MINISTRY OF HEALTH OF UKRAINE
Vinnitsa National Medical University. MI Pirogov
"Approved uyu"
Vice Rector for Academic Affairs
__________________
Professor Huminskyy Yu.Y.
(Signature)
"__ 25 ___" __ 6 ___ 0 201 3
years
Methodological development
for students of Faculty of Dentistry
Post number 5
Academic discipline
"Clinical Immunology and Allergology"
Module number 1
"Clinical Immunology and Allergology"
Modules № 2
.
Study subject
The concept of allergy. Mechanisms of
AZ. Types of immune responses by Jelly and
Coombs. Allergens,
species,
form,
purpose. Statement of skin tests, provocation
tests, laboratory examination methods.
5th
"Medicine", "Pediatrics", "Medical and
preventive care"
4
Rate
Faculty
Number of hours
Allergic diseases in dentistry. Diagnosis and
treatment.
20 1 3 y
1.
A ktualnist theme:
Alerhi th is a very common disease. According to different authors, the alerhichni disease
suffers is 20 -35% of the different countries of th region. The most roэpovsyudzhenymy with
alerhichnyy rhinitis (AR), alerhichnyy dermatitis, asthma bronhialna.
This fact requires special care to medical specialists and advanced in the disease yvchennya Mr.
spine, disability, mortality, and the causes and factors that contribute to alerhichnyh disease
occurrence in An. Since even among fahintsiv have some nerozuminnya vazhlyvosti tollgates
these problems, and only real information about the epidemiological situation of the disease
alerhichnymy can i determine health, i s th Social values form a certain ratio to alerhichnyh
diseases in society, affect zabezpechenist from n ovidnymy fahivtsyamy, diagnostic and healing
tools, hospital cabinet and lizhkovym Foundation and others.
Moreover, the important is i that level distribution in p u dzhenosti alerhichnyh diseases
characterized population immunity is primarily shylnis t b to form in hiperchutly's reactions, and
secondly - the impact on people neantropohennyh i anthropogenic factors such as climate,
industrial and geographical i urbanistskyh.
It should be understood that D is stratsiya cases addressing medical help is not
vidobrazha state rozpovsyudzhenosti alerhichnyh zahnoryuvan. Writings of scientists proved that
rozpovsyudzhenist alerhichnyh disease, which is set in the study of the targeted, naspravdi 6 - 10
in the case of higher than that which is structural reform IS is officially.
2. Learning Objectives (main teaching and learning issues for self pozaudytornoyi).
Students are acquainted with the concept of allergy ehanizm m s of AZ; understand the
mechanisms of hypersensitive reactions (IgE-O seredkovanyh and IgE-not at seredkovanyh)
Know the classification of types of allergic reactions Gell and Coombs, immunological
mechanisms and clinical implications of each type of allergic reactions. Students should learn the
methods of diagnosing AZ: watch by n ostanovka and skin tests, provocation test ymi am and
laboratory method ymi am and examination., Students also need to know the classification of
allergens and their application.
3. Know:
1. Familiar with the incidence of allergies in the world and in Ukraine.
2. Identify the core concept of "allergy" and the mechanisms of its development.
3. Able to gather in-depth history of allergy and immunology and interpret clinical and laboratory
changes and skin tests with allergens.
4. Know the types of immunopathological reactions in Jhelum and Coombs.
5. Know the classification of allergens and their applications.
6. See the method ykamy diagnosis of allergic diseases in vitro.
Be able to:
1. Collect the complaint history of the disease, history of life in patients with suspected
allergic disease.
2. To be able to hold objects-objective examination of the patient;
3. To be able to choose the right skin testing for the patient;
4. Be able to conduct posing provocative tests;
5. To be able to interpret the results of functional methods of examination of the nose and lungs;
6. To be able to assign and interpret laboratory tests (specific and nonspecific).
4.
B azo new level of training.
Subjects
Normal anatomy
Normal physiology
Therapy
Pediatrics
Otorynolyarynholohiya
Clinical Pharmacology
Radiology
Gastroenterology
Dermatology
Infectious Diseases
Section
The structure of organs and body systems.
The mechanisms of functioning of organs and systems.
With ahvoryuvannya respiratory, gastrointestinal, urinary and
neuroendocrine systems.
With ahvoryuvannya respiratory, urinary and neuroendocrine
systems.Features children. Vaccination, especially the response
in children, complications.
Structure and function of the upper respiratory tract.
Groups of drugs used in therapy: corticosteroids, H1
histaminoblokatory, membranostabilizatory, bronchodilators,
and Immunotropic enzymes, probiotics, decongestants, etc..
