From allos - other/antother
Ergos - action
Allergy - altered tissue reactivity
o If you're exposed to antigen, you put up immune response such that
you become immune to that antigen
o However, there are some individuals who react differently
 Instead of putting up immune response, it becomes more
sensitive to that antigen
o If you're allergic to a normal substance
 Develop harmful effects of allergiv reaction; you don't get
immune but more sensitive to that substance
o Substance aka allergens
 Allergens are proteins
 MW 10,000 and above
 Some are polysaccharides
 Some proteins with MW < 10,000 that by themselves cannot
produce an allergic reaction
 Hapten - Combine with body proteins; once you get
them, they can develop an allergic reaction
o
The body's immune response can be
 Humoral
 Cell mediated
 Both
 That's why immunopathologic mechanisms are the same as
your allergic mechanisms
 Anaphylactic reaction
 Same as anaphylactic shock
 Cytotoxic/cytolytic reactions
 Blood transfusion reaction
 You're type B, given type A; develop allergic
reactino
 Toxic complex
 Serum sickness
 AJM  Delayed hypersensitivity/cellular reactions
 Allograph rejection and transplantation
o
Causes of Allergies
 Macroenvironmental factors
 Categorized inhalants
 Pollens, smoke, fumes, odors, dust
 Contactants - anything in contact with skin, mucous
 injectants - drugs, bee stings, transfusions
 Ingestants - drugs, food, drinks
 Micro environmental factors
 Infection
 In many asthmatics, if you develop upper respi
tract infectin, it gets worse because the alleric
condition is exaggerated; so the infection will
trigger the asthma in the patient


o
Emotional factors - grief, joy, elation may
precipitate allergic reaction
 Those depressed may develop rashes due
to just being depressed
Weather changes
 Temperature, humidity, pollution all affect
 Pts who are asthmatic; when in the US
are okay; when arrive in the Philippines
they will have an asthma attack; hotter in
the PI
Diagnosis
 Immunologic test - skin test or mucosal test
 You get the allergen and give it intradermally
 Use the mucosa if you think pt is highly sensitive to
allergen that skin test may trigger the allergic condition
 Skin test of morsako --pt just with skin test --acute asthmatic attack; why do mucosal test (use
conjunctiva - place diluted fluid of allergen in the
conjunctiva; if you see reddening, pt allergic
 Direct skin test
 Makes use of prostnate kushner phenomenom
 PK
 Example - transfer the serum; get serum and you
inject it to guinea pig; try to test if pig is allergic;
egg protein - nnot allergic to egg - transferred
serum; allergic to serum -- the allergic condition
could be transferred
 Indirect skin test
 Environmental test
 Pts who have acute asthamtic attack
 Hospitalize them; presume hospital clean; pt gets
well; send him home; when home, he develops
attack again --due to environment
 Has to be free of allergens
 If house has a pig farm, that triggers the attack

Dietary
 Take a food diary; make a list of what the allergic pt is
eating; if you see that on one day he develops attack
due to eating egg/chicken

Elimination Diet
 Asthma pt; try to refrain him from eating highly
allergenic food (egg, shrimps, chocolates, citrus)

Miscellaneous
 Take the glucopynic index, basophilic index, RISA, RUST
 Radio immuno allergic test - detects the raagin or
IgE; in allergic condition, the antibody involved is
IgE aka raagin; if allergic to egg protein, your
body develops antibodies against egg proteins;

o
those antibodies of IgE type and you call them
raagin;
How you detect rashes from seafood
 Detect if you have IgE that will react to
the protein
Treatment (in general)
 Prevention
 If you're allergic to egg, simply don't eat it
 Immunization aka Desensitization Procedure
 Hyposensitization aka immunization
 Consists of eating the allergen in very low
concentrations initially and gradually increasing it until
you become immune to it
 Example
 Allergic to shrimp --love to eat it though= you
can somehow eat for the weak soup but not
shrimp --afterwards eat one shrimp -- then more
---until you eat the whole shrimp without allergic
reacion
 Chronic asthmatic - attack every day; so
allergologist will do a skin test; usually 20-30
allergens; say pt is allergic to 10 of these; so
allergolosit will mix all those and combine it into
a dilute concentration 1:100,000 and then the
patient injects it every day for one week; after
one week/month, you give now a concentration
of 1:10,000, .1, .2, ++ === after one week you
have given 1 cc -- 1:1000, 1:100, 1:10, 1:1 ---pt
gets immune
 Long process -- maybe 2 years total test
 Doing this doesn't mean that you have treated the
allergic condition; you've actually decreased or
eliminated somehow some of the causes for the
triggering factors
 Rule in allergy - while you get rid of some of the
allergies, new allergies develop if you're
hypersensitive
 So if you're asthmatic, get desensitized, later get
new allergies -still asthmatic

