ATOPY Personal and/or familiar tendency to become sensitized and produce IgE antibodies in response to ordinary exposure to allergens, usually

Transcription

1 Jacek Gocki

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3 ATOPY Personal and/or familiar tendency to become sensitized and produce IgE antibodies in response to ordinary exposure to allergens, usually proteins It is IgE high responser who may or may not have clinical symptoms HYPRESENSITIVITY Objectively reproducible symptoms or signs initiated by exposure to a enviromental factors at a dose tolerated by healthy persons ALLERGY Hypersensitivity reaction initiated by immunologic mechanism, which can be either antibody or cell mediated. Patient have clinical symptoms after contact with allergens Hypersensitivity reaction to a enviromental factors, initiated by specific immunologic mechanisms

4 Holgate S. (red) Allergy 4th ed

5 Listen to the patienet`s account of the symptoms. First question: Tel me about your complains, problems. Importatnt information Months when symptoms are worse Worse in bed at night or in the morning Feel better when outside or inside Beter in dry or wet days Worse when contact with dog or cat or another pets Worse when vacuming or dusting, blankets are shaken Determine the frequency and severity of the symptoms Establish whether there is a presonal or family history of allergy diseasess (asthma, rhinitis, egzema) Symptoms are sesonal or perennial Dust mites perennial Tress: from february/march to may Grasess : from may/june to july/august Weeds: from june/july to august/september

6 Ask about possible allergens at home: dust, cats, dogs Establisch the enviromental factors: High humidity Cigarette smoking Presence of fungus on the wall Ask about occupation and hobbies, adwerse reaction to drugs Ask about food tolerance Ask about previous treatment and efficacy Ask about another diseasess and treatment When symptoms occur first time How symptoms growing Ask about childhood Ask again about the main problem

7 Allergic rhinitis Nasal congestion, rhinorrhoea, sneezing, itching Asthma Wheezing, dyspnoea, chest tightness, cough Atopic dermatitis Itching skin, red and pathy rash, thick skin, constant scratching Anaphylaxis Urticaria, pruritus of lips/ tonge/ palms /soles, gastrointestinal cramping, nausea, vomiting, diarrhoea, chest tightness, wheezing, palpitations, tachykardia, chest pain, syncope, altered mental status, dizzness, uterine contractions in women.

8 Holgate S. (red) Allergy 4th ed

9 Occupational allergy should be obtained in all patients with asthma, rhinitis and egzema Symptoms tend to occur within the workplace or durin evening following work Symptoms improve at weekends and during holidays Commont agents of occupational allergy Laboratory animals Flour (baking) Biological enzymes (soap powder industry) Wood dust Latex Isocyanates Colophony Nickel Crome

10 Holgate S. (red) Allergy 4th ed

11 IgE test Basophil histamine relase test Mast cell tryptase

12 The heart of the allergic response lies in the quantity and specificity of IgE production of patients to allergens Low in fetus Increases with age until the first half of the second decade of life Decrease with age after second decade Total IgE is normal below 100 ku/l in adults Specific IgE is normal below 0,36 ku/l Presence or absence of IgE alone is not conclusive of disease Smokers could have high IgE levels Testing may be done in two ways In vivo- skin test In virto in blood samples

13 Alergen is linked to a solid phase Patient`s allergen-specific IgE antibodies binds to the allergen Wasching unbound antibodies Fluorophore marked human anty-ige antibody binds to patient antibody

14 Elisa test Smal blood samples (20ul) are pipeted into wells of ELISA plate precoated with suspected allergens 1 hour incubation at 37 C Estimation of basopil histamine relase 5% basophil population not relase histamine in vitro Test is used in the investigation of chronic spontaneus urticaria 30% patients with this disease have histamine relased autoantibodies

15 Used to diagnosis conditions where mast cell activation occurs Anaphylaxis Systemic mastocytosis There are two form of mast cell derived tryptase α-tryptase β-tryptase it is marker mast cell activation In anaphylactic schock the level of mast cell tryptase is evaluated above ng/ml

16 Spirometry and spirometry provocation test Provocation test When the clinical history of manifestation of allergy does not match skin testing or vitro assays Provocation test can be considered to asses relationschip between symptoms and physilogical end point We can use pharmacological agents like methylhistamine, or natutal sourse of allergen like food (double blind placebo controled food challange or open provocation test)

17 Diagnostic algorithm for allergy Holgate S. (red) Allergy 4th ed

18 An accurate clinical history is the mainstay of allergy diagnosis Skin prick test/serum IgE test provide objective confirmation of IgE sensitivity Skin prick/serum IgE tests must always be interpreted in the context of the history