Documente Academic
Documente Profesional
Documente Cultură
Aspecte clinice
Diana Deleanu
Boli Alergice
Socul anafilactic
Alergii cutanate
• Dermatita atopica – tipul IV Hs
• Dermatita de contact – tipul IV HS
• Urticaria (nivel straturi superficiale) si
angioedemul (la nivelul startului profund al
dermului)– tipul I HS
ACD group 2009,20;149-60
• Alergenii de Contant (contact direct)
• Tipul I HS: urticarie, angioedem
(polen, medicamente etc)
Proteine Alimente
Ser strain Nucile de copac
Polenul de plante Fructele de mare
Spori de mucegaiuri
Par, piele de animale
Aspecte Clinice ale HS Imediate
Organ Boala Simptome Alergen importanti Calea de
patrundere
Plamin Astm Wheezing, Polen, praf, Inhalare
dispnee, tahipnee animale
Predispozitie Genetica
Sensibilizare
Re-expunere
Simptome
Alergia Alimentara -
Prevalenta
• 5 – 8% la copii mici
• 2 – 3% la adolescenti si adulti
• 1-2% la adulti
• Cel putin 11 milioane de americani
afectati
• Prevalenta este in crestere (abrupt)
Prevalenta increstere in bolile alergice,
inclusiv alergia alimentara
Internarile dintre 1990/91 - 2000/01 in Anglia.
Arahide – 20%
29
Simptome de Alergie
Diagnostic
4 – Rar progreseaza
dincolo de gura
Denumire
• Sindrom oral – Sindrom alergic oral (1987, de catre
Almot et al)
• Sindrom polen-fructe – Sindrom alergic polen-fructe
(polen-fructe-legume)
• Au mai fost utilizate: sindromul de urticarie de
contact la telina (1983); sindromul telina-morcov-
artemisia-condimente (1985); hipersensibilitate de
contact la alimente (2008); sindrom oral-polen (2003)
• Sindromul latex-fructe
Patogeneza
• Reactivitatea incrucisata (cross-reactivitatea) apare cind un Ab
specific format ca raspuns la un epitop reactioneaza cu unul similar
sau identic de la alt antigen
Component-resolved
Diagnosis (CRD)
B
A
E
C D
Ebo et al.,and
CRD University
ISAC | of
DeAntwerp
Boer,
Nieuwhof, Bons and 38
Menheere | April 23, 2013
Alergenii
(mesteacan si fructe)
RAST
Storage protein
intra-allergenic heterogeneity
Storage protein
Storage protein
Profilin
Storage protein
Storage protein
Component-resolved
CRD and ISAC | De Boer,
Nieuwhof, Bons and 41
Diagnosis (CRD)
Menheere | April 23, 2013
Complications Detecting specific IgEs - 1
intra-allergenic heterogeneity
inter-allergenic homogeneity
Profilins Ara h 5
Allergy 2006;61:461
Esofagita eozinofilica
Gastroenterita eozinofilica
1 - Joint Task Force on Practice Parameters, the American Academy of Allergy, Asthma and Immunology, and the
Joint Council of Allergy, Asthma and Immunology. Executive summary of disease management of drug
hypersensitivity: a practice parameter. Ann Allergy Asthma Immunol. 1999 Dec;83(6 Pt 3):665-700.
49
Introducere
Reactii Adverse la Medicament
Tip A (predictibile)2,3 Tip B (nepredictibile)2,3
(80%)
Pseudoalergic
Idiosincrazia
Intoleranta (AINS)
2 - Riedl MA, Casillas AM. Adverse drug reactions: types and treatment options. Am Fam Physician. 2003 Nov 1;68(9):1781-90.
3 - Vervloet D, Durham S. Adverse reactions to drugs. BMJ. 1998 May 16;316(7143):1511-4.
4 - Gruchalla RS. Drug metabolism, danger signals, and drug-induced hypersensitivity. J Allergy Clin Immunol. 2001
50
Oct;108(4):475-88.
Clasification of Drug Allergy
Real life drug - penicillin
Comments Reaction Mechanism Gel &
Coombs
Skin test anaphylaxis IgE mediated Type I
desensitization
19.7% of the
inquired
mentioned
feeling sick after
taking a drug at
least once during
his/her life.
56
Diagnostic
• Istoric (corelarea dintre medicament si datele
din literatura! ) – nu totdeauna reala!!!
• Investigatii
1. in vitro: Immunoassays -Ig, triptaze;
Lymphocytes transformation test (LTT), Flow-
cytometry; Basophil activation test (BAT)
2. in vivo: skin tests, provocation tests
• Monitorizarea raspunsului (supravegherea)
Characteristic chronology of drug-induced eruptions.
separation at 1 hour into immediate or nonimmediate
reactions not sufficiently reflect large overlap between
pathophysiologically determined immediate- and delayed-type clinical
manifestations
• Beta-blocantele
• Inhibitorii ACE
Semne si simptome
Manifestation Percent
Urticaria/angioedema 87
Flush 50
Dyspnea/wheeze 46
Hypotension 30
Gastrointestinal 30
• Anameneza corect
• Atentie la atopici/alergici/astmatici
• Testare (cutanata, evaluare IgE, BAT, de provocare)
• Daca a avut un soc: educare, purtare de Epi/Ana-pen
• Imunoterapie specifica (Desensibilizare)