Symptomatic therapy
 When have symptoms
 If asthmatic, give bronchodilators, antihistamines,
steroids
 Those you are taking are symptomatic therapy only
 You treat the acute attack, but the disease itself is still
there

Supportive
 Asthmatic - should have a clean environment, good
hygiene, nutrition
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
Healthy diet and exercise
If any other illness on pt, try to treat that
 Pt asthmatic and same time has primary cox
infection --treat first the infection
Allergic Conditions
o Skin allergies
 Infantile eczema
 Practically the first appearance of an allergic condition in
an allergic child
 Aka atopic dermatitis
 In dermatology, you have the character of lesion and
site
 Most diseases have predilection sites
 The predilection sites are the cheeks, back of the ears
and the flexor areas of the body and the ass cheeks
 The lesions become papular and weeping lesions
 Papulla becomes moist -- so it starts to weep out
due to moisture
 Pluritis - itchiness
 Predilection areas
 Seen in 2nd or 3rd month of life; try to blame the milk;
baby not eating anything but the milk; why shift pt to
hypoallergenic formula milk
 Soy milk available then; remove cow protein and
subsitute with vegetable protein
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Seborrheic Dermatitis
 Predilection of lesions are along the hairline or even the
whole scalp
 Aka Cranial cap - the whole head is involved
 Along the hairline, the eyebrows, part of ears,
retroauricular areas
 Generalized seborrheic dermatitis
 Whole body lined with condition
 Seen during 2nd or 3rd day / first week of life
 Have to give time for pt to get sensitized; don't get
sensitized to something on the first exposure; should be
on the 2nd or the nth exposure before you develop the
allergic condition; don't develop condition if it's the first
 Have seborrhea with regards to lesion
 Oily, greasy and when it gets dry it develops
flakes (yellow greasy flakes)
 Like dandruff when it gets dry
 Most mothers use oil to try to remove it; but
more you use oil, the more it will occur
Cutaneus Moniliasis
 Cutaneous fungal infection
 Mop like lesions  Borders that are red and white
 Itchy; sometimes mistaken for infantile eczema
note
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
If infantile eczema from weeping continues, there will be
ligandinization -thickening; try to scratch skin due to
itchiness, it thickens; also gets darker,
hyperpigmentation
Hicka sa balat aka infantile eczema aka atopic dermatitis
 Treatment - normal saline solution; steroids
given now; comes in a mild but higher
concentration
Rule in dermatology
 Cream - used if you have a wet lesion (weeping, moist)
 Ointment - used for dry lesions
o
Contact Dermatitis
 Direct - develop a lesion or injury in skin secondary to the
harmful/deleterious effect of the substance
 Not allergic condition
 Sulfuric acid - get chemical burn if your skin exposed;
reddens and have blisters, will rupture (weeping)
 Substance has that effect w
 True
 Causes are the substances to which normal individual
will have no effect
 Cosmetics, leather wrist watch - skin gets itchy
 Treatment
 Apply steroids and remove cause of allergy
o
Oritgaria
 Elevated reddening part of skin
 Small ones or big ones
 Aka giant Urtigaria
Angioedema
 Mucosa is involved
 Example - whole mouth; the mucosa already involved; edema
of mucosal surfaces
 Why angioedema is dangerous; urticaria is just itchy
 Dangerous because it spreads into the resppi mucosa -laryngeal edema -obstructin ----pt may die
 Urticaria - whol
o
o
Urticaria and angiodema
 Anything can cause it
 Exposure to cold --cold urticaria
 From emotion, from bee, from inhalation, == anything
 Treatment
 If generalized, have to give something enteral (oral)
 Oral - antihistamines; new antihistamines that
you don't have sedative effect now available
 Steroids added if necessary
 If angiodema
 Give it paranteral -- antihistamines and steroids