Diagnostic approach to the allergic patient

Allergic conditions in Israel

Allergy von Pirquet von Pirquet immunity (a beneficial effect) immunity (a beneficial effect) or allergic disease (a harmful effect). or allergic disease (a harmful effect).

Atopy (from the Greek atopos, meaning out of place) is often used to describe IgE- mediated diseases. (from the Greek atopos, meaning out of place) is often used to describe IgE- mediated diseases.

Kay, A.B. N Engl J Med 2001;344:30-37 The Role of Cytokines Produced by Th2 Cells in Chronic Allergic Inflammation

Kay, A.B. N Engl J Med 2001;344:30-37 Pathways Leading to Acute and Chronic Allergic Reactions

Taking a history  Patient's account of symptoms  How long has the condition been present?  Impact on lifestyle: how frequent and severe is it?  Does it affect work, school, leisure time, sleep?  Seasonal or perennial?  Trigger factors: allergic or non-allergic?  Exposure to allergens through occupation or hobbies?  Allergens in the home  Does patient have history of asthma, eczema, rhinitis?  Drug or food induced?  Family history  Treatment: compliance, efficacy, side effects  What is the main symptom?

Chronic Rhinitis Non- Allergic Non- Allergic Idiopathic rhinitis Idiopathic rhinitis NARES NARES Hormonal Rhinitis Hormonal Rhinitis Drug induced Rhinitis Drug induced Rhinitis Food induced Rhinitis Food induced Rhinitis Infective Rhinitis Infective Rhinitis Allergic Allergic Seasonal Rhinitis Seasonal Rhinitis Perennial Rhinitis Perennial Rhinitis Occupational Rhinitis Occupational Rhinitis

גישה טיפולית מניעת חשיפה טיפול תרופתי corticosteroids Antileukotrienes Antihistamines חיסונים

Effect of drug treatment

Antiallergic and Anti-inflammatory Effects of Antihistamines Blocking anti H1 receptors Decreased released of some chemical mediators of inflammation from mast cells Decreased migration, accumulation and activation of cells Decreased production and activation of inflammatory products

First generation of Antihistamines

Second generation of Antihistamines

Durham S et al. N Engl J Med 1999;341: Median Weekly Pollen Counts and Symptom, Rescue-Medication, and Visual-Analogue Scores for the Initial Placebo Trial (1989) and for the Current Trial (1993 through 1995)

FUTURE THERAPIES Recombinant allergens Recombinant allergens immunotherapy immunotherapy Anti-IgE therapy Anti-IgE therapy Anticytokine Anticytokine treatment treatment