Sehar Jaferani

Maria Pererria
Kritika Singh
Aldrin Toscano

An allergy is a hypersensitivity disorder of

the immune system.
It is becoming more common because of increasing
urbanization and changes in diet and lifestyle.
It is important to use the term allergy correctly. It
is incorrect to use it where lgE is not involved. This
is especially true for so-called food allergy.

IgE was identified first by K and T Ishizaka.

A serum level of this Ab is about 0.4-1 microgram/ml.
It does not increase very much even in the most severe cases.
This Ab has no hinge region but has an additional constant
domain CH4.
This enables the Fc portion of the molecule to bind to
glycoprotein receptors on basophils and mast cells.
Though its half life in serum is 2-3 days on being bound to a
mast cell or basophil its half life increases by a several weeks.

Mast cells and Basophils

Basophils are very low in circulation (0.5 1%). Mast

cells are found throughout the connective tissue. Some
tissues like mucosal surfaces and GI tract have high
concentrations of mast cells. Apart from releasing lytic
enzymes they also release a large number of cytokines
thus affecting a broad spectrum of biological processes
in the body.

IgE binds a receptor specific for the Fc region of the heavy chain.
Two classes of receptors are present designated Fc R I and Fc R II.
Fc R I is called the high affinity receptor for IgE binding. Between 40 to
90,000 Fc R I receptors are present on a basophil. Fc R I contains 4
polypeptide chains: and and 2 identical chains.
The external region of the chain contains two domains of 90 amino acids
that are homologous with the immunoglobulin like structure.
Fc R I interacts with CH3 and CH4 domains of the IgE molecule via the 2
immunoglobulin like structure of the chain.
The chain is a transmembrane protein and functions as a linker.

IgE CROSSLINKAGE INITIATES DEGRANULATION:

Most often mast cell degranulation occurs by allergen crosslinkage
of bound IgE.
But degranulation can also occur due to other processes like effect
of anaphylatoxins (C3a, C4a, and C5a) and various drugs.
Degranulation begins when allergens crosslink IgE that is bound to
the Fc receptor on a mast cell surface.
Plain binding of IgE to Fc receptors has no effect on mast cells,
cross linking is a necessity.
Further experimentation has revealed that the major step is cross
linkage of two or more Fc R I receptors with or without bound
IgE.
Thus IgE can be bypassed in activation of mast cells. Also
concurrent with this conclusion is that if the Fc R I receptors
crosslinkage is crucial for mast cell degranulation then even the
presence of an allergen is not necessary as this cross linkage can be
made occur even without an allergen being present.

Common symptoms
Affected organ

Symptom

Nose

swelling of the nasal mucosa (allergic

rhinitis) runny nose, sneezing

Sinuses

allergic sinusitis

Eyes

redness and itching of

the conjunctiva (allergic conjunctivitis,
watery

Airways

Sneezing,
coughing, bronchoconstriction ,
sometimes outright attacks of asthma,
in severe cases the airway constricts
due to swelling known as laryngeal
edema

Ears

feeling of fullness, possibly pain, and

impaired hearing

Skin

rashes, such as eczema and hives

(urticaria)

Gastrointestinal tract

abdominal
pain, bloating, vomiting, diarrhea

Allergens

Substances that cause allergies are called allergens.

Over 700 environmental allergens have been identified, characterized
and purified.
These are important for a modern approach to diagnosis and treatment
of allergies.
Differentiation must be made between different allergens whose
amino acid sequence has been completely established.

Important Allergen Groups

1.
2.

3.

Indoor Allergens - House dust, Mites, Cat, Dog, Cockroaches.

Outdoor Allergens - Tree pollen, Grass & Grain Pollen, Herbs,
Weeds
Foods Chicken, Egg, White Cow Milk, Peanuts, Sea food Insect,
Venoms, Bees, Wasps, Molds, Alternaria, Cladosporium,
Aspergillus.

Detection of allergies

Allergy is commonly assessed by skin testing.

