diease

Hypersentivity reactions


OVERVIEW OF Hypersentivity reactions :

Allergy is an exaggerated response of the body’s immune system to the foreign antigen.They compromise a range of disorders from mild to life threatening and affect many organs.          


EPIDEMIOLOGY :

Hypersensitivity reactions accounts for 20-30% of the medical emergencies


CAUSES :

SEASONAL HYPERSENSITIVITY RHINITIS  include the hypersensitivity reactions to the pollen leading to inflammation of the mucosal surfaces of the nose and eye(conjunctivitis).It is also known as the Hay Fever.

Clinical symptoms include sneezing,watery nose and eyes.This can be avoided by staying away from the pollen.

Dust mites

Dust mites are minute organisms that lives in the dust and also in pillows,windows,bedsheets and other household items.This is similar to the pollen allergies and try to keep the house dust free.

Molds

They are small fungus like organisms found in air. Mold is a common trigger for allergies. Mold can also be present indoors such as  the basement, kitchen, or bathroom, as well as outdoors in grass, leaf piles, hay, mulch or under mushrooms.

Animal dander

The proteins secreted from the sweat gland are seen as dander in pet skin and sometimes from the salivary gland of the pet.It act as an allergen.The best precaution is usage of air filter at home and keep your pet cleaned.

Latex

Some people have Latex allergies.Main source is from gloves used in surgeries or for home cleaning.The main manifeatations include itchiness,rashes on the skin surface.infkammation of the skin..

Certain foods

Food allergens include cow milk mainly unpasteurized, egg white, cereals,grains.fish and sea foods.

If you have a food allergy, your symptoms include itching, hives, nausea, vomiting, diarrhea, breathing difficulties and swelling around your mouth.

Insect venom (stings)

The main manifestation include redness , swelling,pain around the bite area.

The most serious reaction to an insect sting is an hypersensitivity one, which needs immediate medical attention. Symptoms of an hypersensitivity reaction to an insect sting include


PATHOPHYSIOLOGY :

The immune system of the body mainly focus on the body’s two subsets of T-lymphocytes, known as T helper cells TH1 and TH2. In the normal immune response, TH1 cells releases the mediators which aids the body to defend against invasion from parasites, bacteria and viruses.

In hypersensitivity individuals, TH2 cells and their mediators encourage the immune system to recognise allergens as an invader, and produce a response against the foreign bodies.Some states that the people living in sterile environment free of exposure to antigen develops reduced immune response to fight against them.

For an allergy to take place,the allergen must be come into contact with the body.. Antigen-presenting CELLS SUCH as the macrophages and dentritic cells which are present in the mucosal surface of the cells sensitize the antigen.. Allergen enters into the immune system in many ways such as through inhalation,through skin contact, and antigen presenting cells sensitize these allergens and provoke an immune response and this allergen is processed and displayed on the surface of the antigen presenting cells. These cells then migrate to the T lymphocytes and presents the antigen to them which in turn activates B cells to secerete IgE antibodies. This IgE antibodies which is specific to the allergen comes into contact with mast cells on the mucosal surface and basophils on the blood.

After the period of sensitisation described above there is a period of latency, and on subsequent re-exposure to the allergen the hypersensitivity response is triggered: allergen cross-links with the IgE on the surfaces of the mast cell or basophil, causing the cell to ‘degranulate’ or release inflammatory mediators. These include largely histamine and other mediators, including cysteinyl leukotrienes, prostaglandins and kinins. They have different actions in terms of symptoms in different organs

TYPES OF hypersensitivity reactions:

TYPE 1 -This reaction is termed as ANAPHYLACTIC REACTION . It is mediated by the IgE antibodies in response to an antigen.

Eg : Administartion of drugs,

sting by wasp or bee,

Hay fever(seasonal hypersensitivity rhinitis) due to pollen sensitization of conjunctiva and nasal passages.

Bronchial asthma due to inhaled allergens such as dust,pollens

Food allergies

Cutaneous(skin) anaphylaxis leading to urticaria.

