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ALLERGY,[object Object],DR. MA. TERESA S. FAJARDO,[object Object],PEDIATRICS,[object Object],HEMATOLOGY / ONCOLOGY,[object Object]
IMMUNOLOGIC BASISOF ALLERGIC DISEASE,[object Object],TO DETECT AND ELIMINATE ANYTHING FOREIGN,[object Object],TO THE BODY,[object Object],BENEFICIAL (IMMUNITY) OR HARMFUL (ALLERGY),[object Object]
 COMPONENTS  IN HOST'S     RESPONSE TO THE               ALLERGEN  ,[object Object],ENVIRONMENT,[object Object],TARGET CELLS,[object Object],B AND T LYMPHOCYTES,[object Object]
IMMUNOLOGIC CAPABILITIES  OF THE HOST,[object Object],PRIMARY ( NON- SPECIFIC ),[object Object],SECONDARY (SPECIFIC),[object Object],TERTIARY ( TISSUE DAMAGING,[object Object],      RESPONSE),[object Object]
PRIMARY RESPONSE,[object Object],MOST PRIMITIVE,[object Object],PHAGOCYTOSIS / INFLAMMATION,[object Object]
SECONDARY RESPONSE,[object Object],SPECIFIC  RESPONSE,[object Object],MECHANISMS :,[object Object],     B CELL / T CELL RESPONSE,[object Object],COMPLEMENT SYSTEM,[object Object],COAGULATIPON SYSTEM,[object Object]
TERTIARY RESPONSE,[object Object],TISSUE – DAMAGING RESPONSES,[object Object], ( TYPES I, II, III, IV ),[object Object],PROPOSED BY GELL AND COOMBS ,[object Object]
MEDIATORS OF ALLERGY,[object Object],PREFORMED MAST CELL MEDIATORS,[object Object],RAPIDLY FORMED MAST CELL MEDIATORS,[object Object]
PREFORMED MAST CELLMEDIATORS,[object Object],VASOACTIVE MEDIATORS,[object Object],CHEMOTACTIC MEDIATORS,[object Object],ENZYMES,[object Object],PROTEOGLYCANS,[object Object]
PREFORMED MAST CELLMEDIATORS  ( VASOACTIVE MEDIATORS),[object Object],HISTAMINE,[object Object],            BRONCHOSPASM AND VASCULAR PERMEABILITY,[object Object],ADENOSINE,[object Object],             INHIBIT PLATELET AGGREGATION,[object Object],             STIMULATE  IRRITANT RECEPTORS,[object Object]
PREFORMED MAST CELLMEDIATOR (CHEMOTACTIC MEDIATORS ),[object Object], 1.  NEUTROPHIL  FACTOR,[object Object],          RECRUITMENT / ACTIVATION OF NEUTROPHIL,[object Object],2.   EOSINOPHIL FACTOR,[object Object],          RECRUITMENT /ACTIVATION OF  EOSINOPHIL  ,[object Object]
PREFORMED MAST CELLMEDIATOR ( ENZYMES),[object Object],1. NEUTRAL PROTEASES ( TRYPTASE , CHYMASE ),[object Object],         COMPLEMENT/ KININ ACTIVATION,[object Object],2.  ACID HYDROLASES ( BETA- GLUCORONIDASE),[object Object],         INFLAMMATION,[object Object]
PREFORMED MAST CELLMEDIATOR (PROTEOGLYCANS),[object Object],HEPARIN,[object Object],     ANTICOAGULANT,[object Object],     ANTICOMPLEMENT  ACTIVITY,[object Object]
RAPIDLY FORMED MAST CELL MEDIATORS,[object Object],PLATELET- ACTIVATING FACTOR,[object Object],PROSTAGLANDIN,[object Object],LEUKOTRIENES,[object Object]
RAPIDLY FORMED MASTCELL MEDIATORS,[object Object],BIOLOGIC ACTIVITY :,[object Object],VASODILATATION,[object Object],VASCULAR  LEAKAGE,[object Object],SMOOTH MUSCLE CONTRACTION,[object Object],GLANDULAR SECRETION,[object Object],   STIMULATION OF THE IRRITANT ( ITCH / SNEEZE )    ,[object Object],   RECEPTORS,[object Object],   PRO –ANTI-INFLAMMATORY MEDIATOR ,[object Object]
