Diagnosis in allergy diseasess Jacek Gocki Allergy diseasess

Diagnosis in allergy diseasess Jacek Gocki

Allergy diseasess �Asthma �Allergic Rhinitis �Eyes Allergic diaseasess �Urticaria and oedema Quincke �Athoipic dermatitis �Contact dermatitis �Food allergy �Drug alllergy �Venom allergy �Anaphylaxis and Anaphylaxic shock

Syptoms �Sujective symptoms �Breathlessness �Wheezing �Cough �Runny nose �Itching �Objective symptoms �Rash �Urticaria �Oedema �Eczema

Breathlessness � Subjective feeling no air in chest, usually connected with difficulty of taking the air to lung (in this case it is objective symptom) � Appear in: � Pneumonia � Heart failure and lung oedena � Heart ichemic diseasess and ischemic stroke � Lung emoblisation � Arrhythmia � Asthma � COPD

Breathlessness in allergy diseasess � Appear in Asthma, in anaphylactic reactions and in anphylactic shock � Breathlessness in asthma: � Paroxysmal – usually in early morning, wake up patient � Usually connected with cough after contact with allergen, infection or sudden exercise and strong emotions (scare) � Long phase of exhale, short inhale � Patient breathing by closed mouth � Could be persistent in advanced asthma � Usually abated after brochodilatator (betamimetic)

Wheezing �Abnormal high or low pithed sound. �Result of narrowing of the airways, such as result of brochospasm or increased secretion of sputum) �Two kinds: �Inhaled – congestion of upper respiratory tract outside chest (tracheitis, laryngitis, tumor or foreign body �Exhaled– congestion of low respiratory tract inside chest (Asthma, COPD, lung embolisation, heart failure, [lung oedema– early phase!!!])

Cough � Most common symptom of respiratory diseasess � Defense reflex to clean of respiratory trakt (sputum, dust, foreign body) � Mechanism: Glottis being kept closed until a high expiratory pressure has built up, and suddenly relased � Separated 10 couching a day is physiologic. . � Cogh could be involuntary and voluntary � Cough : � Acute – to 3 weeks (infestion, alergy, lung embolisation, lung oedem, foreign body, irritand dust and gases) � Subacute : 3 -8 weeks – viral infection � Persistent: 8 and more weeks (astrma, COPD, lung embolisation, cancer, tuberculosis)

Cough � Charakter: � Dry (non-productive) � � ACEI Viral infection Asthma Heart failure � Mist (produktive) � � � Sinusitis, bronchial inflamation Pneumonia COPD Asthma (sometimed) Mukowiscydozis Cancer (sometimes with blood)

Runny nose - Rhinitis � Abnormal secretion of nasal mucosa � Character: � Like a water – alergic � mucus – alergic � Purulent – infektion � Often connected with nasal congestion and sneezing (sometimes several times) � Sometimes with nasal bleeding, cough, hoarseness � Allergy Rhinitis: � Like a water or mucus � Connected with sneezing itching nose and nasal congestion � Sometimes with hoarsensess, cogh

Types of Immunological reaction �Immediate �Cytotoxic �Immunological complexes �Celular

Allergic reaction –Ig. E mediated

Urticaria �Wheal �Rednes �Itching

Oedema Quincke

Eczema �Papules �Rednes �Pustule �Itching

Skin tests �Basic tests in diagnosis of allergology �Two kinds : �PRICK �Intracutaneus �Based on Ig. E madiated reaction �Confirm presence of Ig. E specyfic antybody against allergen and Ig. E madiated reaction in skin after contact with specific allergen �Specyfic Ig. E connected with mastocyt react with allergen, and then mastocyt relase histamine caused vasodilatation

Skin PRICK test �Made by using standarised solutions of allergens �On the skin of forearm put a drop of : �Positive control (histamine solution) �Negative control (solution) �Alergen solution �Then we prick a skin by the drop using lancet �After 20 minutes read test �Positive reaction – minimum 3 mm wheal �Wheal in positive control must be minimum 3 mm �Sometimes accompanied rednes and itching

Skin PRICK test �Recomendation � Suspect allergy �Forbids � Antyhistaminic drugs – false negative results � Dermografism – false positive results � Pregnant – zagrożenie dla płodu w przypadku wystąpienia powikłań �Complications/side effects � Anaphylaxis (0, 02 -0, 04%) �Before testing: � Stop taking Antyhistaminics 3 -10 days, Imipramin and fenotiazyn � Stop taking glikokortykosteroids on skin on tested skin

Skin PRICK test � Standard kit of common allergens in Poland: � Dermatophagoides pteronyssinus � Drematophagoides farinae � Cat � Dog � Hazel � Alder � Birch � Grases and cereals � Ragweed � Cladosporium herbarum � Alternaria tenuis � Positive skin pric test not related with clinical symptoms is only positive test

Patch test � Basic tests in contact allergy � Based on celular reaction between allergen and B limphocytes � Tested allergens are puting (oitment) on 1 cm² paper, next all are puting on skin of the back and leave by oclusion for 48 h. � After 48 h remove and read results � Next reading after 24 h (72 h) and sometimes after next 24 h (96 h)

Patch tests � Recomendation � Suspected contact allergy � Forbids � Exposition for a sun – fase negative results � Using glikokortykosteroids – false negative results – stop taking min for 2 weeks before testing � Dermatitis - false positive results � Compications/side effects � Angry back syndrom � Allergy development � Acceleration of dermatitis

Patch tests � Basic kit of allergens in Europe Hapten (alergen) Cr Ni Co Tiuram Parafenylodwuamin PPD Formaldehyd Calafony Balsam of Peru Lanolin Merkaptany Żywica epoksydowa Parabens Mix perfume Quaterinum Neomycin

Patch tests � Interpretacja nickel � „ 0” or „-” – negative � IR –irritant reaction (rednes) � ‚+” – slighty positive (intumescence) � „++” – positive (+ Papules) � „+++” strong positive (+ Pustule) Positive ++

Ig. E �Tested in bood �Ig. E total �Ig. E specyfic �t. Ig. E is normal < 100 k. U/l �s. Ig. E is normal < 0, 36 k. U/l �ELISA �CAP system