Allergies

Sehar Jaferani
Maria Pererria
Kritika Singh
Aldrin Toscano

Introduction
Anallergyisahypersensitivitydisorderof

theimmunesystem.
Itisbecomingmorecommonbecauseofincreasing
urbanizationandchangesindietandlifestyle.
Itisimportanttousethetermallergycorrectly.It
isincorrecttouseitwherelgEisnotinvolved.This
isespeciallytrueforso-calledfoodallergy.

Antibody IgE:
IgEwasidentifiedfirstbyKandTIshizaka.
AserumlevelofthisAbisabout0.4-1microgram/ml.
Itdoesnotincreaseverymucheveninthemostseverecases.
This Ab has no hinge region but has an additional constant
domainCH4.
This enables the Fc portion of the molecule to bind to
glycoproteinreceptorsonbasophilsandmastcells.
Thoughitshalflifeinserumis2-3daysonbeingboundtoa
mastcellorbasophilitshalflifeincreasesbyaseveralweeks.

Mast cells and Basophils

Basophilsareverylowincirculation(0.51%).Mast
cellsarefoundthroughouttheconnectivetissue.Some
tissueslikemucosalsurfacesandGItracthavehigh
concentrationsofmastcells.Apartfromreleasinglytic
enzymestheyalsoreleasealargenumberofcytokines
thusaffectingabroadspectrumofbiologicalprocesses
inthebody.

IgE binding receptors:

IgEbindsareceptorspecificfortheFcregionoftheheavychain.
TwoclassesofreceptorsarepresentdesignatedFcRIandFcRII.
FcRIiscalledthehighaffinityreceptorforIgEbinding.Between40to
90,000FcRIreceptorsarepresentonabasophil.FcRIcontains4
polypeptidechains:andand2identicalchains.
Theexternalregionofthechaincontainstwodomainsof90amino
acidsthatarehomologouswiththeimmunoglobulinlikestructure.
FcRIinteractswithCH3andCH4domainsoftheIgEmoleculeviathe2
immunoglobulinlikestructureofthechain.
Thechainisatransmembraneproteinandfunctionsasalinker.

IgE CROSSLINKAGE INITIATES DEGRANULATION:

Mostoftenmastcelldegranulationoccursbyallergencrosslinkage
ofboundIgE.
Butdegranulationcanalsooccurduetootherprocesseslikeeffect
ofanaphylatoxins(C3a,C4a,andC5a)andvariousdrugs.
DegranulationbeginswhenallergenscrosslinkIgEthatisboundto
theFcreceptoronamastcellsurface.
PlainbindingofIgEtoFcreceptorshasnoeffectonmastcells,
crosslinkingisanecessity.
Furtherexperimentationhasrevealedthatthemajorstepiscross
linkageoftwoormoreFcRIreceptorswithorwithoutboundIgE.
ThusIgEcanbebypassedinactivationofmastcells.Also
concurrentwiththisconclusionisthatiftheFcRIreceptors
crosslinkageiscrucialformastcelldegranulationtheneventhe
presenceofanallergenisnotnecessaryasthiscrosslinkagecanbe
madeoccurevenwithoutanallergenbeingpresent.

Common symptoms
Affected organ

Symptom

Nose

swelling of the nasalmucosa(allergic

rhinitis) runny nose, sneezing

Sinuses

allergicsinusitis

Eyes

redness anditching of
theconjunctiva(allergic
conjunctivitis, watery

Airways

Sneezing,
coughing,bronchoconstriction ,
sometimes outright attacks of
asthma, in severe cases the airway
constricts due to swelling known
aslaryngeal edema

Ears

feeling of fullness, possibly pain, and

impaired hearing

Skin

rashes, such aseczema andhives

(urticaria)

Gastrointestinal tract

abdominal
pain,bloating,vomiting,diarrhea

Allergens

Substancesthatcauseallergiesarecalledallergens.
Over700environmentalallergenshavebeenidentified,characterized
andpurified.
Theseareimportantforamodernapproachtodiagnosisandtreatment
ofallergies.
Differentiationmustbemadebetweendifferentallergenswhose
aminoacidsequencehasbeencompletelyestablished.

Important Allergen Groups

1.
2.
3.

IndoorAllergens-Housedust,Mites,Cat,Dog,Cockroaches.
OutdoorAllergens-Treepollen,Grass&GrainPollen,Herbs,
Weeds
FoodsChicken,Egg,WhiteCowMilk,Peanuts,SeafoodInsect,
Venoms,Bees,Wasps,Molds,Alternaria,Cladosporium,
Aspergillus.