Small amounts of potential antigens are given by
intradermal injections.
If a person is allergic to the allergen, local mast cells
degranulate and the histamines and other mediators released
produce a wheal and flare reaction within 30 minutes.
This test is very cheap and allows screening of many
allergens at one time.
Disadvantage is it can sensitize the individual to a
particular allergen and in rare cases induce anaphylactic
shock.
Another method is detection of total serum IgE levels by
Radioimmunosorbent test (RIST). This can detect
nanogram levels of IgE.

Peanut Allergy

Peanuts are one of the food allergens most

commonly associated with anaphylaxis, a sudden
and potentially deadly condition that requires
immediate attention and treatment.

Case Study
Name: Shinto Anthony
Age: 35

Patient had a severe peanut allergy till the age of 15. The allergy was
outgrown after an immunotherapy.
The symptoms observed during the allergic reactions were swelling of
face, mostly lips. Also clogging of oesophagus, trouble in breathing,
skin rashes and swallowing were observed.
Her allergist recommended avoiding raw, cooked peanuts and all
peanut containing products.
Her allergist also recommended some herbal remedies for the skin
rashes and clearing of the throat.

Case Study
Name: Rosu Anthony
Age: 6

The symptoms observed during the allergic reactions were

swelling of lips. Also clogging of oesophagus, chest pains
trouble in breathing and swallowing were observed.
Her allergist recommended avoiding raw, cooked peanuts and
all peanut containing products.
Her allergist also recommended Piriteze Cetirizine
hydrochloride
Side effects of the drug observed in the patient were
sleepiness, diarrhea and headache.
Name of the drug: Piriteze
Generic Name: Cetirizine hydrochloride

Tree Nut Allergy

An allergy to tree nuts is one of the most common food

allergies. Along with peanuts and shellfish, it is also one of
the food allergens most frequently linked to anaphylaxis, a
potentially life-threatening reaction that impairs breathing and
can send the body into shock.

Case Study
Name: Hector Mercado
Age: 38

Patient is allergic to cashew nuts and almonds.

The symptoms observed during the allergic reactions were running nose, sneezing,
swelling, chest pains trouble in breathing and swallowing were observed.
His allergist recommended avoiding raw, cooked tree nuts and tree nuts containing
products.His allergist also recommended epinephrine or adrenalin
Side effects of the drug observed in the patient were headaches and shortness of
breath.
Name of the drug: Adrenalin/Epinephrine
Epinephrine is a chemical that narrows blood vessels and opens airways in the
lungs. These effects can reverse severe low blood pressure, wheezing, severe skin
itching, hives, and other symptoms of an allergic reaction.
The following serious side effects may include:
Sweating,Nausea and vomiting,Pale skin,Feeling short of
breath,DizzinessWeakness or tremors.

Wheat Allergy

Wheat allergies, like hay fever and other allergies, develop

when the bodys immune system becomes sensitized and
overreacts to something in the environment. Generally, you
are at greater risk for developing an allergy to any food,
including wheat, if you come from a family in which allergies
or allergic diseases, such as asthma or eczema, are common

Case Study
Name: Radha Sharma
Age: 10

The symptoms observed during the allergic reactions were

running nose, difficulty in breathing, nausea & vomiting
Her allergist recommended avoiding wheat and wheat
containing products.
Her allergist also recommended Epinephrine
Side effects of the drug observed in the patient were
sleepiness, diarrhea and headache.
Name of the drug: Epinephrine/Adrenalin

Epinephrine (adrenaline) is the first-line treatment for anaphylaxis, which can occur
within seconds or minutes, can worsen quickly and can be deadly. In this type of
allergic reaction, exposure to the allergen causes the whole-body release of a flood
of chemicals that can lead to lowered blood pressure and narrowed airways, among
other serious symptoms.
Epinephrine should be used immediately if you experience severe symptoms such
as shortness of breath, repetitive coughing, weak pulse, generalized hives, tightness
in the throat, trouble breathing or swallowing, or a combination of symptoms from
different body areas such as hives, rashes or swelling coupled with vomiting,
diarrhoea or abdominal pain. Repeated doses of epinephrine may be necessary.
If you are uncertain whether a reaction warrants epinephrine, use it right away,
because the benefits of epinephrine far outweigh the risk that a dose may not have
been necessary.
Common side effects of epinephrine may include:
Anxiety
Restlessness
Dizziness
Shakiness
Abnormal heart rate or rhythm
Fluid build up in the lungs.