Interpretation of radiographs WGC, paranasal.
Diseases W CT of liver.
Structure, function and diseases of the skin
AIDS / HIV associated, persistent viral infections.
5. Organization of the content of teaching material
After meeting with the students, the teacher introduces students to the clinic, allergy
diagnostic laboratory, placement and order of training students in the department and then proceed
to study the first theme. Classes are conducted in parallel with the out-patients reception where
students can become familiar with this pathology, collect complaints and history of life and
disease, to r 'lens and not assign other examination if necessary.
During the test, a patient teacher should pay attention to students that: s cargo related to allergies.
From the nose:
Runny nose, discharge, lay, itching, loss of smell.
From the Eye
Itching, pains, tearing, swelling, discharge, redness.
On the part of the respiratory system:
Shortness of breath, spasms, difficulty breathing, seizures, coughing, breathlessness, remote
wheezing, whistling, selection of specimens.
From the hearing:
Itching, zakladennist, hearing loss.
Skin:
Itching, rash, swelling.
Right collected history of the disease makes it possible to deliver not only a clinical
diagnosis, but also causative (ie, suspected cause of the disease).
Some diseases contribute to the development, progression or recurrence AZ (rhinitis, holetsystity,
dysbiosis, etc.) that the walls, palaces should be considered in the diagnosis.
History of the disease - the disease is taken into account: the beginning, the reason
Connectivity of exogenous and endogenous factors, progression, and c rem AI and their causes,
the impact of the seasons, occupational, domestic factors, comorbidities, weather, eating. Previous
research and treatment.
Medical history of life - s padkovist, past illnesses, the presence of the past diathesis, allergic
reactions to vaccinations, medicines, foods, profmarshrut, pet.
- Provides primarily information about AZ in the families in the past and the present, as in the
father and the mother to their relatives.
It should be noted that patients often do not know who is allergic disease, which
is why they should accumulate mainly by identifying the major symptoms characteristic of this
disease.
- Next, gather information about the response to the introduction of serums, vaccines,
drugs, nature of intolerance.
- Determine the issue of seasonality of disease, exposure to physical factors (cold, heat), and so
on.
- According to the theory of Hans Selye and local general adaptation syndrome,
these factors are able to act on the pituitary-adrenal system of glands, depleting resources
hlyukokortykosteroidiv and thereby create conditions for the implementation of the allergic
process.
Then n rovodyat examination of the patient, physical, palpation, and more objective test that can
confirm or reject the diagnosis of AS.
Thus, in patients with seasonal or perennial rhinitis skin wings of the nose, upper
lip has irritation rozchuhy. Rhinoscopy At lower turbinate or bluish gray with patches of redness,
swollen almost shut the nasal membrane. Sometimes polyps are possible. The rear section of the
pharynx, usually visible mucus. At otoscopy is often signs of otitis media. Hyperemia and edema
of the conjunctiva of the eye, can peryorbitalnyy and swelling.
In patients with asthma, according to the state (or salable mezhyprystupnyy period),
disease duration can detect changes in the chest, availability of appropriate physical signs breathing weaken, dry wheezing. While on the contrary, enlarged liver, edema of the lower
extremities may indicate in favor of "cardiac asthma."
It is important to identify specific elements in the skin of atopic or contact dermatitis, nettle
'Yankees.
In questioning and examination, the patient turns all students participating groups.
Then the teacher shows students a sequence of percussion of the chest of comparative and
topographic percussion and auscultation of the lungs and heart, and the results of auscultation after
coughing. Auscultation of patients defined the nature and type of respiration, and the presence of
additional auscultatory phenomena (rales, pleural friction noise, and so on). By percussion and
auscultation of the patient in turn invited all students group.
Auscultation of the heart and other systems of inspection carried out in the usual manner.
A survey of patients conducted in educational room in compliance with the general rules of
ethics. Further discussion on the information received, its interpretation and the process of clinical
thinking in the search for a diagnosis is made after taking .. Attention is drawn to the students that
modern medicine with its possibilities in the treatment of allergic diseases eliminates the need for
keeping secrets with respect to diagnosis. Instead, the explanation to the patient (within the
required limits) of his health will contribute to its active participation in the treatment process. At
the suggestion of a teacher a student expresses an opinion regarding a possible diagnosis and calls
needed more tests that are part of mandatory diagnostic level.
Next, students learn current clinical classification of allergic diseases.
The
most widespread classification received EP proposed Jelly and Coombs.