CYTOKINES,[object Object],NEWLY SYNTHESIZED PROTEINS THAT REGULATE,[object Object],    IMMUNE RESPONSE,[object Object],POTENT PRO- INFLAMMATORY MEDIATORS,[object Object],GROWTH / DIFFERENTIATION OF EOSINOPHILS,[object Object],     AND MAST CELLS,[object Object]
CYTOKINES AND ALLERGY,[object Object],IgE REGULATION,[object Object],EOSINOPHILIA,[object Object],MAST CELL DEV ‘T AND ACTIVATION,[object Object],INFLAMMATION,[object Object]
IMMUNOLOGIC MECHANISM IN ALLERGIC INFLAMMATION,[object Object],ALLERGEN EXPOSURE ----MAST CELL ACTIVATION----,[object Object],VASOACTIVE AMINE ACTIVATION ----  IMMEDIATE,[object Object], REACTIONS ( VASODILATATION, EDEMA, SM CONTRACTION, MUCUS SECRETION)  ------------ 3 -8 HRS,[object Object],LATE PHASE RESPONSE (INFILTRATION OF EOSINOPHILS,[object Object],MONONUCLEARS AND NEUTROPHILS) ----------- AFTER 24 -48 HRS ------,[object Object], T- CELL ACTIVATION ---------  CHEMOTACTIC MEDIATORS -------- CELLULAR INFILTRATION ------,[object Object],INFLAMMATORY MEDIATORS      ------------ EDEMA, DESQUAMATION, CELLULAR INFI;LTRATION AND MUCUS ,[object Object],SECRETION,[object Object]
ALLERGIC RHINITIS,[object Object],SYMPTOMS:,[object Object],   “ SNEEZERS AND RUNNERS”,[object Object],         -- PAROXYSMAL SNEEZING,[object Object],         -- WATERY RHINORRHEA,[object Object],         -- ITCHY NOSE,[object Object],         ---NASAL BLOCKAGE (VARIABLE),[object Object],         -- DIURNAL RHYTHM (WORST DAYTIME IMPROVES ,[object Object],             AT NIGHT,[object Object],          -- OFTEN ASSOCIATED WITHJ CONJUNCTIVITIS,[object Object]
ALLERGIC RHINITIS,[object Object],SYMPTOMS:,[object Object],     BLOCKERS,[object Object],        -- LITTLE OR NO SNEEZING,[object Object],        -- THICK NASAL MUCUS (CATARRH) MORE OFTEN,[object Object],             POSTERIOR (POST NASAL DRIP),[object Object],        -- NO ITCH,[object Object],        -- NASAL BLOCKAGE OFTEN SEVERE,[object Object],       -- CONSTANT BUT MAYBE WORST AT NIGHT,[object Object]
RHINITIS DEFINITION,[object Object],NASAL DISCHARGE,[object Object],BLOCKAGE,[object Object],SNEEZE/ ITCH,[object Object],TWO OR MORE SYMPTOMS FOR MORE THAN ONE HOUR ON MOST DAYS,[object Object]
ALLERGIC RHINITIS,[object Object],TREATMENT,[object Object],ENVIRONMENTAL CONTROL,[object Object],IMMUNOTHERAPY,[object Object],PHARMACOTHERAPY,[object Object],PARENT/PATIENT EDUCATION,[object Object]
ASTHMA,[object Object],CHRONIC, RECURRENT , OCCASIONALLY FATAL,[object Object],CHRONIC INFLAMMATORY DISORDER OF THE,[object Object],   AIRWAYS IN WHICH CELLS PLAY A ROLE, INCLUDING M,[object Object],   MAST CELLS AND EOSINOPHILS,[object Object],WIDESPREAD BUT VARIABLE AIRFLOW OBSTRUCTION ,[object Object],THAT IS OFTEN REVERSIBLE EITHER SPONTANEOUSLY,[object Object],OR WITH TREATMENT ASSSOCIATED WITH AIRWAY,[object Object],RESPONSIVENESS ,[object Object]
PRECIPITANT OF ASTHMA,[object Object],RESPIRATORY INFECTION (VIRAL),[object Object],ALLERGENS,[object Object],FOOD,[object Object],HOUSEHOLD INHALANTS,[object Object],OUTDOOR INHALANTS,[object Object],IRRITANTS,[object Object],EXERCISE,[object Object],EMOTIONAL FACTORS,[object Object]
