This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
AllergyAllergy
Hippokrates (460 – 370 BC) – asthma, eczemaHippokrates (460 – 370 BC) – asthma, eczema Botallo (1565) – pollen allergyBotallo (1565) – pollen allergy Pirquet (1910) – Pirquet (1910) – „„allergy“allergy“ Coca a Cooke (1923) – „Coca a Cooke (1923) – „atopy“atopy“ (heredity) (heredity) Coombs a Gell (1963) – 4 types of Coombs a Gell (1963) – 4 types of
hypersensitivity reactions hypersensitivity reactions Dr Dr Kimishige "Kimi" IshizakaKimishige "Kimi" Ishizaka
discovered the antibody class discovered the antibody class IgEIgE in 1966 in 1966
Treg in allergy
flow cytometry CD4+CD25+CD127- population of lymphocytes
AtopyAtopy
famillial history of allergy disease famillial history of allergy disease
production of IgE antibodies againstproduction of IgE antibodies against
inhalant and some food allergensinhalant and some food allergens
influence of heredity and influence of heredity and environmentenvironment
sensitizationsensitization
Allergens Allergens Allergen:Allergen: A substance that is foreign A substance that is foreign
to the body and can cause an to the body and can cause an allergic reaction (type I reacion) in (type I reacion) in certain people. certain people.
isolation and analysis of structureisolation and analysis of structure recombinant synthesisrecombinant synthesis specispecialal nomen nomenclature: first 3 letters genus, next clature: first 3 letters genus, next
letter species druh a number menas sequence of letter species druh a number menas sequence of isolation isolation
E.g. E.g. Betula verrucosa (birch) Bet v1, Bet v2...Betula verrucosa (birch) Bet v1, Bet v2... Artemisia vulgaris (mugwort) Art v1, Art v2 a Artemisia vulgaris (mugwort) Art v1, Art v2 a
cross-reactivity cross-reactivity - IgE for one allergen - IgE for one allergen recognise similar allergen of the another recognise similar allergen of the another originorigin
identity of sequences identity of sequences >>70 %70 % co-recognition –co-recognition – recognition of higher recognition of higher
amount of epitopes, is not possible to amount of epitopes, is not possible to realise the primary sensitiser realise the primary sensitiser
3-D structure of 3-D structure of cross reactive cross reactive
Diagnosis in allergy diseases Diagnosis in allergy diseases
history – familial occurrencehistory – familial occurrence triggers according to environment and seasontriggers according to environment and season clinical evaluationclinical evaluation
identification of responsible allergenidentification of responsible allergen for allergic rhinoconjunctivitis, bronchial for allergic rhinoconjunctivitis, bronchial
asthma, insect venom allergy, latexasthma, insect venom allergy, latex s.l., s.c. for 3 - 5 yearss.l., s.c. for 3 - 5 years induction of Treg induction of Treg CD4+CD25+127-CD4+CD25+127-
FOXP3(forkhead box FOXP3(forkhead box p3)p3)
antiinflammatory cytokines antiinflammatory cytokines TGFTGFββ a IL-10 a IL-10
Balance between Treg and Th2 reacitvity is diferent in sensitised Balance between Treg and Th2 reacitvity is diferent in sensitised and healthy and healthy
TTrreg eg produce suppressor factors - produce suppressor factors - IL-10 a TGF- IL-10 a TGF- ββAkdis M, 2006Akdis M, 2006
Atopic dermatitisAtopic dermatitis
Prevalence in Europe 10%Prevalence in Europe 10% Unknown etiology and pathogenesis Unknown etiology and pathogenesis
usually worst in childhood: usually worst in childhood:
80% improoving with age80% improoving with age
but 20-50% developing of asthma but 20-50% developing of asthma
skin barrier disorderskin barrier disorder: mutation of : mutation of gen for fillagrin (aggregation of gen for fillagrin (aggregation of filaments of keratinocytes), disorder filaments of keratinocytes), disorder of keratinization of keratinization
loss of water and penetration of loss of water and penetration of allergens into the skinallergens into the skin
starting of sensitization, atopic starting of sensitization, atopic march? march?
Localisation of singns in Localisation of singns in atopic deramtitis in atopic deramtitis in
differnt agediffernt age
SCORADSCORADindexindex
SSeverity everity ScoScoring of ring of AAtopic topic DDermatitisermatitis
AA Extent criteriaExtent criteria BB Intensity criteriaIntensity criteria CC Subjective symptomsSubjective symptoms
SCORAD index :SCORAD index : AA/5 + 7x/5 + 7xBB/2 + /2 + C C ==
The The rule of 9 before the age of 2 : cervical : cervical preponderance preponderance
The The rule of 9 in adults and older children Grading in practice :Grading in practice :
It is advisable to draw lesion spread directly on the It is advisable to draw lesion spread directly on the evaluation sheet and then perform the calculation. evaluation sheet and then perform the calculation.
Subjective symptomsSubjective symptomsThe two most representative items concerning the quality The two most representative items concerning the quality of life of patients are : Pruritus of life of patients are : Pruritus and and Insomnia Insomnia
infection in early childhood – infection in early childhood – wheezing wheezing
Pathologic changes in asthmaPathologic changes in asthmaInfalmmatory cells in bronchial mucosaInfalmmatory cells in bronchial mucosa eosinophils: MBP, ECP, EDN, EPOeosinophils: MBP, ECP, EDN, EPO mast cells: IgE, histamine, LTmast cells: IgE, histamine, LT neutrophils?neutrophils? lymphyocytes cytokines secretion lymphyocytes cytokines secretion Remodelling of bronchial wallRemodelling of bronchial wallepithelium desquamation epithelium desquamation thickeness of basal membrane thickeness of basal membrane hypertrophy of smooth muscleshypertrophy of smooth muscleshyperplasia of mucus glandshyperplasia of mucus glands
Diagnosis of BADiagnosis of BA
historyhistory examination – wheezing , cough examination – wheezing , cough spirometry spirometry challenge tests with metacholinchallenge tests with metacholin PEF monitoring PEF monitoring eNO in exhaled aireNO in exhaled air ECP in the serum ECP in the serum Bronchoscopy: lavage, biopsyBronchoscopy: lavage, biopsy
methotrexatemethotrexate)) anti IgE monoclonal antibody anti IgE monoclonal antibody
omalizumab omalizumab
case report 1case report 1 girl, 10 years oldgirl, 10 years old history: atopic dermatitis history: atopic dermatitis
in early childhood in early childhood
running nose, sneezing, running nose, sneezing, itching of eyesitching of eyes
breathlessnessbreathlessness with with wheezingwheezing also during also during nigths nigths
in the last 5 years, in in the last 5 years, in MMarch and arch and AprilApril
What diagnostic test are What diagnostic test are useful? useful?
What therapy would you What therapy would you recommend? recommend?
allergensallergens
Case report 2Case report 2
Man 45 years old Man 45 years old From 15 years BA, From 15 years BA,
few times at few times at intensive care unit intensive care unit with intubation with intubation and mechanical and mechanical ventilation ventilation
Diagnostic test and Diagnostic test and therapy plann? therapy plann?