Allergens May be I am allergic to flowers. Introduction Hypersensitivity (hypersensitivity reaction) refers to undesirable immune reactions produced.

Allergens

Allergens

May be I am allergic to flowers

1 IntroductionHypersensitivity(hypersensitivity reaction) refers to undesirable immune reactions produced by the normal immune system.

Allergies are hypersensitivities It is overreactions of the immune system to substances that do not cause reactions in most people.Allergen (Substances that often cause reactions)also called antigen that causes allergy.

Antibody TypesImmunoglobulin G (IgG)Immunoglobulin A (IgA)Immunoglobulin M (IgM)Immunoglobulin E (IgE)Immunoglobulin D (IgD)Antibodies (2 of 3)IgGSmaller antibodyPrincipal antibody molecule in response to majority of infectious agentsIgMLarge antibody, a macroglobulinVery efficient combining with fungiIgEFound in minute quantities in blood; concentration is increased in allergic individualsAntibodies (3 of 3)IgAProduced by antibody-forming cells located in the respiratory and gastrointestinal mucosaCombines with harmful ingested or inhaled antigens, forming antigen-antibody complexes that cannot be absorbed, preventing antigens from inducing sensitizationIgDFound on cell membrane of B lymphocytesPresent in minute quantities in bloodHypersensitivities are grouped into four types, I through IV. Based on what parts of the immune system are activated and how long it takes for a reaction to occur. Atopy is the inherited propensity to respond immunologically to such common naturally occurring allergens with continuous production of IgE antibodies.

Type I

IgE Mediated

Classic AllergyType II

IgG/IgM Mediated

rbc lysisType III

IgG Mediated

Immune complexDiseaseType IV

T cell

Delayed Type HypersensitivityGel and Coombs classification of hypersensitivities. BETHERE!7 Introduction two types of hypersensitivities commonly associated with allergies: Type 1 and type 4

type I (immediate hypersensitivities) in which antigens (allergens) combine with specific IgE (immunoglobulin E) antibodies to cause local and sometimes systemic reactions usually within minutes

IntroductionThe first time a predisposed person (FH) is exposed to a potential allergen, they will not have a major reaction; instead, they will create a specific IgE antibody and become sensitized.

The IgE antibody produced then attaches itself to mast cells, in the tissues, and basophils in the blood stream.

Allergen PrimaryIndividual Generation IgE Adhesion IgE binds to the FceRI on mast cell and basophil SecondaryAllergen binds to the IgE on primed target cellCrosslikage of FceRI Degranulate and release the biological mediatorsPreformed granule mediatorsNew generated mediatorsHistamine BradykininLeukotrienes PAF Prostaglandin D2Dilate capillaries,increase permeability, increase mucus secretion, contract smooth muscleSystemic anaphylaxisSkinRespiratory tractDegist tractMechanism of type I hypersensitivity Introductiontype IV (delayed hypersensitivities) reactions caused by the interactions of antigens with specific sensitized T lymphocytes instead of antibodies.

Type IV delayed hypersensitivity reactions are most often skin reactions. Common examples include reactions to metal and jewelry.

IntroductionThey occur when an antigen interacts with specific sensitized T lymphocytes. The lymphocytes release inflammatory and toxic substances, which attract other white blood cells to the exposure site, resulting in tissue injury.

Type IV hypersensitivity is usually a reaction (redness, swelling, hardening of the skin, rash, dermatitis) observed at the exposure site hours to days after exposure Types of AllergensTypes of AllergensThere are many different types of allergens that could trigger an allergicPollen AnimalsDust MitesFoods (Egg, Milk, Peanut, Shellfish, Soy, Tree nut, Wheat, Banana and strawberries)Insect StingsLatexMold

Allergens

Sulfonamide drugsPenicillins salicylate15Allergy symptoms depend on route of allergen entry

