allergi

dr Budi Enoch SpPD

RSUD dr Abdul Aziz
Singkawang
 Allergies, also known as allergic diseases,
are a number of conditions caused
by hypersensitivity of the immune system to
something in the environment that usually
causes little or no problem in most people.
These diseases include hay fever, food
allergies, atopic dermatitis, allergic asthma,
and anaphylaxis.
Symptoms may include red eyes, an itchy
rash, runny nose, shortness of breath, or
swelling.
Food intolerances and food poisoning are
separate conditions.
 The concept of "allergy" was originally introduced in 1906 by
the Viennese pediatrician Clemens von Pirquet, after he noted that some
of his patients were hypersensitive to normally innocuous entities such
as dust, pollen, or certain foods.Pirquet called this phenomenon "allergy"
from the AncientGreek words allos meaning "other"
and ergon meaning "work".
All forms of hypersensitivity used to be classified as allergies, and all were
thought to be caused by an improper activation of the immune system.
Later, it became clear that several different disease mechanisms were
implicated, with the common link to a disordered activation of the immune
system.
In 1963, a new classification scheme was designed by Philip Gell and Robin
Coombs that described four types of hypersensitivity reactions, known as
Type I to Type IV hypersensitivity.
With this new classification, the word "allergy" was restricted to type I
hypersensitivities (also called immediate hypersensitivity), which are
characterized as rapidly developing reactions.
A major breakthrough in understanding the mechanisms of allergy was the
discovery of the antibody class labeled immunoglobulin E (IgE). IgE was
simultaneously discovered in 196667 by two independent groups:Ishizaka's
team at the Children's Asthma Research Institute and Hospital in Denver,
Colorado,and by Gunnar Johansson and Hans Bennich in Uppsala, Sweden.[
Their joint paper was published in April 1969.
 Atopi berasal dari Greek atopos
berarti aneh, karena terdapat
berkelompok dalam keluarga dan
diturunkan: asma, rhinitis allergika,
dermatitis atopik.
Bila kedua orang tua atopik anaknya
terkena atopik 50-75%.
Bila salah seorang atopi, anaknya 25-50%
terkena atopi
 Dikenal dari zaman Mesir kuno
Hieroglypsis Raja mati muda karena
disengat tawon ( 2000 th sebelum
masehi )

Raja Richard III dari Inggris setelah

makan buah Strawbery : bibir,
mata bengkak, gatal, kemerahan,
mencret, pelayannya
dipenggal karena disangka
meracuni raja.
 Allergies are common.
In the developed world, about 20% of people are
affected by allergic rhinitis,about 6% of people
have at least one food allergy, and about 20% have
atopic dermatitis at some point in time.
Depending on the country about 118% of
people have asthma.
Anaphylaxis occurs in between 0.052% of
people.
Rates of many allergic diseases appear to be
increasing.
The word "allergy" was first used by Clemens von
Pirquet in 1906
 allergens penyebab allergi
Common allergens include pollen and certain food.
Metals and other substances may also cause problems.
Food, insect stings, and medications are common causes of
severe reactions.
Their development is due to both genetic and
environmental factors.
The underlying mechanism involves immunoglobulin E
antibodies (IgE), part of the body's immune system, binding
to an allergen and then to a receptor on mast
cells or basophils where it triggers the release of
inflammatory chemicals such as histamine.
Diagnosis is typically based on a person's medical history.
Further testing of the skin or blood may be useful in
certain cases.
Positive tests, however, may not mean there is a significant
allergy to the substance in question
Cara masuk alergen ada 4 macam

