1. Dr Mazen Qusaibaty MD, DIS / Head Pulmonary and Internist Department Ibnalnafisse Hospital Ministry of Syrian health – Email: Qusaibaty@gmail.com Dr Mazen Qusaibaty MD, DIS / Head Pulmonary and Internist Department Ibnalnafisse Hospital Ministry of Syrian health – Email: Qusaibaty@gmail.com Asthma 04

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

3. 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

4. 4

5. 5

6. 6

7. Type I hypersensitivity reaction IgE-mediated inflammatory response 7

8. 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 91:171-184, 1998

9. The diagnosis of an IgE- mediated allergic disorder

10. 1.Expectation the allergen  A careful clinical history 10

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

12. Specific IgE 12

13. 13

14. Allergy Skin tests

15. 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. 16 Sampson HA. Update on food allergy. J Allergy Clin Immunol 2004; 113:805

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

18. 18 Allergen Skin

19. 19 Allergen Mast cell IgE Skin Mast cell IgE B lymphocyte

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

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

23. Indications for Skin Allergy Test 23

24. 1. 1.Allergic asthma 2. 2.Rhinitis 3. 3.Conjunctivitis24

25. 2. 2.Food allergy25

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

27. 4. 4.Venom allergies27

28. 5. 5.Latex allergy28

29. 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

30. Safety 30

31. 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.