allergy in alabama n spring - flowering grasses, ornamental flowers, not pine pollen n fall –...
Post on 19-Dec-2015
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ALLERGY IN ALABAMAALLERGY IN ALABAMA
SPRING - FLOWERING GRASSES, SPRING - FLOWERING GRASSES, ORNAMENTAL FLOWERS, NOT PINE ORNAMENTAL FLOWERS, NOT PINE POLLENPOLLEN
FALL – RAGWEED NOT GOLDENRODFALL – RAGWEED NOT GOLDENROD YEAR ROUND-ANIMALYEAR ROUND-ANIMAL DANDER AND DANDER AND
SALIVASALIVA SUMMER/HUMIDITY -MOLDS/ FUNGUSSUMMER/HUMIDITY -MOLDS/ FUNGUS
RAGWEED GOLDENROD
Welcome to Alabama
Timothy Grass
Bermuda Grass
HYPERSENSITIVITY REACTIONSHYPERSENSITIVITY REACTIONS
TYPE I- ALLERGIC CONJUNCTIVITISTYPE I- ALLERGIC CONJUNCTIVITIS TYPE II- MYASTHENIA GRAVISTYPE II- MYASTHENIA GRAVIS TYPE III-UVEITIS? SJOGRENSTYPE III-UVEITIS? SJOGRENS TYPE IV- CONTACT DERMATITIS & TYPE IV- CONTACT DERMATITIS &
GPCGPC
Allergic conjunctivitis
Myasthenia Gravis
Sjogrens
Phlyctenular Conjunctivitis
ALLERGY CASCADEALLERGY CASCADE
IGE BINDS ANTIGENIGE BINDS ANTIGEN
FORMS DIMER AT SURFACE OF MAST CELLFORMS DIMER AT SURFACE OF MAST CELL
MAST CELL DEGRANULATESMAST CELL DEGRANULATESHISTAMINEHISTAMINEPROSTAGLANDINSPROSTAGLANDINSTHROMBOXANESTHROMBOXANESLEUKOTRIENESLEUKOTRIENESVASOACTIVE AMINESVASOACTIVE AMINESEOSINOPHIL ATTRACTING FACTOREOSINOPHIL ATTRACTING FACTOR
STAGES OF ALLERGIC DISEASESTAGES OF ALLERGIC DISEASE
EARLY PHASEEARLY PHASE MAST CELLS AND PRODUCTSMAST CELLS AND PRODUCTS
LATE PHASELATE PHASE LEUKOCYTESLEUKOCYTES T -LYMPHOCYTEST -LYMPHOCYTES
CHRONIC PHASECHRONIC PHASE T CELLS FACTORST CELLS FACTORS
MAST CELLSMAST CELLS
DIFFERENT TYPES OF MAST CELLSDIFFERENT TYPES OF MAST CELLS CHYMASE POSITIVECHYMASE POSITIVE TYPTASE POSITIVE (all mast cells, most TYPTASE POSITIVE (all mast cells, most
common ocular surface, prevents clotting) common ocular surface, prevents clotting) CHYMASE AND TYPTASE (most CHYMASE AND TYPTASE (most
common in non allergic)common in non allergic)
calcium
Inside Mast Cells
Increase synthesis of phosopholipase A-Increase synthesis of phosopholipase A-production of arachodonic acidproduction of arachodonic acid
Increase protein kinase production-Increase protein kinase production-necessary for degranulationnecessary for degranulation