Alergen Inhalan : masuk melalui hirupan

seperti debu, tungau, bulu binatang
Alergen Ingestan : masuk dengan cara
dimakan atau diminum, seperti susu sapi, telur,
ikan dll
Alergen Injektan : masuk melalui tusukan
dikulit, seperti suntikan obat atau gigitan
serangga dan ikan
Alergen kontaktan : terjadi melalui kontaqk
kulit, seperti logam nikel, kosmetik dll
Signs and symptoms
Many allergens such as dust or pollen
are airborne particles.
In these cases, symptoms arise in areas in
contact with air, such as eyes, nose, and lungs.
For instance, allergic rhinitis, also known as
hay fever, causes irritation of the nose,
sneezing, itching, and redness of the eyes.
Inhaled allergens can also lead to increased
production of mucus in the lungs, shortness
of breath, coughing, and wheezing.
 Insect stings, antibiotics, and certain medicines
produce a systemic allergic response that is also
called anaphylaxis; multiple organ systems can be
affected, including the digestive system,
the respiratory system, and the circulatory
system.
Depending on the rate of severity, it can
cause a skin reactions,
bronchoconstriction, swelling, low blood
pressure coma, and death.
This type of reaction can be triggered suddenly,
or the onset can be delayed.
The nature of anaphylaxis is such that the
reaction can seem to be subsiding, but may recur
throughout a period of time
 Cause
Risk factors for allergy can be placed in two
general categories,
namely host and environmental factors.
Host factors include heredity, sex, race, and age,
with heredity being by far the most significant.
However, there have been recent increases in
the incidence of allergic disorders that cannot
be explained by genetic factors alone.
Four major environmental candidates are
alterations in exposure to infectious
diseases during early childhood,
environmental pollution allergen levels,
and dietary changes
 Foods
Latex
Medications
Toxins interacting with proteins
Genetics
Hygiene hypothesis
Stress
Other environmental factors
 Pathophysiology
In the early stages of allergy, a type I hypersensitivity
reaction against an allergen encountered for the first time
and presented by a professional antigen-presenting
cell causes a response in a type of immune cell called
a TH2 lymphocyte, which belongs to a subset of T
cells that produce a cytokine called interleukin-4 (IL-4).
These TH2 cells interact with other lymphocytes called B
cells, whose role is production of antibodies.
Coupled with signals provided by IL-4, this interaction
stimulates the B cell to begin production of a large
amount of a particular type of antibody known as IgE.
Secreted IgE circulates in the blood and binds to an IgE-
specific receptor (a kind of Fc receptor called FcRI) on
the surface of other kinds of immune cells called mast
cells and basophils, which are both involved in the acute
inflammatory response.
The IgE-coated cells, at this stage, are sensitized to the
allergen
A summary diagram that explains how allergy develops.
 If later exposure to the same allergen occurs, the allergen
can bind to the IgE molecules held on the surface of the mast
cells or basophils.
Cross-linking of the IgE and Fc receptors occurs when more
than one IgE-receptor complex interacts with the same
allergenic molecule, and activates the sensitized cell.
Activated mast cells and basophils undergo a process
called degranulation, during which they release histamine and
other inflammatory chemical mediators
(cytokines, interleukins, leukotrienes, and prostaglandins)
from their granules into the surrounding tissue causing
several systemic effects, such
as vasodilation, mucous secretion, nerve stimulation,
and smooth muscle contraction.
This results in rhinorrhea, itchiness, dyspnea, and anaphylaxis.
Depending on the individual, allergen, and mode of
introduction, the symptoms can be system-wide (classical
anaphylaxis), or localized to particular body systems;
asthma is localized to the respiratory system and eczema is
localized to the dermis
Tissues affected in allergic inflammation
 Degranulation process in allergy. Second exposure to allergen. 1
antigen; 2 IgE antibody; 3 FcRI receptor; 4 preformed
mediators (histamine, proteases, chemokines, heparin); 5
granules; 6 mast cell; 7 newly formed mediators
(prostaglandins, leukotrienes, thromboxanes, PAF)
Late-phase response

After the chemical mediators of the acute response

subside, late-phase responses can often occur.
This is due to the migration of other leukocytes such
as neutrophils, lymphocytes, eosinophils and macroph
ages to the initial site.
The reaction is usually seen 224 hours after the
original reaction.
Cytokines from mast cells may play a role in the
persistence of long-term effects.
Late-phase responses seen in asthma are slightly
different from those seen in other allergic responses,
although they are still caused by release of mediators
from eosinophils and are still dependent on activity of
TH2 cells
Allergic contact dermatitis