PATHOPHYSIOLOGY OFASTHMA ,SEVERE,[object Object],ASTHMA  --  MUCUS SECRETION , BRONCHOSPASM ,EDEMA ---INCREASED RESISTANCE TO AIRFLOW---HYPERINFLATION, ATELECTASIS , CNS DEPRESSION--,[object Object],PULMONARY VASOCONSTRICTION--CARDIAC FAILURE AND COMA,[object Object]
ASTHMA,[object Object],CLINICAL MS:,[object Object],    WHEEZING ,  A HIGH- PITCHED OR  SQUEAKING,[object Object],    EXPIRATORY SOUND,[object Object],     ONSET , ACUTE /INSIDIOUS,[object Object],     COUGH , TACHYPNEA , DYSPNEA,[object Object],    HYPERINFLATION  OF THE CHEST, TACHYCARDIS,[object Object],    ABDOMINAL PAIN WITH VOMITING,[object Object],     LOW GRADE FEVER,[object Object],      HUNCHED- OVER SITTING POSITIUON,[object Object]
MANAGEMENT OFASTHMA,[object Object],ACHIEVE AND MAINTAIN CONTROL OF SYMPTOMS,[object Object],PREVENT ASTHMA EXACERBATIONS,[object Object],MAINTAIN PULMONARY FUNCTIONS AS CLOSE,[object Object],    TO NORMAL LEVELS,[object Object],AVOID ADVERSE EFFECTS FROM ASTHMA MEDICATIONS,[object Object],PREVENT  IRREVERSIBLE AIRWAY OBSTRUCTION,[object Object],PREVENT ASTHMA MORBIDITY,[object Object]
MANAGEMENT PROGRAMS FOR ASTHMA,[object Object],EDUCATE PATIENTS/PARENTS ,[object Object],ASSESS AND MONITOR SEVERITY,[object Object],AVOID OR CONTROL TRIGGERS,[object Object],MEDICATION PLANS  FOR CHRONIC ASTHMA,[object Object],PLANS FOR EXACERBATIONS,[object Object],PROVIDE REGULAR FOLLOW-UP,[object Object]
STATUS ASTHMATICUS,[object Object],SEVERE ACUTE ASTHMA,[object Object],LIFE-THREATENING EPISODE,[object Object],UNRESPONSIVE TO THE USUAL  APPROPRIATE THERAPY,[object Object],   WITH  ADRENERGIC AGENT AND THEOPHYLINE,[object Object],LEADS TO ACUTE RESPIRATORY INSUFFICIENCY,[object Object]
ATOPIC DERMATITIS,[object Object],CHRONIC ,HERITABLE, DISTINCTIVE CUTANEOUS INFLAMMATORY DISEASE CHARACTERIZED BY,[object Object],EARLY AGE OF ONSET  AND INTENSE PRURITUS,[object Object],SKIN LESION: DRY, IRRITATED,  WEEPING,  EXCORIATED,[object Object],LICHENIFIED LESIONS  ON THE FLEXURAL AREAS,[object Object],IN LATE CHILDHOOD AND ADOLESCENSE,[object Object],WIIH GENETIC PREDISPOSITION,[object Object],RELAPSING     ,[object Object],CAN DEVELOP ALLERGIC RHINITIS AND ASTHMA,[object Object]
STAGES OF ATOPIC DERMATITIS,[object Object],INFANTILE STAGE,[object Object],    4TH -6TH MONTH OF AGE,[object Object],     ERYTHEMATOUS, PRURITIC, WEEPING DERMATITIS,[object Object],     IN THE CHEEKS WHICH SPREADS TO THE FOREHEAD,[object Object],     AND EXTENSOR SURFACES OF THE ARMS AND LEGS,[object Object],    CIRCUMORAL  AREA  AND EYELIDS ARE USUALLY SPARED  ,[object Object]
STAGES OF ATOPIC DERMATITIS,[object Object],CHILDHOOD STAGE:,[object Object],   2-4 YRS OF AGE,[object Object],   PRURITIC, EXCORIATED PAPULESON THE FLEXURAL ,[object Object],    SURFACES OF EXTREMITIES AND FACE,[object Object],    LICHENIFICATION IN THE POPLITEAL AND ANTECUBITAL FOSSAE,[object Object],    AND  ANKLES,[object Object],    MAY DISAPPEAR BEFORE 10 YRS,[object Object]