Increase in intracellular calcium levelsIncrease in intracellular calcium levels 24-48 hours increase cytokine production24-48 hours increase cytokine production
CGMPCGMP
INCREASES MAST CELL INCREASES MAST CELL DEGRANULATIONDEGRANULATION
ALPHA AGONISTS INCREASEALPHA AGONISTS INCREASE BY DECREASING CAMPBY DECREASING CAMP
CHOLINERGICS INCREASE CGMPCHOLINERGICS INCREASE CGMP
CAMPCAMP
DECREASES DEGRANULATIONDECREASES DEGRANULATION HISTAMINE INCREASESHISTAMINE INCREASES BETA ADRENERGIC DRUGS BETA ADRENERGIC DRUGS
INCREASEINCREASE ADENYL ADENYL
CYCLASE(PROSTAGLANDINS)CYCLASE(PROSTAGLANDINS)
CAMP CGMP
cAMP cGMP Balance
PROSTAGLANDIN D2PROSTAGLANDIN D2
PRIMARY OCULAR PG IN PRIMARY OCULAR PG IN HYPERSENSITIVITYHYPERSENSITIVITY
CHEMOSISCHEMOSIS REDNESSREDNESS DISCHARGEDISCHARGE EOSINOPHIL CHEMOTAXISEOSINOPHIL CHEMOTAXIS
BIOLOGIC ACTIVITY OF BIOLOGIC ACTIVITY OF PROSTAGLANDINSPROSTAGLANDINS
PGFPGF22 & PGD & PGD22- BRONCHOSPASM- BRONCHOSPASM
PGIPGI22- PULMONARY DILATION & < - PULMONARY DILATION & <
PLATELET AGGREGATIONPLATELET AGGREGATION PGEPGE2 2 BRONCHODILATORBRONCHODILATOR
PGEPGE11 &PGE &PGE22 -> NERVE SENSITIVITY -> NERVE SENSITIVITY
VASODILATIONVASODILATION TXATXA22-VASOCONSTRICTION-VASOCONSTRICTION
BIOLOGIC ACTIVITY OF BIOLOGIC ACTIVITY OF LEUKOTRIENESLEUKOTRIENES
LTBLTB44
PMN ATTRACTANTPMN ATTRACTANT EOSINOPHIL ATTRACTANTEOSINOPHIL ATTRACTANT > > VASCULAR PERMEABILITYVASCULAR PERMEABILITY >.>.EDEMAEDEMA COFACTOR W/ PGECOFACTOR W/ PGE22 & PGD & PGD22
LTCLTC44, LTD, LTD44, LTE, LTE44
BRONCHOCONSTRICTORSBRONCHOCONSTRICTORS MYOCARDIAL DEPRESSANTSMYOCARDIAL DEPRESSANTS
EOSINOPHILS-ACTIVATIONEOSINOPHILS-ACTIVATION
EOSINOPHIL CHEMOTACTIC EOSINOPHIL CHEMOTACTIC FACTOR(LTBFACTOR(LTB44))
HISTAMINASE DECREASESHISTAMINASE DECREASES PHOSPHOLIPASE DECREASESPHOSPHOLIPASE DECREASES ARYL SULFATASE DECREASESARYL SULFATASE DECREASES PLATELET ACTIVATING FACTOR PLATELET ACTIVATING FACTOR
STRONGLYATTRACTSSTRONGLYATTRACTS
EOSINOPHILSEOSINOPHILS
MAJOR BASIC PROTEIN (anti-parasite)MAJOR BASIC PROTEIN (anti-parasite) HIGHLY TOXIC TO EPITHELIUMHIGHLY TOXIC TO EPITHELIUM INCREASES MAST CELL INCREASES MAST CELL
DEGRANULATIONDEGRANULATION EOSINOPHIL CATIONIC PROTEINEOSINOPHIL CATIONIC PROTEIN EOSINOPHIL PEROXIDASE EOSINOPHIL PEROXIDASE
HISTAMINEHISTAMINE