1. Immediate type hypersensitivity (anaphylactic, reahinovyy).
2. Cytotoxic - in this type of hypertension are cells more blood cells. Typically, this occurs as a
result of the damaging effect of drugs, bacteria and viruses. As a result of 'are modified blood cells,
which are formed JSC (IgG, Ig M).
The second type is the basis of such manifestations of drug allergy as leukopenia,
thrombocytopenia, hemolytic anemia, and others. The same mechanism is observed in hemolytic
disease of the newborn.
Diagnosis and its rationale students write in their notebooks.
3. Immunocomplex type.
Tissue damage by immune complexes. Hypertension in these cases is in the
soluble form (drugs, nutrients). AT (IG, Ig M) form immune complexes with the corresponding
AG. These immune complexes circulating in the blood, and in certain circumstances may be
deposited in tissues and vessel walls. This will start the complement, which causes tissue damage.
This type is leading the development of serum sickness, exogenous allergic
alveolitis, autoalerhichnyh diseases.
Type 4 - HCHST (cellular hypersensitivity)
- To it cause particle insoluble antigens (bacteria, fungi). With this type of reaction performed
the role of antibodies lymphocytes. In chronic infections such sensitized lymphocytes are able
to recognize infected cells and neutralize them.
- Contact dermatitis is also occurring in AR 4 types: simple chemical compounds join the fibers
of the skin and become a foreign body to body - developing sensitization.
Then the instructor will explain the method of choice in diagnosis, depending on the allergic
reactions above.
In Type 1 allergic reaction and can also b ut korystovuvatys you with practical but Telegram
and skin test and because the skin is anti t and la Cheap IgE - reag and n s, at 4 type A and L P intra dermal and submarines and spacecraft tional test and. In the 2nd and C st types AlR
production of skin tests are unnecessary.
The next step is to introduce stu to allergens, dividing them into groups.
Group noninfectious allergens:
Pollen AG - there are more than 700 names of plant allergens and pollen. For practical medicine
are important allergens that are most causal significance in the occurrence of AZ:
- Grasses (timothy, chaff, hryastytsya, etc.);
- Cultural cereals (wheat, oats, corn, rye);
- Storms' Jana (ragweed, sagebrush, weeds, nettles, etc..)
- Trees (birch, alder, hazel, oak, poplar)
Personal AG - part of their structure includes epidermal AG. AG is a major household
allergen of house dust containing dermatofahoyidni mikroklischi that the cause of atopic asthma
in 60% of cases.
Moreover, we prove sensitizing role since 'i pet used for filling pillows,
quilts. The most antigenic activity have feathers geese.
Epidermal Ah - m ozhut enter into the composition of household dust and mother and selfimportance (human dander, horses, pigs, sheep wool, cats, dogs, rabbits, guinea pigs, etc.).
Moreover, the very animal fur has significant value as AG, but attached to it
particles of saliva animal epidermis, urine, semen is important.
For example, unlike cats cats more allergenic.
Even when you remove the cat from the room, hypertension is present in it before
24 weeks.
Different breeds of cats, dogs, different allergenicity. Allergenic animal does not
exist.
Food Ah - with ice remember that the quality of food hypertension may be not only the products
you supply, but also substances that are formed during their treatment.
Most vysokoalerhenni - a food protein origin (plant and animal proteins) are
milk, eggs, fish, soy, flour, nuts, peanuts, shellfish.
Represents allergens insects, containing their saliva, venom, body.
Insect allergens - and lerhichni reactions occur bites, uzhalennyah, particles
inhaled allergens. These reactions are distinguished by particularly severe course and high
mortality.
Chemical allergens - a majority of the chemicals with which contact person at home, at work,
metals and their salts, pesticides, polymers, latex.
Group and nfektsiyn's allergen s - including allergens detected fungi, bacteria, viruses, parasites,
most ostishyh Ave.
The teacher said that the main methods of etiological diagnosis of allergic diseases are skin tests
with allergens.
Examples of test is the most vykorystovuyemym by skin tests with allergens.
The teacher said its advantages over other methods. It is the most unified of all skin samples,
virtually eliminating non-specific reactions due to irritation of the skin vessels. Is the most secure.
Another method of diagnosis is provocative tests in which the allergen is injected directly
into the shock body:
Nasal
Con 'yunktyvalnyy
Inhalant
Under the 'tongue (oral)
Provocative tests should be carried out only in allergy departments, trained
professionals, and children under 12 years of their conduct is generally undesirable.
It is also important laboratory tests: ts hey stage is also very organic and consistently
applied. Among laboratory studies should be made:
Nonspecific - blood tests, urine, nasal secretions, sputum, chest radiographs,
paranasal sinuses, fecal helminth eggs dyzbakterioz more.