Dust or pollen are airborne particles. In these cases, symptoms arise in areas in contact with air, such as eyes, nose and lungs. For instance, allergic rhinitis, also known as hay fever, causes irritation of the nose, sneezing, and itching and redness of the eyes.Inhaled allergens can also lead to asthmatic symptoms, caused by narrowing of the airways (bronchoconstriction) and increased production of mucus in the lungs, shortness of breath (dyspnea), coughing and wheezing16Symptoms of food allergy include abdominal pain, bloating, vomiting, diarrhea, itchy skin, and swelling of the skin during hives. Food allergies rarely cause respiratory (asthmatic) reactions, or rhinitis.Substances that come into contact with the skin, such as latex, are also common causes of allergic reactions, known as contact dermatitis or eczema. Skin allergies frequently cause rashes, or swelling and inflammation within the skin.17Insect stings, antibiotics, and certain medicines produce a systemic allergic response that is also called anaphylaxis; multiple organ systems can be affected, including the digestive system, the respiratory system, and the circulatory system.

Depending of the rate of severity, it can cause cutaneous reactions, bronchoconstriction, edema, hypotension, coma, and even death. This type of reaction can be triggered suddenly, or the onset can be delayed. The severity of this type of allergic response often requires injections of epinephrine, sometimes through a device known as the EpiPen or Twinject auto-injector.

18Treatment of AllergyThe three most effective ways to treat allergies are 1- Avoidance2- Immunotherapy3- Medication.

1- Suggestions for avoiding (some) allergens:Remain indoors when the pollen count is high and on windy days. Dust-proof the home, particularly your child's bedroom. Eliminate, when possible, wall-to-wall carpet, Venetian blinds, and down-filled blankets or pillows. Wash bedding, curtains, and clothing often and in hot water to eliminate dust mites. Keep bedding in dust covers, when possible. Use air conditioning instead of opening the windows. Consider putting a dehumidifier in damp areas of the home, but remember to clean it often. Have your child wear a face mask if playing outside when the pollen count is high. Take vacations in areas where pollen is not as prevalent - such as the ocean. 2- Immunotherapy (allergy Shots)Immunotherapy is a type of treatment for allergic children with hay fever and/or asthma. It is also called desensitization, hyposensitization, and allergy shots. A mixture of the various pollens, mold spores, animal dander's, and dust mites to which the child is allergic is formulated. This mixture is called an allergy extract.

Immunotherapy is given by injection under the skin usually into the fatty tissue in the back of the arm.

Injections may be given weekly or twice a week until a maximum dose is tolerated. This is called the maintenance dose. It may take about one year to reach the maintenance dose. At this point, the frequency of injections may be decreased to every other week and finally to once a month. Side effects to immunotherapy There are two types of reactions to immunotherapy:Local: The local reaction is redness and swelling at the injection site. If this condition occurs repeatedly, then the extract strength or schedule is changed. Systemic reaction is one that involves a different site, not the injection site. The symptoms may include nasal congestion, sneezing, hives, swelling, wheezing, and low blood pressure. Such reactions can indeed be serious and life threatening. However, deaths related to immunotherapy are rare. If a systemic reaction occurs, your child may continue taking shots, but of a lower dosage.

Desensitization (immunotherapy,allergy shots) is sometimes recommended if the allergen cannot be avoided and not poten. It includes regular injections of the allergen( for 3 years), given in increasing doses that may acclimatize the body to the allergen. The shots cause the body to make a protective antibody ( IgG) can trigger anaphylaxis. Immunotherapy is not recommended for food allergens 3- Medication1- Mast cell stabilizer.2- Histamine receptor antagonists3- Leukotriene inhibitors4- CorticosteroidsDiagnosis

Blood testing This kind of testing measures a "total IgE levelSkin testing preferred over blood allergy tests because it is more sensitive and specific, simpler to use, and less expensive.also known as "puncture testing" and "prick testing" 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.If a serious life threatening anaphylactic reaction has brought a patient in for evaluation, some allergists will prefer an initial blood test prior to performing the skin prick test. Skin tests may not be an option if the patient has widespread skin disease or has taken antihistamines sometime the last several days.

