1. ASTHMA, ECZEMA Michael Widjaja 08301016030 黄合乐

2. Outline  Preconceived notions  How allergic asthma is triggered  Mechanism of asthma  Methods of treatment of asthma  Factors that lead to asthma  Eczema and the factors that lead to it  Link between asthma and eczema  Conclusion

3. Initial thoughts on asthma  Asthma causes difficulty in breathing  Consists of two parts  Constriction of bronchi  Overproduction of mucus in respiratory tract  Caused by  Allergies  Drastic change in temperature  Exercise  Heritable? family history

4. Initial thoughts on Eczema  Dry itchy skin, redness, cracking, oozing or bleeding  Causes  Allergies  Skin Irritants  Dry weather  Sweat  Eczema linked to Asthma in some way  Genetically linked disease?

5. Anatomy of Asthma

6. Triggers of Asthma  Dust  Pollen  Cockroaches  Cold air  Smoke  Animal dander, skin, dried saliva, hair

7. Mast Cells and Plasma Cells

8. Mechanism of Asthma  Antigen enters body  Plasma cell produce immunoglobulin E(IgE)  IgE binds to surface of mast cells  Future exposures to antigen results in binding of antigen to surface bound IgE  Mast Cells degranulate releasing Histamine and Leukotriene

9. Mast Cell Degranulation

10. Steroid effects of the lung  Leukotriene promotes contraction of smooth muscle of the bronchioles  Histamine increases vascular permeability, causing capillary leakage and edema

11. Treatment of Asthma  Inhaled corticosteroids are preventive medications that treat inflammation of the airways  Bronchodilators (long-acting beta-2 agonist) relax the muscles surrounding the airways for a long period of time

12. Hereditary factors for Asthma  Study done in Arizona involving 344 families

13. Environmental factors for Asthma

14. Genes related to Asthma  Multifactorial  25 genes more commonly associated with asthma  Related to immune system or inflammation  Studies are inconsistent

15. Environmental factors in Asthma  Tobacco smoke  Air pollutants  Caesarean sections  Psychological stress – modulates immune system  Hygiene hypothesis

16. Environmental Factors  Reduction of indoor allergens moderately reduces risk of developing asthma  Conversely exposure to cat and dog allergens during first year of life reduced allergy to cat and dog allergens and developing asthma

17. Eczema- inflammation of epidermis  Redness  Crusting  Flaking  Blistering  Cracking  Oozing  Bleeding  Edema

18. Types of Eczema  Atopic Eczema- due to an overactive immune system  Contact Eczema- contact with allergens  Xerotic eczema – results from dry skin during the winter  Seborrhoeic dermatitis- cause cradle cap in infants

19. Histology of Eczema  Filaggrin gene encodes protein profilaggrin which forms a protective barrier that keeps moisture in and infectious organisms out  Similar to asthma, allergens can bind to IgE receptors on mast cells causing histamine to be released and edema to occur

20. Filaggrin gene  Linked: Asthma, Eczema, Hay Fever  Location: 1q21.31q21.3  Function:  Bundles keratin intermediate filaments  Promotes disulfide-bond formation among the intermediate filaments mammalian epidermis

21. Treatment of Eczema  Moisturizer to fight dry skin  Steroid cream to repress immune system and reduce swelling

22. Genetics of Eczema  Similar to asthma related to family history of allergies  Multiple genes factor control our immune system  Also similar to asthma, environmental factors  Filaggrin gene  SPINK5(Serine protease inhibitor Kazal-type 5) gene plays a role in anti-inflammatory and antimicrobial protection of mucous epithelia

23. Link between Asthma and Eczema  Atopic march  50-70% of children with severe eczema developed Asthma  2/3 of these children will also develop allergic rhinitis

24. Link between Asthma and Eczema  Research done by Washington University School of Medicine  Experimented on mice  Mice were engineered to have defective skin similar to eczema in humans produced TSLP ( thymic stromal lymphopoietin) and developed asthma  Mice with normal skin but overproduced TSLP also developed asthma

25. Link between Asthma and Eczema  TSLP( thymic stromal lymphopoietin)  TSLP also produced in Asthma patients  Secreted into blood stream when skin is damaged, indicating its protective barrier is damaged and further protections are needed  Both lung and skin in contact with open environment  Inflammatory disease of skin also causes inflammation of lungs when TSLP flows in bloodstream to the lungs  TSLP causes lungs to be very sensitive to allergens

26. Summary  Mechanism of Asthma  Triggers of Asthma  Genetic and Environmental factors of Asthma  Cause of Eczema  Genetic and Environmental factors of Eczema  Link between Asthma and Eczema

27. Citations  http://acc6.its.brooklyn.cuny.edu/~scintech/asthma/Genetics2.htm http://acc6.its.brooklyn.cuny.edu/~scintech/asthma/Genetics2.htm  http://www.mamashealth.com/allergies/breathbet.asp http://www.mamashealth.com/allergies/breathbet.asp  http://en.wikipedia.org/wiki/Asthma http://en.wikipedia.org/wiki/Asthma  http://en.wikipedia.org/wiki/Eczema http://en.wikipedia.org/wiki/Eczema  http://www.blisstree.com/articles/filaggrin-gene-and-eczema/ http://www.blisstree.com/articles/filaggrin-gene-and-eczema/  http://www.thetech.org/genetics/ask.php?id=161 http://www.thetech.org/genetics/ask.php?id=161  http://www.blisstree.com/articles/filaggrin-gene-and-eczema/ http://www.blisstree.com/articles/filaggrin-gene-and-eczema/  http://news.bbc.co.uk/2/hi/health/8055038.stm http://news.bbc.co.uk/2/hi/health/8055038.stm  http://www.news-medical.net/news/2009/05/18/Researchers- look-at-eczema-asthma-link.aspx http://www.news-medical.net/news/2009/05/18/Researchers- look-at-eczema-asthma-link.aspx

28. Comments? Questions?