BRONCHOSPASM BRONCHOSPASM VASODILATORVASODILATOR INCREASES VASCULAR INCREASES VASCULAR
PERMEABILITYPERMEABILITY ACTIVATES NERVE TERMINALSACTIVATES NERVE TERMINALS
PLATELET ACTIVATING FACTOR PLATELET ACTIVATING FACTOR RELEASING CELLSRELEASING CELLS
BASOPHILSBASOPHILS MAST CELLSMAST CELLS EOSINOPHILSEOSINOPHILS MONOCYTES/MACROPHAGESMONOCYTES/MACROPHAGES PMN’SPMN’S
T CELL MEDIATED FACTORST CELL MEDIATED FACTORS
IL-3 INDUCES MAST CELL IL-3 INDUCES MAST CELL DEGRANULATIONDEGRANULATION
IL-4 FACILITATES IIL-4 FACILITATES IGGE PRODUCTION E PRODUCTION
BY B LYMPHOCYTESBY B LYMPHOCYTES IL-5 STIMULATES EOSINOPHIL IL-5 STIMULATES EOSINOPHIL
PROLIFERATIONPROLIFERATION
OCULAR RESPONSE IN ARACHADONIC OCULAR RESPONSE IN ARACHADONIC ACID PATHWAYACID PATHWAY
CYCLO-OXYGENASE PATHWAYCYCLO-OXYGENASE PATHWAY LID SWELLINGLID SWELLING CHEMOSISCHEMOSIS VASODILATIONVASODILATION
LIPO-OXYGENASE PATHWAYLIPO-OXYGENASE PATHWAY CHRONIC INFLAMMATIONCHRONIC INFLAMMATION
OCULAR SURFACE HISTAMINE OCULAR SURFACE HISTAMINE RECEPTORSRECEPTORS
HH1 1 RECEPTORS- NEURONAL RECEPTORS- NEURONAL
PRODUCES ITCHING PRODUCES ITCHING
HH2 2 RECEPTORS- VASCULAR RECEPTORS- VASCULAR
PRODUCES REDNESSPRODUCES REDNESS
DIAGNOSIS OF ALLERGYDIAGNOSIS OF ALLERGY
RAST (RADIOALLERGOSORBANT RAST (RADIOALLERGOSORBANT ASSAY)ASSAY)
PRICK TESTSPRICK TESTS INDERATION TESTSINDERATION TESTS DIRECT CHALLENGEDIRECT CHALLENGE CONJUNCTIVAL CHALLENGECONJUNCTIVAL CHALLENGE
CONJUNCTIVAL CHALLENGE FDA REQUIREMENT FOR NEW DRUGSFDA REQUIREMENT FOR NEW DRUGS ALLERGEN APPLIED TO CONJALLERGEN APPLIED TO CONJ REDNESS,WATERING,CHEMOSIS REDNESS,WATERING,CHEMOSIS
GRADEDGRADED RETEST WITH PRETREATMENTRETEST WITH PRETREATMENT
DRUG ACTIONS
MAST CELL STABILIZERSMAST CELL STABILIZERS STEROIDSSTEROIDS ANTIHISTAMINESANTIHISTAMINES ASPIRINASPIRIN NONSTEROIDALSNONSTEROIDALS VASOCONSTRICTORSVASOCONSTRICTORS THEOPHYLLINETHEOPHYLLINE
STEROID ACTIONS
DECREASE mRNADECREASE mRNA INHIBITS PHOSPHOLIPASE AINHIBITS PHOSPHOLIPASE A POTENTIATES B ADRENERGICSPOTENTIATES B ADRENERGICS CONSTRICTS BLOOD VESSELSCONSTRICTS BLOOD VESSELS DECREASES CHEMOTAXISDECREASES CHEMOTAXIS LYMPHOPENIALYMPHOPENIA DECREASES MACROPHAGE FUNCTIONDECREASES MACROPHAGE FUNCTION
GI, RENAL, PLATELET, MACROPHAGE GI, RENAL, PLATELET, MACROPHAGE DIFFERENTIATIONDIFFERENTIATION
