31 IgE based immunopatological reaction type I atopy 32 Allergens Allergic diseases causes symptoms and diagnostics 33 Anaphylaxis causes symptoms and treatment 34 Examples of diseases based on immunopathological reaction type I Treatment ID: 930012
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30. Immunopatological reaction type IV (delayed type). Cutaneous and mucous contact allergy.31. IgE based immunopatological reaction (type I, atopy).32. Allergens. Allergic diseases - causes, symptoms and diagnostics.33. Anaphylaxis (causes, symptoms and treatment).34. Examples of diseases based on immunopathological reaction type I. Treatment.35. Drug allergy.36. IgG and IgM based immunopathological reaction (reaction of hypersensitivity type II).37. Immunocomplex based immunopathological reaction (reaction of hypersensitivity type III).
Slide2Immunopathological reactions
Slide3Classification by Gell
and
Coombs
Immunopathological
reactions
:
immune
response,
which
causes
damage
to
the
body (
secondary
consequence
of
defense
responses
against
pathogens
,
inappropriate
responses
to
harmless
antigens
,
autoimmunity
)
Four
types
of
immunopathological
reactions
:
Type I
reaction
- response
based
on
IgE
antibodies
Type II
reaction
- response
based
on
antibodies
,
IgG
and
IgM
Type III
reaction
- response
based
on
the
formation
of
immune
complexes
Type IV
reaction
- cell-
mediated
response
Slide4Immunopathological reactions
based
on
antibodies
IgG
and
IgM
(
reaction
type II)
Cytotoxic
antibodies
IgG
and
IgM
:
●
complement
activation
●
binding
to
Fc
receptors
on
phagocytes
and
NK
cells
(
ADCC)
Slide5Examples of immunopathological reaction
Type II
Post-
transfusion
reactions
after
administration
of
incompatibile
blood
:
binding
of
antibodies
to
antigens
on
erythrocytes
→
activation
of
the
classical
pathway
of
complement
→ cell
lysis
Hemolytic
disease
of
newborns
:
caused
by
antibodies
against
RhD
antigen
Slide6Autoimmune diseases:
●
organ-
specific
cytotoxic
antibodies
(
antibodies
against
erythrocytes
,
neutrophils
,
thrombocytes
,
glomerular
basement
membrane
...)
●
blocking
or
stimulating
antibodies
Graves
-
Basedow
's
disease
-
stimulating
antibodies
against
the
receptor
for
TSH
Myasthenia
gravis -
blocking
of
acetylcholin
receptor
→
blocking
of
neuromuscular
transmission
Pernicious
anemia
-
blocking
the
absorption
of
vitamin B12
Antiphospholipid
syndrome -
antibodies
against
fosfolipids
Fertility
disorder
-
antibodies
against
sperms
or
oocytes
Slide7Immunopathological reactions
based
on
immune
complexes
formation
(
reaction
type III)
●
caused
by
IgG
antibodies
→
bind
to antigen →
creation
of
immune
complexes
●
immunocomplexes
-
bind
to
Fc
receptors
on
phagocytes
-
activate
complement
●
immune
complexes
,
depending
on
the
quantity
and
structure
,
are
eliminated
by
phagocytes
or
stored
in
tissues
●
pathological
immunocomplexes
response
arises
when
is
a
large
dose
of
antigen,
or
antigen in
the
body
remains
;
arise
10-14
days
after
aplication
of
Ag
and
induced
inflamation
can
get
to
chronic
state
●
immune
complexes
are
deposited
in
the
kidneys
(
glomerulonephritis
),
on
the
surface
of
endothelial
cells
(
vasculitis
)
and
in synovie joint
(arthritis)
Slide8Serum sickness
●
the
therapeutic
application
of
xenogeneic serum (antiserum to snake venom)● creation of immune complexes and their storage in the vessel walls of different organs● clinical manifestations: urticaria, arthralgia, myalgiaSystemic lupus erythematosus● antibodies against nuclear antigens, ANA, anti-dsDNA Farmer's lung (exogenic allergic alveolitis)● IgG antibody against inhaled antigens (molds, hay) Post-streptococcal glomerulonephritis, cryoglobulinemia, revmatoid arthritis, post-infectious arthritis
Slide9Slide10Slide11Slide12Slide13Immunopathological reaction (reaction of hypersensitivity) type I. Allergens - definition, division and nomenclature.
