RESPONS ORGAN PADA REAKSI ALLERGI

H. Zaenal Muttaqien Sofro,M.D.AIFM,Sports & Circ.Med.

Lymph system + Immune cells

6 basic groups of Leukocytes:

Eosinophils Basophils (blood); Mast cells (tissue) Neutrophils Monocytes (blood), macrophages (tissue) Dendritic cells Lymphocytes (plasma, helper, cytotoxic & NK)

.1 .2 .3 .4 .5 .6

APCs

Antigen Presenting Cells (APCs)

Note foreign protein on their surfaces Macrophages, dendritic cells, lymphocytes

Allergy = An abnormally high sensitivity to certain substances, such as pollens, foods, or microorganisms. Common indications of mild allergy may include sneezing, itching, and skin rashes.

A severe allergic reaction is known as an anaphylactic shock which can be lifethreatening (airway constriction & extreme hypotension. Immediate medical attention needs to be administered.

People with allergies have immune systems that overreacts when exposed to substances. These substances (ex. Pollen) causes the body to respond with release of Histamine which is main proponent of allergic reactions in individuals.

Figure 10-1

Neutrophils, Eosinophils

Basophils

4 types of hypersensitivity reactions

(hives)

Allergies

Immune complex disease

Delayed-type hypersensitivity

Mucosal mast cell/Connective tissue mast cell

Figure 10-5
In granules

Produced after activation

Biologic effects of mediators

Biological effects of Eosinophil mediators

Figure 10-9 part 1 of 2

Products released by eosinophils

Figure 10-12

Figure 10-16

FEV1 - the forced expiratory volume of air in one second

Figure 10-18

Systemic anaphylaxis

Use of adrenaline to counteract the effects of system anaphylaxis

In anaphylactic shock, blood vessels leak, bronchial tissues swell and blood pressure drops, causing choking and collapse. Adrenaline (epinephrine) acts quickly to constrict blood vessels, relax smooth muscles in the lungs to improve breathing, stimulate the heartbeat and help to stop swelling around the face and lips (angioedema).

Asthma

Figure 10-22 part 1 of 2

Figure 10-22 part 2 of 2

Treatment of asthma

Skin test for allergy

Food allergies

Type II hypersensitivity is caused by antibodies to altered cell-surface components

Figure 10-27

Type III hypersensitivity reactions (Arthus Reaction) Antibody-Antigen Complexes

Critical mediators appear to be C5a-receptor and FcgRIII--probably present on mast cells

Figure 10-31

Figure 10-29

Figure 10-32

Type IV hypersensitivity Delayed-type hypersensitivity

Figure 10-34

What is missing from this scheme?

Also, note time scale

Figure 10-36

Anaphylaxis
Most severe IgE mediated allergic reaction Massive histamine release within minutes Hives, bronchoconstriction and widespread vasodilation shock

Organ & Tissue Transplants

MHC (= HLA (Human leukocyte Ag)) are the 1 tissue antigens
If donor and recipient HLA match, less rejection

Establishment of self tolerance during T cell development

Failure = Autoimmunity

ABO (and Rh) blood typing (AA, AO, BB, BO, AB, OO)
Blood transfusion problems due to antibodies in plasma Transfusion reaction with hemolysis and possible kidney damage

Fig 24-20

 Discovered in 1911 by Sir Henry Dale, identified as a potent vasoactive substance in guinea pigs and dogs through experiments.
Soon recognized to be major mediator of allergic reactions such as rhinitis, asthma, urticaria (hives), pruritis (itching) and anaphylaxis
HISTAMINE

Histamine stored in special granules, and to exert its action, must be released. Mast Cells Tissue Basophils Blood

ACTIVE SITE

BLOCK action of histamine at the receptor sites Compete with histamine for binding at unoccupied receptors. If histamine is already bound, antihistamines cannot remove histamine.

The binding of H1 blockers to the histamine receptors prevents the adverse consequences of histamine stimulation: Vasodilation Increased gastrointestinal and respiratory secretions Increased capillary permeability
Absorbed well by GI tract with a maximum absorption 1-2 Hr and a high safety margin.

Cardiovascular (small blood vessels)

Histamine effects:
Dilation Increased permeability (allowing substances to leak into tissues)

Antihistamine effects:
Prevent dilation of blood vessels Prevent increased permeability

Immune System Histamine effects: Mast cells release histamine and other substances, resulting in allergic reaction. Antihistamine effects: Bind to histamine receptors, preventing histamine from causing the allergic response.

Smooth Muscle Histamine effects: Stimulate salivary, gastric and bronchial secretions. Antihistamine effects: Prevent salivery, gastric and bronchial secretions.

Management of: Seasonal allergic rhinitis (Hay fever) Nasal allergies Allergic reactions to food, microbes, dust, etc. Motion sickness Sinus congestions Sleep disorders