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MANAGEMENT OF

IMMUNOLOGICAL AND ALLERGIC

DISORDERS

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OVERVIEW

• Diagnosis 

 –  Skin testing  

 –  Blood testing  

• Treatment  –  Pharmacotherapy  

 –  Immunotherapy  

 –  Unproven and ineffective treatments • Epidemiology  

• Medical specialty  

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Diagnosis 

• Before a diagnosis of allergic disease can be confirmed,the other possible causes of the presenting symptomsshould be carefully considered.

•  Vasomotor rhinitis, for example, is one of many maladies that shares symptoms with allergic rhinitis,underscoring the need for professional differentialdiagnosis.

• Once a diagnosis of asthma, rhinitis, anaphylaxis, orother allergic disease has been made, there are severalmethods for discovering the causative agent of thatallergy. 

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Diagnosis cont.

Skin testing • For assessing the presence of allergen-specific

IgE antibodies, allergy skin testing is preferred

over blood allergy tests because it is moresensitive and specific, simpler to use, and lessexpensive.

• Skin testing  is also known as "prick testing“;

series of pricks are made into the patient's skin.Small amounts of suspected allergen areintroduced to sites on the skin and let it cause anallergic response itself). 

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Diagnosis cont.

• Sometimes, the allergens are injected"intradermally" into the patient's skin, with aneedle and syringe. Common areas for testing include the inside forearm and the back.

• If the patient is allergic to the substance, then a visible inflammatory reaction will usually occur within 30 minutes.

•  This response will range from slight reddening 

of the skin to a full-blown hive (called "whealand flare") in more sensitive patients. 

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Diagnosis cont.

• Interpretation of the results of the skin prick testis normally done by allergists on a scale of severity, with +/- meaning borderline reactivity,

and 4+ being a large reaction.• Increasingly, allergists are measuring and

recording the diameter of the wheal and flarereaction.

• Interpretation by well-trained allergists is oftenguided by relevant literature. 

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Diagnosis cont.

• Some patients may believe they have determinedtheir own allergic sensitivity from observation,but a skin test has been shown to be muchbetter than patient observation to detect allergy.

• If a serious life threatening anaphylactic reactionhas brought a patient in for evaluation, someallergists will prefer an initial blood test prior toperforming the skin prick test.

• Skin tests may not be an option if the patienthas widespread skin disease or has takenantihistamines sometime the last several days.

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Diagnosis cont.

• Blood testing

•  Various blood allergy testing methods are alsoavailable for detecting allergy to specificsubstances.

•  This kind of testing measures a "total IgE level"- an estimate of IgE contained within thepatient's serum.

•  This can be determined through the use

immunoassays.• Fluoro immunoassays has a sensitivity of about

70.8% and a positive predictive value of 72.6%.

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Diagnosis cont.

•  A low total IgE level is not adequate to rule outsensitization to commonly inhaled allergens.

•  Statistical methods have shown that patients with a high total IgE have a high probability of allergic sensitization, but further investigation with specific allergy tests for a carefully chosen

allergens is often warranted. 

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Prevention

•  There have been enormous improvements in themedical treatments used to treat allergicconditions.

• Development anti-IL-5 for eosinophilicdiseases.

• Prediction & avoidance of allergens.

• Development of low-allergen foods,

• However it is difficult to achieve avoidance forthose with pollen or similar air-borne allergies.

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 TREATMENT

• Pharmacotherapy

• Several antagonistic drugs are used to block the action of allergic mediators,or to prevent activation of mast cells and degranulation processes.

•  These include antihistamines, cortisone, dexamethasone, hydrocortisone,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, but play little role in chronic treatment of allergic disorders. 

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 TREATMENT

• Immunotherapy• Desensitization or hyposensitization is a

treatment in which the patient is gradually  vaccinated with progressively larger doses of theallergen in question.

•  This can either reduce the severity or eliminatehypersensitivity altogether.

• It relies on the progressive skewing of IgG antibody production, to block excessive IgEproduction seen in atopy.

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 TREATMENT CONT.

•  A second form of immunotherapy involves theintravenous injection of monoclonal anti-IgEantibodies.

•  These bind to free and B-cell associated IgE;signalling their destruction. They do not bind toIgE already bound to the Fc receptor on

basophils and mast cells, as this would stimulatethe allergic inflammatory response.

•  The first agent of this class is Omalizumab.

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 TREATMENT CONT.

•  A third type, Sublingual immunotherapy , is anorally-administered therapy which takesadvantage of oral immune tolerance to non-

pathogenic antigens such as foods and residentbacteria. This therapy currently accounts for 40percent of allergy treatment in Europe.

• In the United States, sublingual immunotherapy is gaining support among traditional allergistsand is endorsed by doctors who treat allergy.

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 TREATMENT CONT.• Unproven and ineffective treatments

• In alternative medicine, a number of allergy treatments are described by its practitioners,particularly naturopathic, herbal medicine,

homeopathy , traditional Chinese medicine andapplied kinesiology .• Systematic literature searches conducted by the

Mayo Clinic through 2006, involving hundreds

of articles studying multiple conditions,including asthma and upper respiratory tractinfection showed no effectiveness of homeopathic treatments, and no difference

compared with placebo.

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THE END 

THANX FOR 

 ATTENTION