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 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 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 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