Ewa Gawr on ska - Ukleja

1. AllergensDepartment of Allergology, Clinical Immunology and Internal DiseasesCollegium Medicum in Bydgoszcz • Ewa Gawronska - Ukleja

2. Definitions and basic knowledge • Inhalatory allergens • Food allergens

3. Atopy – definition • Atopy is a genetic predisposition toward producing specific IgE as a response to low concentration of substance, usually protein, most commonly manifested as allergic rhinitis, bronchial asthma, atopic dermatitis, or food allergy.

4. Allergy - definition • Allergy is a hypersensitivity reaction initiated by immune mechanisms.

5. IgE dependent allergy • Allergic reactions caused by IgE

6. Non IgE - mediated allergy • Caused by other types of antibodies or lymphocytes

7. Allergen definition An antigenic substance capable of inducing hypersensitivity reaction, by inducing production of antigen specific IgE. Allergens can be protein or glycoprotein.

8. CRD • Component resolved diagnosis • The new approach of Molecular Allergology takes the diagnostics one step further by quantifying the allergen specific IgE antibodies to single, pure allergen molecules • Allergen components are proteins and based on structural similarity these are grouped into different protein families. Depending on the properties of these proteins, sensitization to the components leads to different consequences for the patient.

9. We can divide allergens • Based on allergen source (birch, apple, house dust mite and others) • Based on type of protein (tropomyosin, lipogaine, LTP, profilin and others)

11. Allergens classification • Divided into 2 groups: 1 - Main allergens – sensitizing more then 50 % of patients in  certain group for example allergy to house dust mite 2 - Week allergens – week sensitizing ability

12. Allergen contains epitopes. An epitope, also known as antigenic determinant, is the part of an antigen that is recognized by theimmune system, specifically by antibodies, B cells, or T cells. The part of an antibody that recognizes the epitope is called a paratope. Although epitopes are usually thought to be derived from non-self proteins, sequences derived from the host that can be recognized are also classified as epitopes.

13. Classification of inhalatory allergens • Plant allergens • House dust mite • Moulds • Animals dander • Cockroach • Feather • Daphnia

14. In Poland there are 20 species of plants, which can sensitize • Allergen is not thewhole grain, but only its halo. Grass • Most important :  Timothy, Rispengras, Honiggras • Flowering period – from the beginning of May to the half of July; • Grain size - 25 to 35 um. • Pollen amount : in 1 m3 - 280 mln.

15. Weeds • Artemisia vulgaris • Flowering period – from the beginning of September to the half of September • Grain size - 20 to 25 um. • 20% of patients have allergy only to weeds, the rest have also allergy to grass

16. Ragweed (Ambrosia) - the strongest of weed allergens in North America • In Europe- Hungary, Czech Republic, Slovakia, Ukraine, the south of France • People with allergy to weeds should be informed about it , when they are traveling to one of those countries.

17. Trees • Main tree allergens in Poland - birch, hazel, alder • Flowering period – from the end of February to the end of April • Grain size – above 30 um.

18. Poplar • Symptoms are rare • Flowering period – from march to April • Grain size – 35 um.

19. Christmas tree syndrome • Pine tree,spruce, Abies alba, larch - sensitize rare, but some studies describe „Christmas tree syndrome”

20. Cross – allergy ( cross-reactivity, cross-sensivity) • Allergy to the same epitops of different allergens • It means that, IgE antibody produced in atopic patient organism can react with allergens which did not induced they production.

21. Cross – allergy • Birch pollen – apple, potato, hazel nuts, carrot, tomato • Grass pollen – peanuts, soya bean, poteto • Weed pollen - celery

22. House dust mite • Dermatophagoides pteronissinus • Dermatophagoides farinae • Glycophagus domesticus • Euroglyphys mainei • Acarus siro

23. They are arachnid, about 0.25mm (0.01 inch) long. They are invisible to the naked eyes.  • Rapid reproduction cycle: It takes about a month for a dust mite egg to hatch and the mite to mature to an adult. An adult female mite may live another month and lay about 50 (some authors say 200) eggs in skin-ladden house dust.  Can survive in temperatures above 15°C and in a relative humidity above 50%. The ideal temperature is around 25°C. The ideal relative humidity is between 75 - 80%.  Do not need to drink to satisfy their thirst. They absorb water directly from the air through special glands in their skin.  • Dust mites feed on organic detritus such as flakes of shed human skin and flourish in the stable environment of dwellings.

24. Dermatophagoides pteronyssinus is the most popular in Europe (87% - 95% of mite in houses in central Europe)

25. 100 mites on 1 gram of dust are enough to sensitized • House dust mite can be killed by hot water at a temperature above 55°C (130°F). Therefore it is advisable to use bedding items that are washable in water. The pillow, mattress and duvet can be protected by zipped and tightly-woven cotton bedding covers that can prevent dust mites from passing through.