STEROID EFFECTS
DECREASE MESSENGER RNADECREASE MESSENGER RNA
INHIBITS PHOSPHOLIPASE A PRODUCTIONINHIBITS PHOSPHOLIPASE A PRODUCTION
INCREASES CAMPINCREASES CAMP
POTENTIATES B ADRENERGIC DRUGSPOTENTIATES B ADRENERGIC DRUGS
CONSTRICTS BLOOD VESSELSCONSTRICTS BLOOD VESSELS
DECREASES CHEMOTAXISDECREASES CHEMOTAXIS
LYMPHOPENIALYMPHOPENIA
DECREASED MACROPHAGE FUNCTIONDECREASED MACROPHAGE FUNCTION
DRUG ACTIONS STEROIDS-MULIPLE EFFECTSSTEROIDS-MULIPLE EFFECTS
MAST CELL STABILIZERS-INHIBIT CALCIUM MAST CELL STABILIZERS-INHIBIT CALCIUM ENTRY INTO CELLENTRY INTO CELL
ANTIHISTIMINES- EFFECT AFTER RELEASEANTIHISTIMINES- EFFECT AFTER RELEASE
ASPIRIN - INHIBITS CYCLO-OXYGENASE ASPIRIN - INHIBITS CYCLO-OXYGENASE PATHWAYPATHWAY
NONSTEROIDALS- INHIBIT CYCLO-NONSTEROIDALS- INHIBIT CYCLO-OXYGENASE PATHWAYOXYGENASE PATHWAY
COX 1 AND COX 2
COX 1 PRESENT AT STEADY STATE COX 1 PRESENT AT STEADY STATE LEVELSLEVELS HOMEOSTATIC FUNCTIONSHOMEOSTATIC FUNCTIONS
COX 2 ASSOCIATED WITH COX 2 ASSOCIATED WITH INFLAMMATIONINFLAMMATION
VIOXX, CELEBREX, BEXTRAVIOXX, CELEBREX, BEXTRA PREFERENTIAL VS SPECIFICPREFERENTIAL VS SPECIFIC
DRUG EFFECTS
VASOCONSTRICTORS -REVERSE VASOCONSTRICTORS -REVERSE VASODILATIONVASODILATION
THEOPHYLLINE- INCREASE CAMPTHEOPHYLLINE- INCREASE CAMP
FOOD ALLERGYFOOD ALLERGY
VARIABLE EFFECT DUE TO VARIABLE EFFECT DUE TO ABSORBTIONABSORBTION
USUALLY LOCAL GI EFFECTUSUALLY LOCAL GI EFFECT CAN BE IDIOSYNCRATICCAN BE IDIOSYNCRATIC
ALLERGIC SKIN REACTIONSALLERGIC SKIN REACTIONS
ERYTHEMA-REDNESSERYTHEMA-REDNESS FLARE-DIFFUSE REDNESS AROUND FLARE-DIFFUSE REDNESS AROUND
WHEALWHEAL WHEAL-LOCALIZED WHEAL-LOCALIZED
EDEMA,TYPICAL LIDEDEMA,TYPICAL LID ANGIOEDEMAANGIOEDEMA
DRUG ALLERGYDRUG ALLERGY
TOXICITYTOXICITY INTOLERANCEINTOLERANCE IDIOSYNCRATICIDIOSYNCRATIC ALLERGICALLERGIC
IDIOSYNCRATIC REACTIONSIDIOSYNCRATIC REACTIONS
DIRECT MEDIATOR RELEASEDIRECT MEDIATOR RELEASE DIRECT ACTIVATION OF BIOLOGIC DIRECT ACTIVATION OF BIOLOGIC
SYSTEMSYSTEM ENZYME DEFECTENZYME DEFECT UNDERLYING DISEASEUNDERLYING DISEASE SIMILAR TO ANAPHYLAXIS?SIMILAR TO ANAPHYLAXIS?
Anaphylaxis
TREATMENT OF ALLERGYTREATMENT OF ALLERGY
AVOIDANCEAVOIDANCE THERAPEUTIC AGENTSTHERAPEUTIC AGENTS
CHRONICCHRONIC ACUTEACUTE
IMMUNOTHERAPYIMMUNOTHERAPY
Effects of Immune Therapy