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Title:

Allergy and Allergic Diseases

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Allergy and Allergic Diseases Incidence steadily rising Trebling in the last 20 years 1/ /3 of the population will develop clinical allergic condition – PowerPoint PPT presentation

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Date added: 4 April 2019
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Title: Allergy and Allergic Diseases


1
Allergy and Allergic Diseases
  • Incidence steadily rising
  • Trebling in the last 20 years
  • 1/ /3 of the population will develop clinical
    allergic condition
  • Amongst the highest rates in the World
  • Costs Quality of Life issues
  • 3 million consultations costing 300 million
    70,000 Admissions costing 80 million 1
    billion drugs expenditure

2
Allergic Diseases adverse, heightened
immunological responses (hypersensitivity) to
external agents
3
(No Transcript)
4
Allergic disease prevalence
  • Asthma
  • X 6 in Children
  • X 3-4 in Adults
  • Population Prevalence 12 15

Atopic Dermatitis Allergic Rhinitis Food
Allergy also increasing Anaphylaxis 7-fold
5
Asthma / Allergic Disease Genetics
  • Strong Genetic Association
  • Cytokine genes IL-4, IL-5, IL-10, TGF-b
  • IgE receptor genes
  • LPS responsiveness genes
  • Skin barrier function genes - fillagrin
  • Twin Concordance 75
  • 1 affected parent - 40
  • 2 Affected Parents - 60
  • Same Disease - Even Higher

but genes do not explain the growing prevalence
6
Asthma Epidemiology
Socioeconomic factors
  • West Germany Vs East Germany
  • Prevalence Studies
  • Inverse relationship with
  • Family Size
  • Family Order
  • Day Care in Early Years Outside the Home
  • Place of residence Farm / Animal exposure Vs
    City

Asthma Prevalence Vs GNP per capita adapted from
ISAAC study
7
The Hygiene Hypothesis
Centers for Disease Control, Atlanta
Promotion of Allergic Immune Responses
8
The Infant Immune System
9
The Infant Immune System Normal Maturation
Controlled Inflammation
10
Allergy Investigation
  • HISTORY
  • Laboratory tests (RASTs) / in-vivo skin testing
    IgE-dependent
  • Challenges Useful Experienced Monitored
    setting
  • Usefulness Disease / Interpreter
  • Alternative testing no basis in logic

11
Allergy Management
12
Allergy Management cont./
Immune Manipulation
  • Conventional Immunosuppression
  • Variable
  • Not Widespread
  • Allergen Desensitization Therapy / Immunotherapy
  • Molecular engineering
  • Allergen sequencing
  • IgG4 / TGF-b production
  • TH Redirection
  • M. Vaccae
  • Probiotic therapies
  • Allergen / Cytokine / CpG motif Conjugate
    Vaccines

13
Allergy Management cont. 2/
Anti-IgE Therapy
Stopping the Cascade
  • Humanised Mouse MAb
  • Omalizumab
  • Asthma
  • Reduced steroid use hospitalization rescue
    treatments
  • Reduced IgE IgE Receptor
  • FDA Approval 2003
  • Incorporation in Asthma Guidelines

14
ANAPHYLAXIS
/ - Stridor Breathing / Speaking Difficulty
Hypotension Collapse GI Symptoms
15
Epidemiology
  • Sharp increase
  • Under-reported
  • 30 950 / 100,000 / year US meta-analysis
  • 0.5 2.0 lifetime prevalence
  • 1 / 12 / year recur
  • UK 75 / 100,000 / year
  • Fatalities 1 / 2.5 million / year lower in
    children

16
Triggers
  • Potentially anything careful history
  • Commonest -
  • Foods peanuts Other tree nuts fish and
    shellfish milk
  • Venoms wasp, bee
  • Drugs penicillins anaesthetics ASA and
    NSAIDs ACEIs
  • Other Medical Contrast media Latex

17
Why Does This Happen?
Foods peanut egg milk seafoods Drugs penicillin
s suxamethonium Mabs Latex Venoms
18
(No Transcript)
19
Adrenaline Autoinjectors
  • UK Resuscitation Council Guidelines
  • Irish Consensus Document from IGI IMJ Jan 2008
  • Definite
  • Anaphylaxis in Asthma
  • Limited access to care
  • Trace amount triggers
  • Severe hypotension ( venoms)
  • Probably
  • High incidence of Severe reactions ( nuts /
    shellfish)
  • Comorbidities
  • No
  • Asthma alone positive skin tests alone clear
    avoidable trigger positive family history

20
Food Sensitivity and Other Allergic Disorders
  • Does Food Allergy Cause Other Conditions?
  • Atopic Eczema
  • Co-existence of conditions
  • High Frequency of RAST / PST Positivity
  • Severe gt Mild Younger gt Older
  • Exclusions
  • Challenges
  • Asthma
  • Severe acute reactions
  • Early food allergy positively predicts later
    asthma
  • Younger gt Older
  • Consider in difficult asthma

21
Asthma / Allergy Prevention
  • Food allergen avoidance / Breastfeeding
  • - food allergy prevention
  • Other allergic disorders ?
  • Exposure to allergens in infancy e.g. house dust
    mite food antigens pollens --? IgE production
  • Early food exposure as a preventative in at risk
    infants?
  • Conflicting evidence re pet exposure
  • RESEARCH

Early Allergen Exposure
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