Dr Mazen Qusaibaty MD, DIS / Head Pulmonary and Internist Department Ibnalnafisse Hospital Ministry of Syrian health – Dr Mazen Qusaibaty MD, DIS / Head Pulmonary and Internist Department Ibnalnafisse Hospital Ministry of Syrian health – Asthma 04

Tests for Allergy Allergy tests are Not Useful for the diagnosis of asthma Allergy tests are Not Useful for the diagnosis of asthma2

Tests for allergy They can be helpful to confirm sensitivity to suspected allergic triggers of respiratory symptoms They can be helpful to confirm sensitivity to suspected allergic triggers of respiratory symptoms Guide on-going management of asthma Guide on-going management of asthma3

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Type I hypersensitivity reaction IgE-mediated inflammatory response 7

Th2 cell B cell Eosinophil IL-4 IL-13 Mast cell FceRI IgE Histamine Leukotrienes Prostaglandins Cytokines Atopic disease IL-5 Antigen presenting cell Allergen Holgate, Q J Med 91: , 1998

The diagnosis of an IgE- mediated allergic disorder

1.Expectation the allergen  A careful clinical history 10

11 Allergens Exposure Exposure Asthmatic Winter 1.Expectation of the Allergens spring

Specific IgE 12

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Allergy Skin tests

Allergy skin tests are performed to a panel of indoor and outdoor aeroallergens Allergy skin tests are performed to a panel of indoor and outdoor aeroallergens15

16 Sampson HA. Update on food allergy. J Allergy Clin Immunol 2004; 113:805

Pathophysiologic mechanism of SPT Immediate Hypersensitivity - Type I Hypersensitivity 17 Skin

18 Allergen Skin

19 Allergen Mast cell IgE Skin Mast cell IgE B lymphocyte

20 Mast cell Allergen Mediators Nerves Vessels IgE Skin B lymphocyte Glands

Mast cell Allergen Mediators Nerves Vessels IgE Glands Skin Pruritus Swelling Erythema 15 – 30 min B lymphocyte

Indications for Skin Allergy Test 23

1. 1.Allergic asthma 2. 2.Rhinitis 3. 3.Conjunctivitis24

2. 2.Food allergy25

3. 3.Some medication allergies (penicillin allergy)26

4. 4.Venom allergies27

5. 5.Latex allergy28

1. 1.Allergic asthma, rhinitis, and conjunctivitis 2. 2.Food allergy 3. 3.Some medication allergies (penicillin allergy) 4. 4.Venom allergies 5. 5.Latex allergy29

Safety 30

Overall incidence of systemic reactions Overall incidence of systemic reactions  3.6 percent 31 Bagg A, Chacko T, Lockey R. Reactions to prick and intradermal skin tests. Ann Allergy Asthma Immunol 2009; 102:400.