how angioedema, serum accident) are life-menacing and require
medical emergency measures. Adrenalin, plasmaexpander and cortisone are used.
An adrenalin syringe (EpiPen ®) which they should carry for emergency case always on themselves can be prescribed for the patient with which is known that they run the risk to suffer an anaphylaktic shock (e.g. with insect allergies).
Quellen
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