TYPE 2: (cytotoxix or cytolytic reactions)-

In this reaction humoral antibodies and complement system(a type if immune response) comes into the role.This reaction results in lysis of target cells.Cells take part in this reaction include  tissue macrophages,platelets,natural killer cells ,neutrophils and eosinophils and amin antibodies taking place in this reaction include IgG and IgM.This reaction appears after 15-30 minutes after the exposure.

Eg:Transfusion Reactions,Autoimmune haemolytic anaemia,Idiopathic Thrombocytopnic Purpura,Drug induced cytotoxic antibodies,Haemolytic disease of the Newborn(Erythroblastosis foetalis),Graves disease,Myasthenia Gravis,Type 1 diabetes mellitus.

TYPE 3:(Immune complex Mediated)-

Participation of IgG and IgM antibodies,neutrophils,mast cells and complement system plays an important role in this type of reaction.Duration of the reaction is 6 hours after exposure to the antigen.

Eg:Immune complex Glomerulonephritis,Good Pasteur syndrome,Systemic Lupus Erythematosis,Rheumatoid artheritis,Framer’s Lung.

TYPE 4:(Delayed type or Cell mediated Reaction)-

The cells takes part in these reaction include Mast cells,Basophils,Macrophages and CD8+ cells.


COMMON CLINICAL SIGNS AND SYMPTOMS :

Difficulty breathing, cough.

Generalized (widespread) hives that appear as a red, itchy rash that spreads to areas other than the area that was stung.

Swelling of your face, throat or mouth tissue.

Wheezing or difficulty swallowing.

Restlessness and anxiety.

Rapid pulse.

Dizziness or a sharp drop in your blood pressure.


DIAGNOSTIC :

SKIN PRICK TEST:

           Several markings are made on the patient skin and each mark should be 2 cm apart.

         Hypersensitivity solution is taken.

          A drop is placed on the skin and the prick is made with the lancet and the reactions happens within 15-20 mints and the results are checked and graded accordingly.

 Intradermal skin test

It is similar to skin test in which the the small amount of allergen is injected into the skin.This test is done if the prick test is negative.

Challenge test

This test is done in food allergy cases.The patient is asked to consume small amount of the allergen and the effects are supervised under healthcare proffesional

Blood test

In this test, a sample of your blood is drawn. This test is also called serum IgE testing or ImmunoCAP test.InnumoCAP test is based in the fluoro Immunoassay and complement system.It is used to measure the amount of antibodies produced in response.

Patch test

This test involves placing a small amount of possible allergens on your skin (usually your back) and then covering each of them with a bandage. Your allergist may perform this test if they suspect an allergy in which the hypersensitivity reaction is delayed. The bandages are left in place for two to three days before you return to the office to have the bandages removed and your skin examined.

Component-Resolved Diagnostic Tests or Molecular-Based Diagnosis:s

        This test is done in food allergy patients to patients to obtain what type of proteins they are hypersensitivity to it.

Mast cell Tryptase Levels Assessment:

      The serum level of  β-tryptase  can be used to assess anaphylaxis and mast cell activation.


TREATMENT AND PROGNOSIS :

Asthma:Bronchodilators

Dermatitis:Corticosteroids and oral histamines

Adrenaline-Anaphylactic reactions

Immunotherapy-it is indicated in patients who couldnt able to control the hypersensitivity reactions.

Decongestants-helps to cure running nose in hypersensitivity rhinitis

Duplimab- used in the treatment of dermatitis

cetrizine,Chlorpheniramine - used in the treatment of hypersensitivity rhinitis.

corticosteroids -Hives

Epinephrine-Anaphylaxis reaction.


PREVENTION :

Stay away from the allergens

If reactions occurs start the treatment early.


Medicines used in the Treatment :

Davidson princple and manual of general medicine-22nd edition

Harshmohan Pathology -4 th edition

http://medicinenet.com

http://cdcgov.in

http://who.in