Anaphylaxis - pathophysiology, clinical manifestation, treatment.
Diagnostic procedures used in allergology.
Treatment of allergic diseases.
Examples of diseases based on immunopathological reaction of type I.
Slide14Mechanism of IgE–mediated reactionType I – Allergy
Al
l
ergen
IgE
bound to the surface of the mast cell
Degranula
tion, mediator release
+
Slide15Al
l
ergi
c
r
ea
ction
IL-4
IL-5
Eo
s
ino
phil
IgE
B
T
T
Th2
APC
A
l
lergen
T
Th1
IFN-
B
IgG
IL-12
IL-12
Th1/Th2
response
Slide16Immunopathological reaction (reaction of hypersensitivity) type I. Allergens - definition, division and nomenclature.
Anaphylaxis - pathophysiology, clinical manifestation, treatment.
Diagnostic procedures used in allergology.
Treatment of allergic diseases.
Examples of diseases based on immunopathological reaction of type I.
Slide17AllergensInhaled (airborne)FoodVenoms
Drugs
Slide18Inhaledallergensseasonalperennialpollen
molds
mites
animals
birch
grass
mugwort
ragweed
EXAMPLES
AlternariaCladosporiumAspergillusDermatophagoidespteronyssinusDermatophagoidesfarinaecatdog
Slide19FoodallergensEXAMPLEScow s milkeggsvegetables, fruits, nutsfish, seafoodaditives
AGE
Slide20Hymenoptera venom allergensEXAMPLEShoney bee(bumble bee)wasp, yellow jacket(hornet)
Slide21Drug allergensEXAMPLESpenicillines, cephalosporinesnon-steroidal antiinflammatory drugsiodine contrast medialocal anestheticsperipheral myorelaxantslatexethylenoxid
Slide22Immunopathological reaction (reaction of hypersensitivity) type I. Allergens - definition, division and nomenclature.
Anaphylaxis - pathophysiology, clinical manifestation, treatment.
Diagnostic procedures used in allergology.
Treatment of allergic diseases.
Examples of diseases based on immunopathological reaction of type I.
Slide23Anaphylaxis Grade
Skin
GI-
t
ra
c
t
Respira
tory tract
Cardiovascular systemIItching, urticaria, flush, angioedema---IIItching, urticaria, flush, angioedema Nausea, crampsRhinorrhoea, dyspneaTachycardia, arythmia, decrease of blood pressureIIIItching, urticaria, flush, angioedema DiarrhoeaLaryngeal oedema, b
ronchospasm
Cardiovascular shock, faints
IV
Itching, urticaria, flush, angioedema
Diarrhoea
Respiratory arrest
Cardial arrest
Slide24Treatment of anaphylaxis Adrenaline / Epinephrine:Intramuscular – in patients with clinical symptoms of shock, oedema of the airways and pronounced dyspnoea
Dosage in adults
:
0.5 ml
-
1:1000
dilution
In case of necessity repeat every 5-10 minutes
Slide25Immunopathological reaction (reaction of hypersensitivity) type I. Allergens - definition, division and nomenclature.
Anaphylaxis - pathophysiology, clinical manifestation, treatment.
Diagnostic procedures used in allergology.
Treatment of allergic diseases.
Examples of diseases based on immunopathological reaction of type I.
Slide26Diagnosis of allergyHistoryClinical examinationSkin tests
Specific IgE in the serum
Provocation and elimination tests
Slide27Slide28Immunopathological reaction (reaction of hypersensitivity) type I. Allergens - definition, division and nomenclature.
Anaphylaxis - pathophysiology, clinical manifestation, treatment.
Diagnostic procedures used in allergology.
Treatment of allergic diseases.