STAGES OF ATOPIC DERMATITIS,[object Object],ADULT STAGE :,[object Object],     HIGHLY PRURITIC , CONFLUENT PAPULES ON THE ,[object Object],     DORSAL ASPECT  OF THE HANDS, UPPER EYELIDS AND,[object Object],     FLEXURAL  AREAS  OF  THE  EXTREMITIES,[object Object]
STIGMAS OF ATOPICDERMATITIS,[object Object],LICHENIFICATION ,[object Object],DENNIE ‘S LINE,[object Object],ATOPIC PALMS,[object Object],BUFFED NAILS,[object Object],WHITE DERMOGRAPHISM,[object Object],DELAYED BLANCHED PHENOMENON,[object Object],DRYNESS XEROSIS,[object Object],ATOPIC PERSONALITY,[object Object],HOUSEWIFE’S ECZEMA,[object Object],ATOPIC FOOT,[object Object],ALLERGIC SHINERS,[object Object]
CRITERIA FOR  THE DIAGNOSISOF ATOPIC DERMATITIS,[object Object],MUST HAVE  3 OR MORE BASIC FEATURES :,[object Object],1.PRURITUS,[object Object],2.TYPICAL MORPHOLOGY /DISTRIBUTION,[object Object],3.TENDENCY TO RECURRENCES,[object Object],4.PERSONAL OR FAMILY HISTORY,[object Object]
CRITERIA FOR THE DIAGNOSIS OF ATOPIC DERMATITIS,[object Object],PLUS ANY THREE OR MORE OF THE FF FEATURES:,[object Object],   ICHTHYOSIS, ELEVATED SERUM IgE , EARLY AGE ONSET,[object Object],    CUTANEOUS INFECTION, IMPAIRED T- CELL IMMUNITY,[object Object],    HAND/FOOT DERMATITIS , NIPPLE ECZEMA, , CHEILITIS,  ,[object Object],    RECURRENT CONJUNCTIVITIS, DENNIE MORGAN INFRAORBITAL FOLD,[object Object],    CATARACT, ORBITAL DARKENING, PITYRIASIS ALBA  ,[object Object],     FOOD HYPERSENSITIVITY,[object Object]
ATOPIC DERMATITIS,[object Object],TREATMENT,[object Object],    AVOID ENVIRONMENTAL FACTORS,[object Object],    GOOD HYDRATION OF THE AFFECTED AREAS,[object Object],    MOISTURIZERS,[object Object],     CORTICOSTEROIDS IN THE SUBACUTE PHASE,[object Object]
URTICARIA ( HIVES),[object Object],RAISED ERYTHEMATOUS SKIN LESIONS ASSOCIATED,[object Object],WITH MARKED PRURITUS,[object Object],DUE TO VASODILATATION OF SMALL VENULES,[object Object],AND CAPILLARIES AND EXUDATION OF FLUID,[object Object],INTO THE SUPERFICIAL DERMIS,[object Object],ANGIOEDEMA  IS URTICARIA INVOLVING THE DEEPER SUBCUTANEOUS TISSUES,[object Object]
CLASSIFICATION OF URTICARIA,[object Object],IMMUNOLOGIC,[object Object],     ANAPHYLACTIC / CYTOTOXIC/ IMMUNE COMPLEX,[object Object],ANAPHYLACTOID,[object Object],      HEREDITARY ANGIOEDEMA/ CHEMICAL/ ASPIRIN SENSITIVITY      ,[object Object],PHYSICAL,[object Object],        DERMATODRAPHIA/ COLD/ CHOLINERGIC/ SOLAR/PRESSURE,[object Object],MISC ,[object Object],     INFECTION/ PIGMENTOSA/ PSYCHOGENIC/IDIOPATHIC,[object Object]
URTICARIA,[object Object],TREATMENT,[object Object],    SYMPATHOMIMETIC AGENTS :  EPINEPHRINE ,[object Object],    ANTIHISTAMINICS,[object Object],    CORTICOSTEROIDS,[object Object]
ALLERGIC CONTACT DERMATITIS,[object Object],COMMON DISORDER IN CHILDHOOD,[object Object],ERYTHEMA, PAPULES, VESICLES,  SWELLING,[object Object],WEEPING ANG ITCHING,[object Object],24 -48 HRS AFTER EXPOSURE,[object Object],TYPE IV,[object Object]
CAUSES OF CONTACTDERMATITIS,[object Object],IRRITANTS            ANIMALS,[object Object],PLANTS                 CLOTHING,[object Object],NICKEL                  DRUGS,[object Object],CHROMATE,[object Object],MERCURY,[object Object],COSMETICS,[object Object]
