Immunopathological reaction reaction of hypersensitivity type I Allergens

§ Immunopathological reaction (reaction of hypersensitivity) type I. § Allergens - definition, division and nomenclature. § Anaphylaxis - pathophysiology, clinical manifestation, treatment. § Diagnostic procedures used in allergology. § Treatment of allergic diseases. § Examples of diseases based on immunopathological reaction of type I.

Mechanism of Ig. E–mediated reaction Type I – Allergy + Allergen Ig. E bound to the surface of the mast cell Degranulation, mediator release

Th 1/Th 2 response Ig. E IL-4 B Allergen IL-12 T Th 2 APC T IL-5 Allergic reaction Eosinophil IL-12 T Th 1 IFN- B Ig. G

§ Immunopathological reaction (reaction of hypersensitivity) type I. § Allergens - definition, division and nomenclature. § Anaphylaxis - pathophysiology, clinical manifestation, treatment. § Diagnostic procedures used in allergology. § Treatment of allergic diseases. § Examples of diseases based on immunopathological reaction of type I.

Inhaled (airborne) Allergens Food Venoms Drugs

EXAMPLES pollen birch grass mugwort ragweed molds Alternaria seasonal Inhaled allergens Cladosporium perennial mites Aspergillus Dermatophagoides pteronyssinus Dermatophagoides farinae animals cat dog

EXAMPLES cow s milk eggs Food allergens vegetables, fruits, nuts fish, seafood aditives AGE

EXAMPLES Hymenoptera venom allergens honey bee (bumble bee) wasp, yellow jacket (hornet)

EXAMPLES penicillines, cephalosporines non-steroidal antiinflammatory drugs Drug allergens iodine contrast media local anesthetics peripheral myorelaxants latex ethylenoxid

§ Immunopathological reaction (reaction of hypersensitivity) type I. § Allergens - definition, division and nomenclature. § Anaphylaxis - pathophysiology, clinical manifestation, treatment. § Diagnostic procedures used in allergology. § Treatment of allergic diseases. § Examples of diseases based on immunopathological reaction of type I.

Anaphylaxis Grade Skin GI-tract Respiratory tract Cardiovascular system I Itching, urticaria, flush, angioedema - - - II Itching, urticaria, flush, angioedema Nausea, cramps Rhinorrhoea, dyspnea Tachycardia, arythmia, decrease of blood pressure III Itching, urticaria, flush, angioedema Diarrhoea Laryngeal oedema, bronchospasm Cardiovascular shock, faints IV Itching, urticaria, flush, angioedema Diarrhoea Respiratory arrest Cardial arrest

Treatment of anaphylaxis Adrenaline / Epinephrine: l Intramuscular – in patients with clinical symptoms of shock, oedema of the airways and pronounced dyspnoea l Dosage in adults: 0. 5 ml - 1: 1000 dilution In case of necessity repeat every 5 -10 minutes

§ Immunopathological reaction (reaction of hypersensitivity) type I. § Allergens - definition, division and nomenclature. § Anaphylaxis - pathophysiology, clinical manifestation, treatment. § Diagnostic procedures used in allergology. § Treatment of allergic diseases. § Examples of diseases based on immunopathological reaction of type I.

Diagnosis of allergy History Clinical examination Skin tests Specific Ig. E in the serum Provocation and elimination tests

§ Immunopathological reaction (reaction of hypersensitivity) type I. § Allergens - definition, division and nomenclature. § Anaphylaxis - pathophysiology, clinical manifestation, treatment. § Diagnostic procedures used in allergology. § Treatment of allergic diseases. § Examples of diseases based on immunopathological reaction of type I.

Specific immunotherapy Pharmacotherapy Allergen avoidance Treatment of allergic diseases

Allergen avoidance • Anti-mites bedding • Pollen filters • Stay in mountains during pollen season • Animal avoidance

Pharmacotherapy • Antihistamines • Corticosteroids • Symptomathic treatment

Specific immunotherapy • Subcutaneous • Sublingual

Ig. E IL-4 B-cell Allergen APC Th 2 CD 80/86 CD 28 HLA TCR CD 4 - IT T cell Eosinophil IT IL-5 - + Allergic + response - TGF- b Tr 1 IL-10 Th 1 IFN-g + B-cell Ig. G

§ Immunopathological reaction (reaction of hypersensitivity) type I. § Allergens - definition, division and nomenclature. § Anaphylaxis - pathophysiology, clinical manifestation, treatment. § Diagnostic procedures used in allergology. § Treatment of allergic diseases. § Examples of diseases based on immunopathological reaction of type I.

Atopic diseases • Allergic rhinitis is affection of the nose (and ocular conjunctiva) caused by Ig. Emediated inflammation of nasal mucosa after allergen exposure. l Allergic asthma is chronic inflammatory disease of the airways in which a wide variety of cells (mast cells. Eosinophils, TH 2 lymphocytes) and mediators play a role. • Atopic dermatitis is inflammatory disease of the skin which is mediated by T cells and stimulated by Ig. Edependent reactions. Allergic rhinitis Ig. E mediated food allergy Atopic dermatitis Allergic asthma