Immunopathological reaction (reaction of hypersensitivity) type I.

1. Immunopathological 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.

2. Mechanism of IgE–mediated reaction Type I – Allergy + Degranulation, mediator release IgE bound to the surface of the mast cell Allergen

3. Th1/Th2 response IgE IL-4 B Allergen IL-12  T Th2 T APC IL-5 Allergic reaction Eosinophil IL-12  T Th1 IFN- IgG B

4. Immunopathological 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.

5. Inhaled (airborne) Food Allergens Venoms Drugs

6. EXAMPLES birch pollen grass seasonal mugwort ragweed Inhaled allergens molds Alternaria Cladosporium Aspergillus Dermatophagoides pteronyssinus mites perennial Dermatophagoides farinae animals cat dog

7. EXAMPLES cow s milk eggs vegetables, fruits, nuts fish, seafood aditives Food allergens AGE

8. EXAMPLES honey bee (bumble bee) Hymenoptera venom allergens wasp, yellow jacket (hornet)

9. EXAMPLES penicillines, cephalosporines non-steroidal antiinflammatory drugs iodine contrast media local anesthetics peripheral myorelaxants latex ethylenoxid Drug allergens

10. Immunopathological 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.

11. Anaphylaxis

12. Treatment 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

13. Immunopathological 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.

14. Diagnosis of allergy History Clinical examination Skin tests Specific IgE in the serum Provocation and elimination tests

16. Immunopathological 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.

17. Treatment of allergic diseases Pharmacotherapy Allergenavoidance Specific immunotherapy

18. Anti-mites bedding • Pollen filters • Stay in mountains during pollen season • Animal avoidance Allergen avoidance

19. Antihistamines • Corticosteroids • Symptomathic treatment Pharmacotherapy

20. Subcutaneous • Sublingual Specificimmunotherapy

21. IgE IL-4 B-cell Allergen + Eosinophil Th2 IL-5 Allergicresponse CD80/86 HLA CD28 TCR - IT - T cell - b TGF- CD4 IT Tr1 IL-10 + IgG IFN-g B-cell Th1 APC +

22. Immunopathological 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.

23. Atopic diseases • Allergic rhinitisis affection of the nose (and ocular conjunctiva) caused by IgE-mediated inflammation of nasal mucosa after allergen exposure. • Allergic asthmais chronic inflammatory disease of the airways in which a wide variety of cells (mast cells. Eosinophils, TH2 lymphocytes) and mediators play a role. Allergicrhinitis IgE mediated food allergy Atopicdermatitis Allergy Allergicasthma • Atopic dermatitis is inflammatory disease of the skin which is mediated by T cells and stimulated by IgE-dependent reactions.

24. Drug allergy – differential diagnosis • toxicity – high dose, disorder of metabolism or elimination of the drug • intolerance – sensitive individuals • idiosyncrazy - intolerance based on another defect • other side effects of the drug (Jarish - Herxheimer reaction, sy. Hoigne, alteration of enzyme function, candidasis, inhibition of histaminases, ...) • symptoms of the current disease

25. Type of the immunopathological reaction • IgE • cytotoxic reaction • immunocomplex reaction • delayed type of hypersensitivity

26. IgE • PNC -barbiturates • ACTH -gelatine • insuline -opioids • latex -etylenoxide • myorelaxants

27. Cytotoxic reaction • PNC, cephalosporines • rifampicine • alfametyldopa

28. Immunocomplex reaction • PNC • streptomycine • cephalosporines • PAS • hydantoinates

29. Delayed type of hypersensitivity • „para“ group - sulphonamides, procaine, PAS, azote colourants, prothazine, chlorpromazine • streptomycine • PNC