ALLERGIC REACTIONS

AHMAD ASRAF BIN AMIRULLAH

 Definitions
• ALLERGY - clinical conditions of IgE-mediated allergic diseases that have have a familial
predisposition and manifest as hyperresponsiveness in the target organs
• Atopy - results of a complex interaction between multiple gense and environmental factors to
develop allergic diseases
Gell and Coombs Classification of Hypersensitivity
Disorders
INTERVAL
BETWEEN
TYPE EFFECTOR CELL EXAMPLES
EXPOSURE &
REACTION
Anaphylaxis, urticaria,
I Anaphylactic <30min
IgE allergic rhinitis,
(Immediate) 2-12h
asthma

Variable - minutes to Rh hempolytic anemia,

II Cytotoxic Antibody IgG, IgM, IgA
hours thrombocytopenia
Antigen-Antibody
III Immune complex agregates leading to Rheumatoid arthritis,
1-3 weeks
reaction local or systemic SLE
inflamation
TB skin test, contact
2-7 days after drug
IV Delayed type Lymphocytes dermatitis, graft versus
exposure
host disease
Pathophysiology
 Allergies to be covered
• Allergic rhinitis

• Atopic dermatitis

• Urticaria and Angioedema

• Insect bites

• Food allergy

• Anaphylaxis
 Allergic Rhinitis
Inflammatory disorder of the nasal mucosa marked by nasal congestion,
- Known as Hay fever
It could be:
- Seasonal : airborne pollens
- Perennial (indoor allergens) : house dust mites, mold, cockroaches, pets
Clinical manifestation:
- Sneezing, Snorting throat clearing
- Rhinorhea
- Red eye
- Cough
- Hoarseness
Physical examination:
• Allergic shiners - dark periorbital swollen
eyelids or conjuctiva
• Nose - allergic salute --> transverse nasal crease,
turbinate hypertrophy, polyps
• Mouth - cobbletoning of oropharynx

• Ears - Retracted tympanic membrane

• Chest - wheezing
 Investigation
3 common test:
• Skin testing

• Nasal smear

• In vitro testing for serum levels of specific IgE antibodies

(RAST - radioallergosorbent test)

 Management
Prevention
• Removing pet, room / house hygiene

Pharmacotherapy:

1. Intranasal corticosteroids - beclometasone, budesonide,

fluticasone, mometasone

2. Antihistamine - diphenhydramine, cetirizine, loratadine

3. Decongestants - pseydoephedrine
 Atopic Dermatitis
Chronic, pruritic, relapsing inflammatory skin condition

Factors like genetic predesposition(family history), disturbances of skin barrier, environmental

interactions, infectious trigger

Triggers like anxiety, stress, climate, allerges, infections

35% of child with atopic dermatitis have coexisting food allergies

Filaggrin structural protein in the epidermis play a role to skin barrier function. Gene mutation in
fillagrin gene plays a role with severe AD
Clinical Features of A Dermatitis
 Investigation & Management
Investigation
- skin test
- RAST (Radioallergosorbent test)

Management
- reduce number or severity of flares and to increase the number of disease-free periods , reduce trigger factors
- bland emollients, mild non alkali soaps
- Topical steroids - topical beclomethasone
- Topical immunomodulating drugs - topical tacrolimus (2nd line)
 Urticaria
• URTICARIA - hives, vascular reaction of skin
characterized by wheals surrounded by a red
halo or erythema
• PRURITUS
• swelling of upper dermis
• ACUTE causes - foods(eggs,milk,
peanuts,shellfish), medications, insect
stings(hornets,wasp), contact
allergy(latex,pollen,caterpillar), transfusion
reactions
• Management - antihistamines, corticosteroid
 Angioedema
• caused by similar pathogenic mechanism as
urticaria but pathology is in the deep dermis and
subcutaneous tissue
• SWELLING commonly affects the face or
portion of an extremity
• may be painful or burning and last several days
 Drug Allergy
Hypersensitivity reaction occurs during or after use of the drug

Type A (PREDICTABLE) - side effects, drug interaction, drug toxicity

Type B (UNPREDICTABLE) - hypersensitivity

Clinical features - severe skin reactions, high grade fever, join pain(50%), changes in vision,
difficult breathing, abdominal discomfort, vomiting

Management - depends on severity. severe drug allergy require supportive treatment with
corticosteroids, fluid and electrolytes maintenance, good oxygenation or ventilatory support
 Anaphylaxis
Severe life threatening generalised or systemic
hypersent reaction.

Characterized by rapidly (minutes to hours)

developing airway, breathing and circulation
problems associated with skin or mucosa changes
Discharge plan:

1. education to caregivers

2. adrenaline auto injector (adrenaline card /

allergic card)
 Anaphylaxis
Anaphylaxis is likely when 3 criteria’s met:

- Sudden onset or rapid progression of symptoms (minutes to hours)

- Life threatening airway and/or Breathing and/or Circulation problems
- Skin and/or mucosal changes ( flushing, urticaria, angioedema)
 Anaphylaxis
Life threatening features:
Airways:
- Airway swelling e.g. throat or tongue swelling
- Hoarseness of voice
- Stridor
Breathing:
- Dyspnea (bronchospasm, pulmonary edema)
- Wheeze
- Confusion by hypoxia
- Cyanosis
- Respiratory arrest
 Anaphylaxis
Circulation problems

- Shock
- Cardiovascular collapse (faintness, palpitation, LOC)
- Cardiac arrest
Key points for severe reaction:

- Previous severe reaction

- History of increasingly severe reaction
- History of asthma
- Treatment with B-blocker
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