allergy. allergies in the past in 4 b.c. the greek physician hippocrates (460bc-370 bc) noticed that...
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Allergy
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Allergies in the past
• In 4 b.c. the Greek physician• Hippocrates (460BC-370 BC)• noticed that particular foods,• although harmless for some• people, cause disease in
others.
• Galen (AD 131-201) also wrote
• about allergic reactions to some
• plants, but he proposed no• explanation that
phenomenon.
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Anaphylaxis
1902 г. Charles Richet, together with Paul Portier - Anaphylaxis 1913 г. Charles Richet received a Nobel prize for his contribution in the field of anaphylacticreactions
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Allergy
1906 Clemens Peter von Pirquet and Bela Schick – allergy (gr. Allos – other и ergon –reaction) Pirquet reaction – skin tuberculinscarification test, upon which Mantoux in1907 introduced a test for diagnosis oftuberculosis.
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Definition
Pirquet, 1906 – Allergy is altered reactivityto a distinct antigen (allergen). Gell & Coombs, 1968 – Hypersensitivitydue to which immunilogically induced tissue
destruction develops
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Reactivity
• Species (primary, genetically coded)• Group (population)• Gender• Age• Individual Non-specific• Specific • Physiologic• Pathologic
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Types of reactivity
• Normergic (normergia)• Hypergic (hypergia)• Hyperergic (hyperergia)• Anergic (anergia)• Positive (effective defense mechanisms) Negative (undeveloped or “exhausted”
defense mechanisms
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Modulating factors
External (environmental)• Physical, chemical, biological• Society Constitutional (internal)• Gender• Age• Type of neural system• Profile of autonomic nervous system• Endocrine status
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Resistance
• Natural (unreceptiveness)• Acquired (in postnatal period)• Artificially• Active (vaccinations)• Passive (serotherapy, blood transfusion)• Naturally• Active (disease)• Passive (AB through placenta• or mother’s milk
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Immunologic resistance
• Complex mechanism of defensive and• adaptive reactions• Highly specific response• Aimed against• external (bacteria, viruses, etc.) and• internal (functionally inefficient and• mutated cells) factors.
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Immune response - phases
• 1. Processing and presenting of the antigen• 2. Recognition of the complex МНС *- antigen
with• activation of ТН lymphocyte• 3. Activation of В-cells and/or Т-cytotoxic• lymphocytes• 4. Elimination of the antigen
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Immune response - mechanism
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Stimulation of TH lymphocyte
Co-stimulatorysignal
Mainsignal
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Immunological memory
Primary Immune Response Secondary Immune Response
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General characteristics
• Allergic reactions are typical only forhomeothermic animals and men• Allergies are usually preceded bysensibilization and underlying geneticpredispositionя• Allergies are immunologically mediateddiseases
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Allergens and routes ofadministration
• Pollens• House dust mites• Goose down, wool, furs• Foods• Animal products• Cosmetics, dyes,
plastics• Medicines
• Inhalant allergens
• Ingestant allergens
• Contactant allergens• Injected allergens
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Hypersensitivity - types
• Humoral type• Anaphylaxis• Cytotoxic reactions• Immune complexes• Cell-mediated type• Mixed
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Type I – cytotropic type• Explosive response - within minutes of contact• with the allergen• Mediated mainly by IgE• Mediators of anaphylaxis• Preformed• Histamine• Serotonin• Newly created• Metabolites of arachidonic acid• Cytokines• Atopic diseases – bronchial asthma, allergic• rhinitis, urticaria etc.
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Type I – mechanism•• Immunologic• phase
• Pathobiochemical• phase
• Clinical phase
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Signs and symptoms in a patient withacute asthma attack
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Type II – Cytotoxic AntibodyReaction
• Mediated by IgG and IgM to specific antigens• • Endogenous or exogenous (haptens) allergens• Examples• • Transfusion Reaction• • Rhesus Incompatibility (Rh Incompatibility)• • Mycoplasma pneumoniae related cold
agglutinins• • Hashimoto' Thyroiditis• • Good pasture's Syndrome• • Delayed transplant graft rejection
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Type II – mechanism
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Type III: Immune Complex Reaction
• • Antigen-antibody complexes deposit in tissue• • Reaction within 1-3 weeks after exposure• Examples• – Systemic Lupus Erythematosus• – Erythema Nodosum• – Polyarteritis nodosa• – Arthus Reaction (e.g. Farmer's Lung)• – Rheumatoid Arthritis• – Elephantiasis (Wuchereria bancrofti reaction)• – Jarisch-Herxheimer Reaction• – Serum Sickness
• Localized or generalized vasculitis
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Type III – mechanism
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Type IV: Delayed-Type Hypersensitivity
• Mediated by T-Lymphocytes to• specific antigens• – Involves major histocompatibility complex• (MHC)• – Reaction within 2-7 days after exposure• • Examples• – Mantoux Test (PPD)• – Allergic Contact Dermatitis (e.g. Nickel• allergy)
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Type IV – mechanism
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Contact allergies
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Diagnostic tests I
• Skin prick test: drop of the allergen is placed on the skin and a small quantity is introduced into the skin.
• Intradermal test: allergen is injected
intradermally
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Skin prick testing
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Antiallergic therapy
Allergen avoidance Immunotherapy Specific hyposensibilization Drug therapy Antihistamines, ʙ2 mimetics,Corticosteroids, Adrenaline