1. Allergology

2. Basic concepts n Allergy is an inappropriate and harmful response to normally harmless substance n Allergy is usually caused by proteins called allergens n Common allergens: pollens, dust mites, animals, moulds, food, chemicals n Allergy develops after several encounters with the offending allergen

3. Allergic diseases n Immunopathogenesis - mostly 1st type of hypersensitivity, IgE mediated n Genetic predispozition  environment n Clinical presentation: –Inhalation allergy: rhinitis, asthma –Skin allergy: eczema, urticaria, angioedema –Ocular allergy: conjunctivitis –Food allergy: GIT, non-GIT symptoms –Systemic allergy: insect venoms, drugs, potentially all other allergens

4. History of allergy n Asthma and hayfever were well described by the middle of the 19 th century n 1873 Charles Backley proved that grass pollen was the cause of hayfever n 1901 Charles Richet described anaphylaxis

5. History of allergy n 1906 the term allergy was coined by Von Pirquet n 1921 Prausnitz and Kustner showed passive transfer of allergy n 1923 Coca and Cooke used the term atopy to describe inherited human hypersensitivity conditions n The immunoglobulin E was discovered in 1967

6. Allergic inflammation n Predominance of Th2 secerning IL4, IL13 n Senzitization - stimulation and proliferation of IgE producing B cells n Early response - IgE mediated, histamine release n Delayed response – cell mediated, eosinophills

7. Development of allergic disease n Atopy is genetic propensity to mount exaggerated IgE response n Allergy is clinical manifestation of atopy n Development of allergy depends on the genetic predispozition and environmental exposure to allergens

8. Epidemiology n Almost 30% of the population develop one or more allergic disorders n Nearly 40% of the populaation is senzitized to one or more allergens n The prevalence of asthma varies from 2-36% in different countries

9. Diagnostic strategy in allergology n Natural history n Physical examination n In vivo allergological tests n In vitro allergological tests n Other tests

10. Historical information n Family - asthma, atopy n Allergological - former food, drug allergy - home and occupational environment n Personal - perinatal complications - breast feeding, GER - eczema, urticaria - respiratory tract infections n Current problems - respiratory, skin, GIT tract involvement - triggers of smptoms - daily and seasonal variation of symptoms - effects of previous treatment

11. Physical examination n Observation, general symptoms - height and weight - cynosis, digital clubbing - respiratory rate - retractions, flaring of the alae nasi - mouth breathing - allergic shiners, salute,Dennie lines

12. Physical examination n Skin examination - atopic dermatitis: generalized, in predilections - dermographism - urticaria

13. Physical examination n Mucosas - conjunctival - nasal n Chest, breathing - AP diameter - wheezing

14. n Skin testing - prick tests - intradermal tests n Provocation tests - bronchial provocation /allergen, histamine/ - oral provocation n Lung function In vivo tests

15. In vitro tests n ESR n Blood count - differential count - eosinophilia /above 5% ofeosinophils/ n Smear of mucous secretions / above 5-10% of eosinophils n Serum immunoglobulin and complement content /IgG, IgA, IgM, C3, C4/ n Total and specific IgE serum content n / ELISA, RAST, FEIA, CAP system…/ n Leukocyte histamine release test

16. Principle of the ELISA test

17. Other examinations n ECG n X-ray n microbiological cultivation n viral serology n sweat chloride test n biochemical evaluation n endocrinology