Immunopathological reaction type IV (delayed type). Cutaneous and mucous contact allergy. IgE 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 IgE–mediated reaction Type I – Allergy Allergen IgE bound to the surface of the mast cell Degranulation, mediator release +

Allergic reaction IL-4 IL-5 Eosinophil IgE B T T Th2 APC Allergen T Th1 IFN-  B IgG IL-12  IL-12  Th1/Th2 response

Immunopathological reaction type IV (delayed type). Cutaneous and mucous contact allergy. IgE 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.

Allergens Inhaled (airborne) Food Venoms Drugs

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

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

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

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

Diagnosis of allergy History Clinical examination Skin tests Specific IgE in the serum Provocation and elimination tests

Immunopathological reaction type IV (delayed type). Cutaneous and mucous contact allergy. IgE 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 GradeSkinGI-tractRespiratory tract Cardiovascular system IItching, urticaria, flush, angioedema --- IIItching, urticaria, flush, angioedema Nausea, cramps Rhinorrhoea, dyspnea Tachycardia, arythmia, decrease of blood pressure IIIItching, urticaria, flush, angioedema DiarrhoeaLaryngeal oedema, bronchospasm Cardiovascular shock, faints IVItching, urticaria, flush, angioedema DiarrhoeaRespiratory 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. IgE 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 l Allergic asthma is chronic inflammatory disease of the airways in which a wide variety of cells (mast cells. Eosinophils, TH2 lymphocytes) and mediators play a role. Atopic dermatitis Allergic rhinitis Allergic asthma Allergic rhinitis is affection of the nose (and ocular conjunctiva) caused by IgE-mediated inflammation of nasal mucosa after allergen exposure. Atopic dermatitis is inflammatory disease of the skin which is mediated by T cells and stimulated by IgE- dependent reactions. IgE mediated food allergy Allergy

Treatment of allergic diseases Allergen avoidance Pharmacotherapy Specific immunotherapy

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

Pharmacotherapy Antihistamines Corticosteroids Symptomathic treatment

Specific immunotherapy Subcutaneous Sublingual

APC IgE IL-4 IL-5 Allergic response Eosinophil Th2 B-cell + + Tr1 IL-10 TGF -  IT Th1 IgG IFN-  B-cell IT - CD4 CD80/86 T cell Allergen TCR HLA CD28

Immunopathological reaction type IV (delayed type). Cutaneous and mucous contact allergy. IgE 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 l 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

Type of the immunopathological reaction l IgE l cytotoxic reaction l immunocomplex reaction l delayed type of hypersensitivity

IgE n PNC-barbiturates n ACTH -gelatine n insuline -opioids n latex-etylenoxide n myorelaxants

Cytotoxic reaction l PNC, cephalosporines l rifampicine l alfametyldopa

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

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

Local anaesthetics l paraaminobenzoic acid esthers l amides

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

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

Latex allergy l Contact type - additives l Immediate type - Hev b1 - Hev b 10

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

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

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

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

Manifestations l exanthemas, oedemas l anaphylaxis

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