Although allergic contact dermatitis is

termed an "allergic" reaction (which usually
refers to type I hypersensitivity), its
pathophysiology actually involves a reaction
that more correctly corresponds to a type
IV hypersensitivity reaction.
In type IV hypersensitivity, there is activation
of certain types of T cells (CD8+) that
destroy target cells on contact, as well as
activated macrophages that
produce hydrolytic enzymes.
 ASMA ALERGI
ASMA HANYA MENYERANG MEREKA YANG MEMILIKI
SALURAN NAPAS YANG HIPERREAKTIVITAS

HIPERREAKTIVITAS TERSEBUT ( BERMULA DARI FAKTOR

KETURUNAN ), DENGAN PENGARUH FAKTOR-FAKTOR
TERTENTU, BAIK NON-SPESIFIK MAUPUN SPESIFIK, DAPAT
MENIMBULKAN ASMA

FAKTOR-FAKTOR NON-SPESIFIK : DEBU KAPUR, ASAP ROKOK

DINGIN, KABUT, TEGANG DAN EMOSI

FAKTOR-FAKTOR SPESIFIK : POLLEN, BULU HEWAN, DEBU

RUMAH, RACUN SERANGGA, ATAU ALERGEN LAIN
GEJALA ASMA :
TERDIRI DARI BEBERAPA GEJALA DAN YANG UTAMA ADALAH
SESAK, DAPAT BERUPA MENGI, SESAK MALAM, SESAK
WAKTU MENJALANKAN LATIHAN JASMANI ATAU BATUK
KRONIK.
BILA TERJADI SERANGAN, SALURAN NAPAS MENYEMPIT
OLEH KARENA :
1. SPASME (KONTRAKSI) OTOT POLOS DARI SALURAN
NAPAS.
2. EDEMA YAITU TERKUMPULNYA CAIRAN DISELAPUT
LENDIR SALURAN NAPAS.
3. PRODUKSI MUKUS/LENDIR YANG BERLEBIHAN (TEBAL
DAN PEKAT) OLEH KELENJAR SALURAN NAPAS.

Ke 3 faktor tersebut akan mempersempit saluran napas dan

mengganggu aliran udara melalui saluran napas
 Functio
Kalor Rubor Tumor Dolor laesa
Diagnosis
Effective management of allergic diseases relies on the ability
to make an accurate diagnosis.
Allergy testing can help confirm or rule out allergies.
Correct diagnosis, counseling, and avoidance advice based on
valid allergy test results reduces the incidence of symptoms
and need for medications, and improves quality of life.
To assess the presence of allergen-specific IgE antibodies, two
different methods can be used: a skin prick test, or an
allergy blood test. Both methods are recommended, and
they have similar diagnostic value.
Skin prick tests and blood tests are equally cost-effective, and
health economic evidence shows that both tests were cost-
effective compared with no test.
Also, early and more accurate diagnoses save cost due to
reduced consultations, referrals to secondary care,
misdiagnosis, and emergency admissions
An allergy testing machine being operated in the diagnostic
immunology lab
Skin prick testing