Detection of allergies

Allergyiscommonlyassessedbyskintesting.
Smallamountsofpotentialantigensaregivenby
intradermalinjections.
Ifapersonisallergictotheallergen,localmastcells
degranulateandthehistaminesandothermediatorsreleased
produceawhealandflarereactionwithin30minutes.
Thistestisverycheapandallowsscreeningofmany
allergensatonetime.
Disadvantageisitcansensitizetheindividualtoaparticular
allergenandinrarecasesinduceanaphylacticshock.
AnothermethodisdetectionoftotalserumIgElevelsby
Radioimmunosorbenttest(RIST).Thiscandetectnanogram
levelsofIgE.

Food Allergy
Peanut Allergy

Peanuts are one of thefood allergensmost

commonly associated with anaphylaxis, a sudden
and potentially deadly condition that requires
immediate attention and treatment.

Case Study
Name:ShintoAnthony
Age:35

Patienthadaseverepeanutallergytilltheageof15.Theallergywas
outgrownafteranimmunotherapy.
Thesymptomsobservedduringtheallergicreactionswereswellingof
face,mostlylips.Alsocloggingofoesophagus,troubleinbreathing,
skinrashesandswallowingwereobserved.
Herallergistrecommendedavoidingraw,cookedpeanutsandall
peanutcontainingproducts.
Herallergistalsorecommendedsomeherbalremediesfortheskin
rashesandclearingofthethroat.

Case Study
Name:RosuAnthony
Age:6
Thesymptomsobservedduringtheallergicreactionswereswelling
oflips.Alsocloggingofoesophagus,chestpainstroubleinbreathing
andswallowingwereobserved.
Herallergistrecommendedavoidingraw,cookedpeanutsandall
peanutcontainingproducts.
HerallergistalsorecommendedPiritezeCetirizinehydrochloride
Sideeffectsofthedrugobservedinthepatientweresleepiness,
diarrheaandheadache.
Nameofthedrug:Piriteze
GenericName:Cetirizinehydrochloride

Tree Nut Allergy

Anallergytotreenutsisoneofthemostcommonfood
allergies.Alongwithpeanutsandshellfish,itisalsooneof
thefoodallergensmostfrequentlylinkedtoanaphylaxis,a
potentiallylife-threateningreactionthatimpairsbreathingand
cansendthebodyintoshock.

Case Study
Name:HectorMercado
Age:38

Patientisallergictocashewnutsandalmonds.
Thesymptomsobservedduringtheallergicreactionswererunningnose,sneezing,
swelling,chestpainstroubleinbreathingandswallowingwereobserved.
Hisallergistrecommendedavoidingraw,cookedtreenutsandtreenutscontaining
products.Hisallergistalsorecommendedepinephrineoradrenalin
Sideeffectsofthedrugobservedinthepatientwereheadachesandshortnessof
breath.
Nameofthedrug:Adrenalin/Epinephrine
Epinephrineisachemicalthatnarrowsbloodvesselsandopensairwaysinthe
lungs.Theseeffectscanreverseseverelowbloodpressure,wheezing,severeskin
itching,hives,andothersymptomsofanallergicreaction.
Thefollowingserioussideeffectsmayinclude:
Sweating,Nauseaandvomiting,Paleskin,Feelingshortof
breath,DizzinessWeaknessortremors.

Wheat Allergy

Wheat allergies,likehayfeverandotherallergies,develop
whenthebodysimmunesystembecomessensitizedand
overreactstosomethingintheenvironment.Generally,you
areatgreaterriskfordevelopinganallergytoanyfood,
includingwheat,ifyoucomefromafamilyinwhichallergies
orallergicdiseases,suchasasthmaoreczema,arecommon

Case Study
Name:RadhaSharma
Age:10
Thesymptomsobservedduringtheallergicreactionswere
runningnose,difficultyinbreathing,nausea&vomiting
Herallergistrecommendedavoidingwheatandwheat
containingproducts.
HerallergistalsorecommendedEpinephrine
Sideeffectsofthedrugobservedinthepatientwere
sleepiness,diarrheaandheadache.

Nameofthedrug:Epinephrine/Adrenalin

Epinephrine(adrenaline)isthefirst-linetreatmentforanaphylaxis,whichcan
occurwithinsecondsorminutes,canworsenquicklyandcanbedeadly.In
thistypeofallergicreaction,exposuretotheallergencausesthewhole-body
releaseofafloodofchemicalsthatcanleadtoloweredbloodpressureand
narrowedairways,amongotherserioussymptoms.
Epinephrineshouldbeusedimmediatelyifyouexperienceseveresymptomssuch
asshortnessofbreath,repetitivecoughing,weakpulse,generalizedhives,tightness
inthethroat,troublebreathingorswallowing,oracombinationofsymptomsfrom
differentbodyareassuchashives,rashesorswellingcoupledwithvomiting,
diarrhoeaorabdominalpain.Repeateddosesofepinephrinemaybenecessary.
Ifyouareuncertainwhetherareactionwarrantsepinephrine,useitrightaway,
becausethebenefitsofepinephrinefaroutweightheriskthatadosemaynothave
beennecessary.
Commonsideeffectsofepinephrinemayinclude:
Anxiety
Restlessness
Dizziness
Shakiness
Abnormalheartrateorrhythm
Fluidbuildupinthelungs.