26. Moulds (Mold) allergens • Moulds are parasite or saprophyte. There are 120 000 of known species of molds • Humidity is 70% • Spore size 2-5 µm

27. Mold spore • Concentration of mold spores, which causes allergy symptoms in patients with hypersensitivity, is 2800 spores of Cladosporium in m3 (threshold value).

28. Mold allergens • New research technique enabled us to describe main allergens, which react with IgE antibody in blood serum. • Aspergillus : Asp J 1, Asp J 2, Asp J 3 i Asp J 12, • Alternaria: Alta 1, Alta 2, Alta 3, Alta 6, Alta 7, Alta 10 • Cladosporium ( Cla h 1, Cla h 2, Cla h 3)

29. Seasonal inhalatory allergy Summer, autumn -Alternaria -Cladosporium

30. Perennial inhalatory allergy • Aspergillus • Penicillium

31. Food allergy • Yeast • Blue cheese, cammembert • Vine • Bear • Champagne

32. Food allergy • Mold on food • Greengrocery • Fruits

33. Asthma & allergy to molds • Allergy to Alternaria alternata is a risk factor of sever asthma!!!

34. Treatment • Avoiding exposition • Immunotherapy • Symptoms management

35. Avoiding exposition to allergen Mold in the home can usually be found indamp,dark or steam filled areas e.g. bathroom or kitchen, cluttered storage areas, recently flooded areas, basement areas, plumbing spaces, areas with poor ventilation and outdoors in humid environment.

36. Allergy to cat • The main cat allergen is Fel d 1 – a glycoprotein. This molecules can fly in the air for many hours. They can be transported on clothes, and appear in places without cats. • The biggest source of allergens are saliva, sebaceous glands and anal glands • Some cats are week, some are strong producers of allergens. • There is about2-30 % of people with allergyto cats in population.

37. Dog allergens • The main dog allergen (Can f 1) occurs in dogs dander, also in saliva, urine, and skin. Sometimes it can fly in the air. Patients with allergy to cats and dogs often have hypersensitivity to other animals.

38. Cattle allergens • Cattle allergens have week sensitizing ability. Allergy to cows dander can occur in farm workers.

39. Horse allergens • Horse allergens easily spread in the air, they are in dander, urine and sweat. Allergy symptoms appear during contact of sensitized person with animal.

40. Feather • Feathers of many birds are inhalatory allergens, e.g. : hen, duck, turkey, goose, also canary and parrot • Feather of different species have separate allergens. But there exist probably one allergen, which is the same in many different species.

41. Food allergens • In 1995 „Food and Agriculture Organization” experts - from USA, for the first time used the term : „the big 8 food allergens” • Milk • Eggs • Peanuts • Nuts • Seafood • Shellfish • Soy • Wheat.

42. Food allergens • Food allergens are soluble in water • Cooking can reduced sensitizing ability of allergen. • In infants the most frequent allergy is allergy to cows milk and egg • In adults peanuts, fishes, fruits and vegetables.

43. Egg white allergens • Egg white contains many allergens, nowadays we know about 23, but 4 of them are main: Gal d 1, Gal d 2, Gal d 3, Gal d 4. Egg white contains water(88%) and proteins (10%), which are the most important source of allergens.

45. Milk allergens In Europe, milk allergy occurs in 1,9 to 2,8% of children below 2 . It contains about 30 sensitizing proteins. The strongest are: • - β - laktoglobulin – the most frequent (80%) • - λ - laktoalbumin –sensitizing 50% of patients with milk allergy • - albumin of cattle serum –30% • - casein

46. Milk allergens • Casein which is the most important cheese allergen, is sensitizing about 60% of patients and is the most temperature resistant protein in milk. • Goat and sheep milk has many mutual features, their proteins could induce cross-reactivity.

47. Fish allergens • Fish contain strong allergens, so allergy to fish is very common in children and adults. • They contain 2 kinds of allergens : 1. Mutual for all species 2. Specific for each species • Fish allergens are temperature resistant.

48. Epidemiology • Allergy to fish is one of the most frequent (in USA about 10% of patients with food allergy, are allergic to fish) • This fact is nowadays more and more meaningful, because the consumption of fish is increasing • Fish more often sensitize children and this allergy does not recede with age.

49. Symptoms can appear not only after consumption, but also in the inhalatory way (fumes of fried or cooked fish) and during skin contact.

50. Attention !!! • Fish contains histamine, so after their consumption, patients can have a toxic reaction.