Allergy

 Type of hypersensitivity reactions of the immune system. Allergy

may involve more the one type of reaction.

 An allergy is a immune reaction to something that does not affect

most other people. Substances that often cause reactions are:
 Pollen
 Dust mites
 Mold spores
 Pet dander
 Food
 Insect stings
 Medicines
 …….
 Allergy

Risk factor
Host factors; heredity, gender, race, and age.
 Environmental factor; infectious diseases during early
childhood, environmental pollution, allergen levels
and dietary changes.
 Hypersensitivity

 Hypersensitivity (hypersensitivity reaction) refers

to undesirable immune reactions produced by the
normal immune system.

 Hypersensitivity reactions require a pre-sensitized

(immune) state of the host.

 Hypersensitivity reactions: four types; based on

the mechanisms involved and time taken for the
reaction, a particular clinical condition (disease)
may involve more than one type of reaction.
Classification of Immunologic Reactions (Gel and Coombs)
Hypersensitivity Reactions
 Allergy

Ig E mediated (Type I
hypersensitivity)
Allergy
Non Ig E mediated
 IgE Mediated: Type I

Overreaction to an allergen that is contact through skin,

inhaled through lung, swallowed or injected.

Triggered by harmless substances such as; pollen, dust,

animal danders, food, … can also occur as a result of
drug or bee stings or stings from other insects (an
allergen).

 An allergen; an antigen that causes allergy. Either

inhaled, ingested, .. Can be complete protein antigens
(Pollen and animal dander) or low molecular weight
proteins.
 Atopy

 Atopy is the genetic predisposition to make IgE antibodies in

response to allergen exposure.

 Etiology is unknown but there is strong evidence for a complex of

genes with a variable degree of expression encoding protein factors.

 Allergic rhinitis, allergic athma, atopic dermatitis are the most

common manifestation of atopy. Allergic gastroenteropathy is
rara. These manifestation may coexist in the same patients at
different times. Atopy can be asymptomatic.
 Common allergens associated with type I hypersenstivity

Proteins  Foods
 Foreign serum  Nuts

 Vaccines  Seafood

Plant pollens  Eggs

 Peas, beans
 Rye grass
 Milk
 Ragweed
 Timothy grass  Insect products
 Bee venom
 Birch trees
 Wasp venom
Drugs  Ant venom
 Penicillin
 Cockroach calyx
 Sulfonamides
 Dust mites
 Local anethetics
 Salicylates
 Mold spores
 Animal hair and dander
 Mechanism

While first-time exposure may only produce a mild

reaction, repeated exposures may lead to more serious
reactions. Once a person is sensitized (has had a previous
sensitivity reaction), even a very limited exposure to a very
small amount of allergen can trigger a severe reaction.

Most occur within seconds or minutes after exposure to the

allergen, but some can occur after several hours, particularly
if the allergen causes a reaction after it is partially digested.
In very rare cases, reactions develop after 24 hours.
 Immunopathogenesis

 Both mast cells and basophils are involved in

immunopathogenesis of IgE mediated diseases. Mast
cells and basophils have a high affinity IgE cell
membrane receptors for IgE.

 Immediate hypersensitivity reactions are mediated

by IgE, but T and B cells play important roles in
the development of these antibodies
 Mast Cell

 Mast cell are abundant in the mucosa of the

respiratory, gastrointestinal tracts and in the skin,
where atopic reaction localize.

 Mast cell release mediator cause the pathophysiology

of the immediate and late phases of atopic diseases.
Mast Cell Activation
Mast cell

Hours
Minutes
Classic Allergic Reaction
Flushing Late –phase Reaction
Hypotension Eosinophil infiltration
Increased mucus production Neutrophil infiltration
Pruritus Fibrin deposition
Smooth muscle contraction Mononuclear infiltration
Vascular leakage Tissue destruction
 Performed Mediators/ Primary Mediators

Histamine: is one well-known mediator. This mediator acts on histamine 1

(H1) and histamine 2 (H2) receptors to cause: contraction of smooth
muscles of the airway and GI tract, increased vascular permeability and
vasodilation, nasal mucus production, airway mucus production, pruritus,
cutaneous vasodilation, and gastric acid secretion.
Serotonin: increased vascular permeability and contraction of smooth
Muscles.
Tryptase: is a major protease released by mast cells; its exact role is
uncertain, but it can cleave C3 and C3a. Tryptase is found in all human
mast cells but in few other cells and thus is a good marker of mast cell
activation.
Proteoglycans: include heparin and chondroitin sulfate.
Chemotactic factors
………………….
 Performed Mediators/ Secondary Mediators

–Platelet activating factor

–Leukotriens
–Prostaglandinin
–Bardykainin
–Cytokines
–IL1 ,TNF
–IL2,IL3,IL4,IL5,L6
 Important Clinical Aspects of Immediate
Hypersensitivity
Route of entery Typical allergens Main symptoms Disease Main organ

Inhalation Pollens, house Wheezing, Asthma Lung

dust, animal dyspnea,
danders tachypnea
Contact with Pollens Runny nose, Rhinitis, conjunctivitis Nose and Eyes
mucous membrane redness and Hay fever
itching of eyes
Uncertain Uncertain Pruritic, Eczema (atopic Skin
Ingestion Various foods vesicular lesions dermatitis)
Various Drugs Pruritic, bullous Urticaria
lesions

Ingestion Various food Vomiting Allergic Intestinal tract

diarrhea gastroenteropathy
Sting Insect venom;bee Shock, Anaphylaxis Systemic
Various Drugs; penicillin hypotension,
Ingestion Foods; Peanuts wheezing
Food Hypersensitivity

Source: http://www.allergycentre.com.my/index.html
 Food Hypersensitivity

Source: http://www.allergycentre.com.my/index.html