Specific - Definition of IgE. For diagnosis of allergy statement of fact not increase total IgE, we
should identify the allergen-specific IgE.
For determination of specific IgE using:
radioimunosorbentnyy test (RAST);
enzyme immunoassay (EIA);
chemiluminescent (HLA, MA ST).
The teacher also development 'yasn yuyetsya need for expert consulting other industries, ENT,
dermatologist, pediatrician, internist, hastroentroloha, pulmonologist.
6. Plan and organizational structure of educational classes allergist uu
(240 minutes).
Number
c/o
Stages classes
Distribution
time
*
Types of
1.
1.1.
The preparatory phase
Organizational matters.
35 min
5 min
F
1.2.
Formation of motivation
5 min
s
1.3.
2.
Control of entry
level of training
(Standardized controls).
The main stage (specify
all kinds of work that students perform under
during this phase).
25 min
120 min
Structured n y
Oral survey
poll by standa
analysis of the
of objective
examination.
test control
criteria of kno
3.
The final stage
25 min
3.1.
Control endline
training.
15 min
3.2.
Overall training
student activities.
3.3.
Informing students
the topic of the next session.
5 min
5 min
Note:
* Forms of control and training tools specifically defined by the Department for each stage of training;
Controls ** theoretical and practical training of students need to be standardized.
7. Methods of educational process in the practice (seminar) class.
Theory
7.1. The preparatory phase.
Features of the clinical examination of patients with allergies: complaints, history of disease
course, an hereditary amnez, past illnesses, working and living conditions; Physical examination
methods: the value of palpation, percussion and auscultation in the examination of patients with
respiratory diseases. M METHODS survey in vivo in vitro
To acquaint students with specific goals and plan lessons.
Conduct student familiarity with clinical basis on which the rate of clinical immunology and
allergy departments and phthisiology. Conduct initial control level of training students in an
objective examination of patients with allergic diseases.
7.2. The main stage
This phase involves performing each student independently and under the supervision of the teacher
below mentioned practical work.
Task 1
Students conduct surveys and objective examination of the patient with ent diseases and
allergies, using inspection, palpation, auscultation, percussion.
Task 2
Number
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Task
Who usually have allergic diseases?
What method of registering AZ gives the most realistic picture of the prevalence of these
diseases?
Who can conduct screening AZ under orders from the Ministry of Health and Medical Sciences
of Ukraine № 127/18?
What are the 4 types of AR on Coombes and Jelly?
What is the best way to diagnose IgE-dependent reactions?
When can interpret a skin test to allergens?
How long does the registration is carried prick-test?
How long does the registration is made patch test?
What may be called perennial allergens AR?
What can be caused by seasonal allergens AR?
What science studies "aeropalinolohiya"?
What is characteristic of allergic diseases?
Task 3
Solve tests:
1. The main complaints specific to AZ?
Answer - runny nose, paroxysmal coughing, itching and swelling of the skin, attacks of
breathlessness.
2. What is the sequence pylkuvannya plants?
Answer - trees and meadow grasses, drill 'Jana.
3. H azvit synonyms type 1 AR?
Answer - anaphylactic, reahinovyy.
4. What substances including foods have the greatest ability to sensitize?
Answer - proteins.
Task 4
Challenges to self:
№/№
1.
Task
Which of the following substances considered a major mediator of vascular edema?
2.
In women over 20 years at 8 years old in August - September there rhinitis, conjunctivitis, an
joined asthma. Skin tests of pollen allergens - are positive. What is interleukin vyrishuvalne i
in the synthesis of antibodies that cause disease?
3.
What are n rovokatsiyni allergic tests?
4.
In allergic diseases is typical:
5.
Female for 4 years in August complaining about nasal nose, mucous discharge from it, snee
eyelids, watery eyes. When used suprastin these symptoms disappear. What type of allerg
takes place?
6.
The patient usually complains of sneezing in the morning, 15-20 times in a row, itchy no
numerous watery discharge from the nose, runny nose, sore eyes. Which one is the most i
tests for diagnosis?
7.
Patient after a walk in the country complaining about runny nose, itchy nose, sneezi
eyes. What antibodies are involved in the pathogenesis?
By allergist turned sick that represents "is tearing complaints to the streets eyu rhinorrhea, i
redness of the eyes. symptoms appear annually in April and May. disease on to think?
8.
9.
When exogenous allergic alveolitis
(EAA) is dominated by an allergic reaction:
10.