Examples of diseases based on immunopathological reaction of type I.
Slide29Treatment of allergic diseases
Allergen
avoidance
Pharmacotherapy
Specific immunotherapy
Slide30Allergen avoidance
Anti-mites bedding
P
ollen filters
Stay in mountains during pollen season
Animal avoidance
Slide31Pharmacotherapy
Antihistamin
es
Corticosteroids
Symptomathic treatment
Slide32Specific
immunotherapy
Sub
cutaneous
Sublingual
Slide33APC
IgE
IL-4
IL-5
Al
l
ergic
response
Eo
sinophil
Th2
B-cell
+
+
Tr1
IL-10
TGF
-
b
-
-
+
IT
Th1
IgG
IFN-
g
B-cell
IT
-
CD4
CD80/86
T cell
A
l
lergen
TCR
HLA
CD28
Slide34Immunopathological reaction (reaction of hypersensitivity) type I. Allergens - definition, division and nomenclature.
Anaphylaxis - pathophysiology, clinical manifestation, treatment.
Diagnostic procedures used in allergology.
Treatment of allergic diseases.
Examples of diseases based on immunopathological reaction of type I.
Slide35Atopic diseasesAllergic asthma is chronic inflammatory disease of the airways in which a wide variety of cells (mast cells. Eosinophils, TH2 lymphocytes) and mediators play a role.
Atopi
c
dermatitis
Al
l
ergi
c
rhinitisAllergic asthmaAllergic rhinitis is affection of the nose (and ocular conjunctiva) caused by IgE-mediated inflammation of nasal mucosa after allergen exposure.Atopic dermatitis is inflammatory disease of the skin which is mediated by T cells and stimulated by IgE-dependent reactions.IgE mediated food allergyAllergy
Slide36Definition – differential diagnosistoxicity – high dose, disorder of metabolism or elimination of the drugintolerance – sensitive individuals idiosyncrazy - intolerance based on another defectother side effects of the drug (Jarish - Herxheimer reaction, sy. Hoigne, alteration of enzyme function, candidasis, inhibition of histaminases, ...)symptoms of the current disease
Slide37Type of the immunopathological reaction IgEcytotoxic reactionimmunocomplex reactiondelayed type of hypersensitivity
Slide38IgEPNC -barbituratesACTH -gelatineinsuline -opioidslatex -etylenoxidemyorelaxants
Slide39Cytotoxic reactionPNC, cephalosporines rifampicinealfametyldopa
Slide40Immunocomplex reactionPNCstreptomycinecephalosporinesPAShydantoinates
Slide41Delayed type of hypersensitivity„para“ group - sulphonamides, procaine, PAS, azote colourants, prothazine, chlorpromazinestreptomycinePNC
Slide42Local anaestheticsparaaminobenzoic acid esthersamides
Slide43Local anaesthetics - diff. dg. of adverse eventsvasovagal syncopesurgical traumaadverse effect of adrenalinetoxicity of administered drugreaction to conservants (parabens, sulphites)
Slide44Local anaesteticsDiagnostic procedures - skin tests – risk of false positivity - provocation test
Slide45Latex allergyContact type - additivesImmediate type - Hev b1 - Hev b 10
Slide46Latex allergyRisk groups: - healthcare personal (surgeons 2-6%) - patients with repeated surgeries (children with spina bifida - 20-30%)Risk factors - women - younger age - preexisting eczema - atopy
Slide47Latex allergyTriggers - gloves - drains - catheters - condomsImmediate manifestation - urticaria, dyspnoea, tachycardia
Slide48Latex allergyDiagnosis - skin test - specific IgE in serumSolution - hypoallergenic products (vinyl gloves etc.)
Slide49Allergy to beta-lactam antibiotics Penicillins: frequency - max. 4 - 5 % of administrations (less severe skin disorders) anaphylaxis <0,1 % Cephalosporins: less frequent than in penicillins
Slide50Manifestations exanthemas, oedemasanaphylaxis
Slide51Risk factorsnot atopynot allergy to moldsi.v. administration