Immunopathological reaction type IV delayed type Cutaneous and

Immunopathological reaction type IV (delayed type). Cutaneous and mucous contact allergy. Ig. E mediated immunopathological reaction (type I, atopy). Allergens. Allergic diseases – causes, symptoms and diagnostics. Anaphylaxis (causes, symptoms and treatment). Examples of diseases based on immunopathological reaction type I. Treatment. Drug allergy.

Immunopathological reaction type IV (delayed type). Cutaneous and mucous contact allergy. Ig. E mediated immunopathological reaction (type I, atopy). Allergens. Allergic diseases – causes, symptoms and diagnostics. Anaphylaxis (causes, symptoms and treatment). Examples of diseases based on immunopathological reaction type I. Treatment. Drug allergy.

Immunopathological reaction type IV (delayed type). Cutaneous and mucous contact allergy. Ig. E mediated immunopathological reaction (type I, atopy). Allergens. Allergic diseases – causes, symptoms and diagnostics. Anaphylaxis (causes, symptoms and treatment). Examples of diseases based on immunopathological reaction type I. Treatment. Drug allergy.

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 type IV (delayed type). Cutaneous and mucous contact allergy. Ig. E mediated immunopathological reaction (type I, atopy). Allergens. Allergic diseases – causes, symptoms and diagnostics. Anaphylaxis (causes, symptoms and treatment). Examples of diseases based on immunopathological reaction type I. Treatment. Drug allergy.

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

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

Immunopathological reaction type IV (delayed type). Cutaneous and mucous contact allergy. Ig. E mediated immunopathological reaction (type I, atopy). Allergens. Allergic diseases – causes, symptoms and diagnostics. Anaphylaxis (causes, symptoms and treatment). Examples of diseases based on immunopathological reaction type I. Treatment. Drug allergy.

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 type IV (delayed type). Cutaneous and mucous contact allergy. Ig. E mediated immunopathological reaction (type I, atopy). Allergens. Allergic diseases – causes, symptoms and diagnostics. Anaphylaxis (causes, symptoms and treatment). Examples of diseases based on immunopathological reaction type I. Treatment. Drug allergy.

Atopic diseases • Allergic rhinitis is affection of the nose (and ocular conjunctiva) caused by Ig. E-mediated 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

Specific immunotherapy Pharmacotherapy Allergen avoidance Treatment of allergic diseases

Allergen avoidance • Anti-mites beddings • 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 type IV (delayed type). Cutaneous and mucous contact allergy. Ig. E mediated immunopathological reaction (type I, atopy). Allergens. Allergic diseases – causes, symptoms and diagnostics. Anaphylaxis (causes, symptoms and treatment). Examples of diseases based on immunopathological reaction type I. Treatment. Drug allergy.

Definition – differential diagnosis toxicity – high dose, disorder of metabolism or elimination of the drug l intolerance – sensitive individuals l idiosyncrazy - intolerance based on another defect l other side effects of the drug (Jarish Herxheimer reaction, sy. Hoigne, alteration of enzyme function, candidasis, inhibition of histaminases, . . . ) l symptoms of the current disease l

Type of the immunopathological reaction Ig. E l cytotoxic reaction l immunocomplex reaction l delayed type of hypersensitivity l

Ig. E n PNC n ACTH n insuline n latex n myorelaxants -barbiturates -gelatine -opioids -etylenoxide

Cytotoxic reaction PNC, cephalosporines l rifampicine l alfametyldopa l

Immunocomplex reaction PNC l streptomycine l cephalosporines l PAS l hydantoinates l

Delayed type of hypersensitivity „para“ group - sulphonamides, procaine, PAS, azote colourants, prothazine, chlorpromazine l streptomycine l PNC l

Local anaesthetics l paraaminobenzoic acid esthers l amides

Local anaesthetics - diff. dg. of adverse events vasovagal syncope l surgical trauma l adverse effect of adrenaline l toxicity of administered drug l reaction to conservants (parabens, sulphites) l

Local anaestetics l Diagnostic procedures - skin tests – risk of false positivity - provocation test

Latex allergy Contact type - additives l Immediate type - Hev b 10 l

Latex allergy Risk groups: healthcare personal (surgeons 2 -6%) - patients with repeated surgeries (children with spina bifida - 20 -30%) l Risk factors - women - younger age - preexisting eczema - atopy l

Latex allergy Triggers - gloves - drains - catheters - condoms l Immediate manifestation - urticaria, dyspnoea, tachycardia l

Latex allergy Diagnosis - skin test - specific Ig. E in serum l Solution hypoallergenic products (vinyl gloves etc. ) l

Allergy to beta-lactam antibiotics l Penicillins: frequency - max. 4 - 5 % of administrations (less severe skin disorders) anaphylaxis <0, 1 % l Cephalosporins: less frequent than in penicillins

Manifestations l exanthemas, oedemas l anaphylaxis

Risk factors not atopy l not allergy to molds l i. v. administration l