Skin testing is also known as "puncture testing" and

"prick testing" due to the series of tiny punctures or
pricks made into the patient's skin.
Small amounts of suspected allergens and/or
their extracts (e.g., pollen, grass, mite proteins, peanut
extract) are introduced to sites on the skin marked
with pen or dye (the ink/dye should be carefully
selected, lest it cause an allergic response itself).
A small plastic or metal device is used to puncture or
prick the skin.
Sometimes, the allergens are injected "intradermally"
into the patient's skin, with a needle and syringe.
Common areas for testing include the inside forearm
and the back
Skin testing on arm
Skin testing on back
 Blood testing
An allergy blood test is quick and simple, and can be ordered by a
licensed health care provider (e.g., an allergy specialist), GP, or
PED.
Unlike skin-prick testing, a blood test can be performed
irrespective of age, skin condition, medication, symptom, disease
activity, and pregnancy.
Adults and children of any age can take an allergy blood test.
For babies and very young children, a single needle stick for
allergy blood testing is often more gentle than several skin tests.
An allergy blood test is available through most laboratories.
A sample of the patient's blood is sent to a laboratory for
analysis, and the results are sent back a few days later.
Multiple allergens can be detected with a single blood sample.
Allergy blood tests are very safe, since the person is not exposed
to any allergens during the testing procedure.
 Radiometric assays include the radioallergosorbent test
(RAST test) method, which uses IgE-binding (anti-IgE)
antibodies labeled with radioactive isotopes for quantifying
the levels of IgE antibody in the blood.[
Other newer methods use colorimetric or fluorescence-
labeled technology in the place of radioactive isotopes.
The RAST methodology was invented and marketed in
1974 by Pharmacia Diagnostics AB, Uppsala, Sweden, and
the acronym RAST is actually a brand name.
In 1989, Pharmacia Diagnostics AB replaced it with a
superior test named the ImmunoCAP Specific IgE blood
test, which uses the newer fluorescence-labeled
technology.
American College of Allergy Asthma and Immunology
(ACAAI) and the American Academy of Allergy Asthma and
Immunology (AAAAI) issued the Joint Task Force Report
"Pearls and pitfalls of allergy diagnostic testing" in 2008, and
is firm in its statement that the term RAST is now obsolete
 Prevention
The consumption of various foods during pregnancy has
been linked to eczema; these include celery, citrus fruit,
raw pepper, margarine, and vegetable oil.
A high intake of antioxidants, zinc, and selenium during
pregnancy may help prevent allergies.
This is linked to a reduced risk for childhood-onset
asthma, wheezing, and eczema.
Further research needs to be conducted.
Probiotic supplements taken during pregnancy or infancy
may help to prevent atopic dermatitis.
After birth, an early introduction of solid food and high
diversity before week 17 could increase a child's risk for
allergies.
Studies suggest that introduction of solid food and
avoidance of highly allergenic food such as peanuts during
the first year does not help in allergy prevention
 Management
Management of allergies typically
involves avoiding what triggers the
allergy and medications to improve
the symptoms.
Allergen immunotherapy may be
useful for some types of allergies
Medication
Several medications may be used to block the
action of allergic mediators, or to prevent
activation of cells and degranulation processes.
These include antihistamines, glucocorticoids,
epinephrine (adrenaline), mast cell stabilizers,
and antileukotriene agents are common
treatments of allergic diseases.
Anti-cholinergics, decongestants, and other
compounds thought to impair
eosinophil chemotaxis, are also commonly used.
Though rare, the severity of anaphylaxis often
requires epinephrine injection, and where medical
care is unavailable, a device known as
an epinephrine autoinjector may be used
 Mekanisme Anti Alergi Kortikosteroid

x
x

x
KORTIKOSTEROID
x
Anti alergi :
Inhibisi Aktivasi limfosit B Mengurangi konsentrasi immunoglobulin E
mengurangi pelekatan Ig E dengan sel mast mengurangi pelepasan mediator
alergi seperti Histamin
Immunotherapy