Dust Allergy
Pollen Allergy
Pollen comes from trees, grasses, flowers and
weeds. People can be allergic to different types of
pollen. For instance, some people are allergic to
pollen from only beech trees; others areallergic
to pollenfrom only certain kinds of grasses.

Case Study
Name:AidahJaffri
Age:15

Thesymptomsobservedduringtheallergicreactionwererunningnose,itchyeyes,sneezing
andheadache
Patientgotasthmabecauseofpollenallergy
Herallergistrecommendedavoidingvisitstobotanicalgardens.
HerallergistalsorecommendedCitoval10mg
Sideeffectsofthedrugobservedinthepatientwerefatigue,sleepinessandweakness.

DrugName/BrandName:Citoval10mg
GenericName:Cetrizine10mg

PatientsusingCitovalmayencounterunwantedsideeffectssuchas:

Drowsiness,Fatigue,Dizziness,TremorsandInsomnia

Drug Allergy
Penicillin Allergy
Despiteitsefficacy,somepeoplesteerclearofpenicillinfor
fearofexperiencinganallergicreactiontothemedication.
Understandingpenicillinallergiesisimportantforavarietyof
reasons.
Forcertainconditions,penicillinisthebest(oronlyproven)
therapy.
Somepatientsneedpenicillinbecausetheyareallergicto
othertypesofantibiotics.

Case Study
Name:MadhuraPatel
Age:19

PatientisallergictoPenicillin
Thesymptomsobservedduringtheallergicreactionsweretightness
inthechestanddifficultybreathing,swellingofthetongue,throat,
noseandlips,dizzinessandfaintingorlossofconsciousness
Hisallergistrecommendedimmunotherapy
Hisallergistalsorecommendedepinephrineoradrenalin
Sideeffectsofthedrugobservedinthepatientwereblurredvision,
chestpainordiscomfort,chesttightnessorheaviness
DrugName:Adrenalin

Allergy to Paraphenylenediamine (PPD)

Paraphenylenediamine (PPD) is a chemical substance that is
widelyusedasapermanenthairdye.
It may also been found in textile or fur dyes, dark coloured
cosmetics, temporarytattoos, photographic developer and
lithography plates, photocopying and printing inks, black
rubber,oils,greasesandgasoline.

CaseStudy
Name:MariumIbrahim
Age:50
Thesymptomsobservedduringtheallergicreactionswere
swellingoftheface(forehead,neck,sideburns,nose,lips)and
pusformation
HisallergistrecommendedavoidinghairdyescontainingPPD
Hisallergistalsorecommendedepinephrineandanantiinflammatoryointment
Sideeffectsofthedrugobservedinthepatientwerenausea
andheadache
DrugName:Epinephrine

Discussion

Whetherallergysufferershavesymptomsthataremildorsevere,theyreallyonlywantone
thing:relief.
Soitsparticularlydistressingthattheverymedicationtheyhopewilleasesymptomscan
causedifferent,sometimesmoresevere,allergicresponses.
Anallergicresponsetoamedicationforallergiescanoftengoundiagnosed.
Thispresentationshedslightonadverseresponsestotopicalskinpreparations;helpsidentify
patientswhoarehypersensitivetoanti-histamines,andidentifiesallergicresponsestovarious
drugsusedinthetreatmentofasthmaandallergies.
Allergytoatopicalcortico-steroidmaynotbeevidentrightawaybecauseitsjobistobring
downinflammation.
Butthepatientsshouldsuspectanallergytotheirmedicationif:theirrashdoesntrespond,it
getsworsewiththemedication,orimprovesinitially,thenflares.
Othertopicalmedicationsthatcancauseallergiesareantibioticslikebacitracinand
neomycinfoundinadhesivebandagesanestheticsandanti-fungals.
Formostantihistaminemedications,apatchtestcanbedonetodetermineifthepatientsare
reactingto:theactualdrugcomponent,thepreservatives,thefragrance,orthedelivery
systemofthedrug.
Themajorityofanti-histaminereactionsaffecttheskin,appearingashivesorarash.

Recommendation

The government should fund hospitals for an allergy department,

where people can take free allergy test

People suffering from allergies or the ones who have had placebo
attacks should take an allergy and asthma test once in a while in an
allergist clinic or a hospital and take a look at your symptoms and see if
you should find relief.

Patients should track and manage EIB symptoms over time.

(Shortness of breath, wheezing, coughing, chest tightness and unusual

fatigue are all symptoms of exercise-induced bronchoconstriction
(EIB). Most people with asthma have EIB. But, its also possible to have
EIB and not have asthma)

The patients should track and manage their nasal allergy symptoms,
and share their reports with an allergist.