E. SUTEDJA DERMATO – VENEROLOGICA DEPT. MEDICAL FACULTY UNPAD ATOPY and MORBIDITY E. SUTEDJA DERMATO – VENEROLOGICA DEPT. MEDICAL FACULTY UNPAD

“ ATOPY “  GREEK “ WRONG PLACED” What’s is atopy ?? “ ATOPY “  GREEK “ WRONG PLACED” COCA & COOKE ( 1923 ) HEREDITARY DISORDER INHERITED HYPERSENSITIVE TYPE 1 (CLINICAL) ENVIROMENTAL FACTORS ASTHMA, HAY FEVER, ECZEMA, URTICARIA, AND FOOD ALLERGIES HISTORY

HISTORY COCA & GROOVE (1925) ISHIZAKA (1966) THE CAUSE  REAGIN IN SERUM ISHIZAKA (1966) THE REAGIN  IgE HISTORY

DEFINITION AN INHERITED TENDENCY FOR HYPERPRODUCTIVE OF IgE ANTIBODY TO COMMON ENVIROMENTAL ALLERGENS TYPE 1 HYPERSENSITIVE, AN IMMUNOLOGIC REACTION WHICH PRODUCES TISSUE DAMAGE ON REEXPOSURE TO ANTIGEN DEFINITION

PATHOPHYSIOLOGY INHERITED  GEN CHROMOSOME 5  IL4 (TH2) CHROMOSOME 11q  IgE production FILAGGRIN GENE : CHR 1q21 ( GENE MUTATION)  EPIDERMAL BARRIER DISFUNCTION   PATHOPHYSIOLOGY

ENVIROMENTAL ALLERGEN SKIN CONTACT INJECTION INGESTION INHALATION SHOCK BEE POLLEN TOXIC PLANTS DRUGS DRUGS DUST ANIMAL DANDER NUTS & SEAFOOD POLLEN FUNGI LATEKS ANIMAL DANDER

PHATOMECHANISM

SYMPTOMS ATOPIC DISEASE( ATOPIC MARCH) NOSE RHINITIS ALLERGY EDEMA & HYPERSEKRESI MUCOUS VASCULAR ANAPHYLAXIS VASODILATATION BRONCHIAL ASTHMA LUNGS MUSCULAR SPASME ATOPIC DERMATITIS & URTICARIA SKIN VASODILATATION INCREASE CAPILER PERMEABILITY ATOPIC DISEASE( ATOPIC MARCH)

ATOPIC DEMATITIS “ ATOPIC ECZEMA “ FIRST ATOPIC MARCH REDUCED SKIN LIPID LAYER > INCREASED TRANSDERMAL WATER LOSS > LOWERED RESISTANCE TO IRRITANT SUBSTANCES ASSOCIATED WITH OTHER ATOPIC DISEASES ASTHMA IN 30% ALLERGIC RHINITIS IN 35% CHILDREN PREVALENCE 15-20% 75% GET IT BY 6 MOUNTH AND 80% START < 5 YRS CLEARS IN 60% BY EARLY ADOLESCENCE TYPICALLY EPISODIC – RELAPSE AND REMISSION ATOPIC DEMATITIS “ ATOPIC ECZEMA “

ADULTS PREVALENCE 2-10% GENETIC COMPONENT – PRESENT IN 80% WHEN BOTH PARENTS AFFECTED AND 60% WHEN 1 AFFECTED

CLINICAL MANIFESTATION THE ITCH THAT RASHES The most common skin disorder seen in infants and children 60% present in first year of life “Atopic March”: atopic dermatitis→food allergies→asthma→allegic rhinitis Interruption of atopic dermatitis may↓incidence of asthma and allergic rhinitis Characterized by exacerbations and remissions CLINICAL MANIFESTATION copyright pvernon 10-09

AN IMMUNE RESPONSE TO INHALED ALLERGENS ALLERGIC RHINITIS

CLINICALLY DEFINED AS A SYMPTOMATIC DISORDER OF THE NOSE, INDUCED AFTER ALLERGEN EXPOSURE, BY AN IgE MEDIATED INFLAMMATION OF THE NASAL MEMBRANES TYPE 1 IgE HYPERSENSITIVITY REACTION IN THE MUCOUS MEMBRANES OF THE NASAL AIRWAYS IMMUNE RESPONSE OCCURING WITHIN MINS OF EXPOSURE TO ALLERGEN INFLAMMATION OF THE NASAL MUCOUS MEMBRANE ALLERGIC RHINITIS

CLINICAL FEATURES : Rhinorrhoea Nasal irritation, itching, vestibulitis Sneezing, ichy watery eyes Long term nasal obstruction, anosmia, polyps

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