Allergen immunotherapy is useful for environmental

allergies, allergies to insect bites, and asthma.
Its benefit for food allergies is unclear and thus not
recommended.
Immunotherapy involves exposing people to larger
and larger amounts of allergen in an affect to change
the immune system's response.
Meta-analyses have found that injections of allergens
under the skin is effective in the treatment in allergic
rhinitis in children[and in asthma.
The benefits may last for years after treatment is
stopped.
It is generally safe and effective for allergic rhinitis and
conjunctivitis, allergic forms of asthma, and stinging
insects.
Anti-allergy immunotherapy
 Treatment anaphylactic
reaction
Early recognition of an anaphylactic reaction is mandatory,
since death occurs within minutes to hours after the first symptoms.
Mild symptoms such as pruritus and urticaria can be controlled by
administration of 0.3 to 0.5 mL of 1:1000 (1 mg/mL) epinephrine
SC or IM, with repeated doses as required at 5- to 20-min intervals
for a severe reaction.
If the antigenic material was injected into an extremity, the rate of
absorption may be reduced by prompt application of a tourniquet
proximal to the reaction site, administration of 0.2 mL of 1:1000
epinephrine into the site, and removal without compression of an
insect stinger, if present.
An IV infusion should be initiated to provide a route for
administration of 2.5 mL epinephrine, diluted 1:10,000, at 5- to
10-min intervals, volume expanders such as normal saline, and
vasopressor agents such as dopamine if intractable hypotension
occurs. Replacement of intravascular volume due to postcapillary
venular leakage may require several liters of saline
 Epinephrine provides adrenergic effects, resulting in
vasoconstriction, bronchial smooth-muscle relaxation,
and attenuation of enhanced venular permeability.
When epinephrine fails to control the anaphylactic
reaction, hypoxia due to airway obstruction or
related to a cardiac arrhythmia, or both, must be
considered.
Oxygen alone via a nasal catheter or with nebulized
albuterol may be helpful, but either endotracheal
intubation or a tracheostomy is mandatory for
oxygen delivery if progressive hypoxia develops.
Ancillary agents such as the antihistamine
diphenhydramine, 50-100 mg IM or IV, and
aminophylline, 0.25-0.5 g IV, are appropriate for
urticaria-angioedema and bronchospasm, respectively.
Intravenous glucocorticoids, 0.5-1 mg/kg of
medrol, are not effective for the acute event but
may alleviate later recurrence of bronchospasm,
hypotension, or urticaria
Prevention of anaphylaxis
Prevention of anaphylaxis must take into account the
sensitivity of the recipient, the dose and character of the
diagnostic or therapeutic agent, and the effect of the route of
administration on the rate of absorption.
Beta blockers are relatively contraindicated in
persons at risk for anaphylactic reactions, especially
those sensitive to Hymenoptera venom or those undergoing
immunotherapy for respiratory system allergy.
If there is a definite history of a past anaphylactic reaction to
a medication, even though mild, it is advisable to select a
structurally unrelated agent. A knowledge of cross-reactivity
among agents is critical since, for example, cephalosporins
have a cross-reactive ring structure with the penicillins.
When skin testing, a prick or scratch skin test should
precede an intradermal test, since the latter has a higher risk
of causing anaphylaxis
 These tests should be performed before the administration
of certain materials that are likely to elicit anaphylactic
reactions, such as allergenic extracts.
Skin testing for antibiotics or chemotherapeutic agents
should be performed only on patients with a positive clinical
history consistent with an IgE-mediated reaction and in
imminent need of the antibiotic in question; skin testing is of
no value for non-IgE-mediated eruptions. With regard to
penicillin, two-thirds of patients with a positive reaction
history and positive skin tests to benzylpenicilloyl-polylysine
(BPL) and/or the minor determinant mixture (MDM) of
benzylpenicillin products experience allergic reactions with
treatment, and these reactions are almost uniformly of the
anaphylactic type in those patients with minor determinant
reactivity.
Even patients without a history of previous clinical reactions
have a 2-6% incidence of positive skin tests to the two test
materials, and about 3 per 1000 with a negative history
experience anaphylaxis with therapy, with a mortality of
about 1 per 100,000
 Epidemiology
The allergic diseaseshay fever and asthmahave
increased in the Western world over the past 23
decades.Increases in allergic asthma and other
atopic disorders in industrialized nations, it is
estimated, began in the 1960s and 1970s, with
further increases occurring during the 1980s and
1990s,although some suggest that a steady rise in
sensitization has been occurring since the 1920s.
The number of new cases per year of atopy in
developing countries has, in general, remained
much lower
Beberapa kasus allergi
 ALERGI MANIFESTASINYA PADA KULIT

3 BENTUK MANIFESTASI REAKSI ALERGI PADA KULIT

1. URTIKARIA, MERUPAKAN BENTOL DIATAS KULIT

DENGAN DASAR KEMERAHAN DAN DISERTAI RASA
GATAL, BENTOL DPT SANGAT LUAS, TNP RASA
GATAL
2. DERMATITIS ATOPIK ATAU EKSEMA, MERUPAKAN
RUAM KULIT, TERUTAMA DIDAERAH LIPAT SIKU,
LUTUT DAN TENGKUK
3. DERMATITIS KONTAK, MERUPAKAN RUAM KULIT
PADA DAERAH YANG BERKONTAK DENGAN BAHAN
PENYEBAB
 Wheal and Flare
Flare Wheal Flare

vasodilatation & activated

leakage of plasma congestion mast cell
fluid and protein
(edema)

vasodilatation at vasodilatation at
edge of lession edge of lession
Abbas ea, Cellular & Molecular Immunology, WB Saunders, 4th ed, 2000 : 427
Hives are a common allergic symptom.
Urticarial eruptions
Allergic Rhinitis
Thanks Friends