25Food allergyThe common allergens are:peanuteggmilkfishcrustaceanssoygluten Wheat sesametree nuts walnuts, almonds, cashews, pistachios

Food allergy symptoms can include one or more of the following: Hives, rash, tingling of the mouth or throat, abdominal cramps, vomiting, diarrhea, swelling of the face or tongue, or difficulty breathing. People with the same food allergy may have different reactions.

Food allergies can be fatal26For your information27Peanut Allergies: Hidden IngredientsArachis oilGround nuts, ground peanutsImitation walnuts or almondsMixed nuts*Mixed nut buttersNut butters*Nut extracts*Nut flavorings*Peanuts

Peanut butterPeanut butter chipsPeanut extractPeanut flavoring*Peanut flourPeanut oilGround nut oilPeanut syrupSatay sauce** May contain peanuts28Tree Nut: Hidden IngredientsAlmondsBrazil nutsCashewsChestnutsFilberts/hazelnutsGianduja*Hickory nutsMacadamia nutsMarzipan/almond pasteNougatNu-Nuts artificial nuts

Nut butters (cashew butter)Nut milks (almond milk)Nut oilNut paste (almond paste)Pecans (Mashuga nuts)Pine nutsPistachiosPralinesPure almond or other nut extractWalnuts

* Gianduja is a creamy mixture of chocolate and chopped nuts found in premium or imported chocolate29Wheat Allergy Hidden IngredientsBleached all-purpose flourBranBread, bread crumbsBulgur wheat, Durum wheatCake and pastry flourCereal extracts, cereal binder, cereal filler, cereal proteinCracker mealCream of Wheat Malt-O-Meal CouscousDurumEnriched flour, bread flour (white or wheat)FarinaFlour, granary flour

GliadinGlutenGrain-based coffee substitutesGraham cracker, graham flourHydrolyzed proteinHydrolyzed vegetable proteinInstant soup stockModified food starchMSG (Monosodium glutamate)Pasta, noodlesPuddings, wheat thickenersSoy sauceSpelt, Triticale

30Wheat Allergy Hidden IngredientsVegetable starchVitamin E pills (some)Wheat flour and wheat branWheat germ, wheat starchWheat gluten, gluten flourWheat semolina, semolina flourWhite (grain) vinegar

PLEASE NOTE:Stabilizers, spices and emulsifiers can also indicate the presence of wheatSome alcoholic beverages (beer, whisky and gin) may cause allergic reactions in individuals with wheat allergies.

Oats, barley, rye, triticale, and spelt may also cause problems for people with gluten sensitivity.Buckwheat is an herb and does not contain gluten. www.gluten.net31Egg Allergy Hidden IngredientsAlbuminApovitellinBatterCholesterol-free eggsCustardDried eggEgg, egg glazesEggnogEgg noodlesEgg white solidsEgg yolks GlobulinLecithin (could be derived from soy)

LivetinLysozymeMarzipanMayonnaiseMeringueMouseOvalbuminOvamucoid/ovamucinOvovitellin/vitellinPowdered or liquid eggsPuddingQuicheSimplesseSouffle

32Milk Allergy: Hidden IngredientsBechamel sauceButter, butter solidsButter fatButter flavorButtermilkCaseinCaseinatesCheese (any kind)Cottage cheeseCreamCurdsCustardDried milk solidsEvaporated milkGheeHalf-and-halfHigh protein flourIce cream, ice milk

Lactate solidsLactoglobulin, lactalbuminLactoseMalted milkMargarineMilk (any kind, except soy)Milk proteinMilk solidsNon-fat dry milkNougatPuddingRennetSodium caseinSour or whipping creamWheyYogurt (any kind, except soy)