Pollen Allergy
Pollen comes from trees, grasses, flowers and
weeds. People can be allergic to different types of
pollen. For instance, some people are allergic to
pollen from only beech trees; others are allergic to
pollen from only certain kinds of grasses.

Case Study
Name: Aidah Jaffri
Age: 15

The symptoms observed during the allergic reaction were running nose, itchy eyes, sneezing
and headache
Patient got asthma because of pollen allergy
Her allergist recommended avoiding visits to botanical gardens.
Her allergist also recommended Citoval 10mg
Side effects of the drug observed in the patient were fatigue, sleepiness and weakness.
Drug Name/Brand Name: Citoval 10mg
Generic Name: Cetrizine 10mg

Patients using Citoval may encounter unwanted side effects such as:

Drowsiness,Fatigue,Dizziness,Tremors and Insomnia

Penicillin Allergy

Despite its efficacy, some people steer clear of penicillin for

fear of experiencing an allergic reaction to the medication.
Understanding penicillin allergies is important for a variety of
reasons.
For certain conditions, penicillin is the best (or only proven)
therapy.
Some patients need penicillin because they are allergic to
other types of antibiotics.

Case Study
Name: Madhura Patel
Age: 19

Patient is allergic to Penicillin

The symptoms observed during the allergic reactions were tightness in
the chest and difficulty breathing, swelling of the tongue, throat, nose
and lips, dizziness and fainting or loss of consciousness
His allergist recommended immunotherapy
His allergist also recommended epinephrine or adrenalin
Side effects of the drug observed in the patient were blurred vision,
chest pain or discomfort, chest tightness or heaviness
Drug Name: Adrenalin

Allergy to Paraphenylenediamine (PPD)

Paraphenylenediamine (PPD) is a chemical substance that is

widely used as a permanent hair dye.
It may also been found in textile or fur dyes, dark coloured
cosmetics, temporary tattoos, photographic developer and
lithography plates, photocopying and printing inks, black
rubber, oils, greases and gasoline.

Case Study
Name: Marium Ibrahim
Age: 50
The symptoms observed during the allergic reactions were
swelling of the face (forehead, neck, sideburns, nose, lips) and
pus formation
His allergist recommended avoiding hair dyes containing PPD
His allergist also recommended epinephrine and an antiinflammatory ointment
Side effects of the drug observed in the patient were nausea
and headache
Drug Name: Epinephrine

Whether allergy sufferers have symptoms that are mild or severe, they really only want one
thing: relief.
So its particularly distressing that the very medication they hope will ease symptoms can
cause different, sometimes more severe, allergic responses.
An allergic response to a medication for allergies can often go undiagnosed.
This presentation sheds light on adverse responses to topical skin preparations; helps identify
patients who are hypersensitive to anti-histamines, and identifies allergic responses to various
drugs used in the treatment of asthma and allergies.
Allergy to a topical cortico-steroid may not be evident right away because its job is to bring
down inflammation.
But the patients should suspect an allergy to their medication if: their rash doesnt respond, it
gets worse with the medication, or improves initially, then flares.
Other topical medications that can cause allergies are antibiotics like bacitracin and neomycin
found in adhesive bandages anesthetics and anti-fungals.
For most antihistamine medications, a patch test can be done to determine if the patients are
reacting to: the actual drug component, the preservatives, the fragrance, or the delivery
system of the drug.
The majority of anti-histamine reactions affect the skin, appearing as hives or a rash.

The government should fund hospitals for an allergy

department, where people can take free allergy test
People suffering from allergies or the ones who have had
placebo attacks should take an allergy and asthma test once
in a while in an allergist clinic or a hospital and take a look
at your symptoms and see if you should find relief.
Patients should track and manage EIB symptoms over time.
(Shortness of breath, wheezing, coughing, chest tightness
and unusual fatigue are all symptoms of exercise-induced
bronchoconstriction (EIB). Most people with asthma have
EIB. But, its also possible to have EIB and not have asthma)
The patients should track and manage their nasal allergy
symptoms, and share their reports with an allergist.