Which one is the most informative skin tests in the diagnosis of allergic rhinitis?
11.
Over time before the skin allergy tests should be abolished antihistamines 2nd generation?
12.
Specify the type of allergic reaction can be detected during skaryfikatsiynoyi skin test?
13.
In typical IV allergic reactions preferred method of skin tests will be:
14.
Which reactions include a lerhichni reaction?
7.3. The final stage.
We estimate the current activities of each student during class, the analysis of student
achievement, announced evaluation of each student and put in the log of visits and student
achievement. Group leader at the same time puts assessment roll of the success and attendance of
students, teacher assures them his signature.
It is advisable to briefly inform students about the topic of the next lesson and instructional
techniques to prepare for it.
8. Applications.
8.1. Theoretical questions preparatory phase:
1. Features collect history of the disease and the history of life.
2. The main complaint of patients with AS and their characteristics.
3. Basic research methods.
4. Types of AR by Jelly and Coombs.
5. Classification of allergens.
8.2. To formulate a diagnosis according to the clinical classification.
Problem number 1.
The girl of 4 years with the introduction of penicillin there was burning sensation, redness of the
skin, anxiety, fear of death, headache, buzzing in your ears, chest pain, blood pressure - 60/30 mm
Hg .. c. The introduction of the drug stopped, provided first aid. What type of allergic reaction has
taken place?
Answer: P eahynovyy;
Problem number 2.
Ambulance delivered a patient complaining of itchy skin rash monomorphic, vomiting, acute
abdominal pain. From history we know that the patient ate for dinner eggs and fish in large
numbers. Previously, these products did not cause any complaints. Skin tests with food allergens
are negative. Your diagnosis?
Answer: Five sevdoalerhichna sprinkled "Janko
Problem number 3.
Female patients with acute nettle "Iancu, which emerged after taking analhinu. Applying for
treatment in the first place?
A: The elimination of causal factors, they called "binding (sorbents) or O (laxatives)
Problem number 4.
The student was sent to the therapy department after deterioration in patients receiving medicines
for the treatment of acute bronchitis antibiotics (flemoksyn), mucolytics (Bromhexine). Condition
moderate in the formula of blood: WBC 0.6 10 / L in the formula There eosinophils 80% and 20%
monocytes. The diagnosis of leukemia is excluded. What is the mechanism of disease?
Answer :
Allergic reaction type 2
Problem number 5.
The student was sent to the therapy department after health crisis in patients receiving medicines
for the treatment of acute bronchitis (antibiotics, vidharkuyuchi. Serious condition. The
formula of blood: WBC 0.6 10 / L, eosinophils are present in the formula, 80% and 20%
monocytes . diagnosis of leukemia excluded. confirmation for leukemia should be used:
Answer: determining the titer of cytotoxic antibodies: IgG and IgM
Problem number 6.
The child after eating the dish of strawberries originated rash on the skin that itch. Previously,
when the child had used a small amount of strawberries are no. Doctor prescribed Claritin and
banned the use of strawberries.Does the doctor was right? Whether in this case are allergic to
strawberries?
Answer: Psevdoalerhichna reaction. Recommend eat a small amount of strawberries
Problem number 7.
The boy 9 years old leather trunk and limbs moderately hyperemic, infiltrated covered papular
elements excoriation. Playing white dermographism. Sick of early childhood. Exacerbations occur
in case of violation I diet. What surveys should be carried out for the diagnosis and determine the
cause of the disease?
Answer: skin tests with food allergens eliminatsino-provocation tests
Problem number 8.
Once inside analhinu a patient with "appeared sprinkled" Janko, increased body temperature, in
the blood - leukopenia. What type hypersensitivity developed in the patient?
Answer: C ytotoksychnyy
9. Suggested Reading
Basic
1.
2.
3.
GN Drannyk: Clinical and ymmunolohyya allerholohyya. - C. - 20 10.
B. M. Puhlyk: Эlementarnaya allerholohyya. - Vinnitsa. - 2002.
BM Puhlyk: olohiya allergies. - Vinnitsa. - 2004.
Learn more
1. Pыtskyy VI, NV Adryanova Al ergic disease. - Moscow, 20 10.
2. E Sidorenko. N. Clinical Allergology. - 2005.
3. Roy Patterson, Leslie K. Hrezmer Paul. Allerhycheskye illness (diagnosis and
Treatment). - Moscow - in 2000
Guidelines prepared
Associate IV Korytska
Guidelines approved at a meeting of
" 25 "6 0 "20 1 3 , the protocol number 1
Loading iduvach k afedr and
MD Professor BM Puhlyk