33Soy Allergy: Hidden IngredientsEdamame soy beanHydrolyzed soy proteinLecithinMisoModified food starchNattoShoyu sauceSoy albuminSoy beans (curds, granules)Soy concentrateSoy cheeseSoy flourSoy gritsSoy meat, soy meal

Soy milk, soy ice creamSoy nutsSoy oilSoy protein concentrateSoy protein isolateSoy sauceSoy sproutsSoy yogurtTamariTempehTextured soy protein (TSP)Textured vegetable protein (TVP)Tofu

34Soy Allergy: Hidden IngredientsThe following are label ingredients that may contain the presence of soy protein:

Hydrolyzed plant proteinHydrolyzed vegetable proteinNatural flavoring

Many gluten free products contain soy. Check the label.

Vegetable brothVegetable gumVegetable starch35Fish/Shellfish Allergy: Hidden IngredientsAlboneClams (cherrystone, littleneck, pismo, quahog)Cockle (periwinkle, sea urchin)CrabCrawfish (crayfish, ecrevisse)Fish oil capsulesFish broth or stockLobster (langouste, langoustine, coral, tomalley)Mollusks

Parvalbumin is the protein infish that is known to provokeallergic reactions.MusselsWorcestershire sauce (may contain anchovies)OctopusOystersPrawnsScallopsScampiShrimpSnailSquid (calamari)Sushi

36Fish/Shellfish Allergy: Hidden IngredientsThe following ingredients may indicate the presence of shellfish protein:BouillabaisseFish stockSeafood flavoring (crab or clam extract)Surimi37Corn Allergy: Hidden IngredientsBaking powder*CerealsConfectioners (powdered) sugarCorn ANYTHING!Dextrin or maltodextrinDextrose, glucose, or fructoseGolden syrup (treacle)Glucona delta lactoneHigh-fructose corn syrupHominy, gritsInvert sugar, invert syrupMalt, malt syrup, malt extractModified food starch (may be corn)

Mono- and diglyceridesMonosodium glutamate (MSG)PolentaSorbitolStarch, food starchSucrose (may derive from corn)Vanilla extractVegetable oil (may be corn)Xanthan gumZein (protein from corn, sometimes used in time-released medications)

*Do not confuse with baking soda. Baking powder contains a mixture of leavening agents and a moisture-absorber such as cornstarch.Substitutions for Corn Featherweight Baking Powder or Arrowroot38Latex AllergiesBanana Avocado Chestnut Hazel Nut Kiwi Melons Passion FruitFigTomatoCarrot Celery Papaya PotatoPineappleMangoPeachProteins found in these items have a similar chemical composition to latex and a reaction may occur from consuming these foods: 39Substitutions for Wheat ProductsRice flourTapioca flourCornstarchPotato Starch FlourSoy bean flourArrowrootCornmealCorn flour

Gluten Free Mix6 cups of rice flour, 2 cups of potato starch flour, 1 cup of tapioca flour. Combine, store in a cool, dry place for use as needed. Makes 9 cups.

40Milk SubstitutionsBaked goods containing soy, rice or almond milksCornstarch puddings made with fruit juiceFrozen tofu dessertsMilk-free margarine (parve), salad dressings (almond milk)Milk-free sherbets, ices and sorbets (Alpine Ice)Milk-free or soy milk shakesNut, soy or rice milksSoy cheese and soy yogurtSome non-dairy creamers

41Egg SubstitutionsFor each egg, try one of the following:

1 packet of plain gelatin mixed with 2 tbsp warm water. Mix into other ingredients immediately before it thickens.1 tsp. baking powder, 2 tbsp. Vinegar1 tsp. yeast dissolved in cup warm water1 tbsp. apricot puree1 tbsp. water, 1 tbsp. cooking oil, & 1 tsp. baking powderEgg Replacer, such as Ener-G 1/2 tbsp. powder and 2 tbsp. water

42