ADVERSE FOOD REACTION,[object Object],IMMUNOLOGIC REACTION  RESULTING FROM INGESTION OF FOOD PRODUCTS,[object Object],AND ADDITIVES,[object Object],           I,[object Object]
FOOD ALLERGY(HYPERSENSITIVITY),[object Object],IMMUNOLOGIC REACTION RESULTING FROM ,[object Object],   INGESTION OF FOOD ADDITIVE ,  IgE MEDIATED,[object Object]
FOOD ANAPHYLAXIS,[object Object],CLASSIC ALLERGIC HYPERSENSITIVITY REACTION,[object Object], TO FOOD OR FOOD ADDITIVES INVOLVING IgE AND THE ,[object Object],  RELEASE OF CHEMICAL MEDIATORS,[object Object]
FOOD INTOLERANCE,[object Object],ABNORMAL NON-IMMUNOLOGIC PHYSIOLOGIC RESPONSE TO FOOD OR FOOD ADDITIVES,[object Object]
FOOD IDIOSYNCRASY,[object Object],HYPERSENSITIVITY WITHOUT IMMUNE RESPONSE,[object Object]
FOOD TOXICITY,[object Object],ADVERSE REACTION CAUSED BY DIRECT ACTION,[object Object],   OF FOOD ADDITIVE/ FOOD ON THE HOST RECIPIENT,[object Object],    WITHOUT IMMUNE MECHANISM FOUND NATURALLY,[object Object],   IN FOOD OR  SECONDARY TO CONTAMINATION BY MICROORGANISM OR PARASITES,[object Object]
RISK OF MANIFESTINGATOPY BASED ON FAMILYHISTORY OF ATOPY,[object Object],FAMILY  HISTORY  OF  ATOPY            RISK OF ,[object Object],                                                                    ATOPY      ,[object Object],BIPARENTAL( SAME ALLERGY)              50-80 %,[object Object],BIPARENTAL OR UNIPARENTAL             40-60%,[object Object],  PLUS ONE SIBLING,[object Object],UNIPARENTAL OR SIBLING                      20-49%,[object Object],NEGATIVE                                                     5-15 %,[object Object]
MANIFESTATIONS OFFOOD ALLERGY,[object Object],GASTROINTESTINAL:: VOMITING, ENTEROCOLITIS,MALABSORPTION, BLEEDING ,[object Object],RESPIRATORY : RHINITIS, ASTHMA, OTITIS MEDIA,[object Object],DERMATOLOGY : URTICARIA, ATOPIC DERMATITIS,,[object Object],ALOPECIA,[object Object],NEUROLOGIC : SEIZURE, LETHARGY,[object Object],HEMATOLOGY : ANEMIA,[object Object],ANAPHYLACTIC SHOCK,[object Object]
ADVERSE DRUG REACTION,[object Object],“ AN EFFECT WHICH IS  UNINTENDED  AND OCCURS,[object Object],AT DOSES NORMALLY USED IN MAN FOR PROPHYLAXIS,[object Object],DIAGNOSIS AND THERAPY “,[object Object], OCCURS WITHIN A REASONABLE TIME FOLLOWING ADMINISTRATION OF THE DRUG,[object Object],REACTIONS : INTOLERANCE, IDIOSYNCRASY, HYPERSENSITIVITY ,PSYCHOGENIC,[object Object]
CLASSIC ANTIHISTAMINICS,[object Object],ETHANOLAMINES,[object Object],    EXAMPLES : DIPHENHYDRAMINE , CARBINOXAMINE,[object Object],     CLEMASTINE, DIMENHYDRINATE,[object Object],     GENERAL COMMENTS:  SEDATIVE EFFECT HIGH,,[object Object],     MODERATE ANTICHOLINERGIC EFFECTS, RELATIVE LOW,[object Object],     GIT EFFECTS ,[object Object]
CLASSIC ANTIHISTAMINICS,[object Object],ALKYLAMINES : CHLORPHENIRAMINE , TRIPROLIDINE,,[object Object], BROMPHENIRAMINE, PHENIRAMINE,[object Object],GENERAL COMMENTS : LOW SEDATIVE , ANTICHOLINERGIC AND GI EFFECTS , BEST  GROUP,[object Object],FOR DAYTIME USE,[object Object]
CLASSIC ANTIHISTAMINICS,[object Object],ETHYLENEDIAMINES: ANTAZOLINE TRIPELENNAMINE,[object Object],GENERAL COMMENTS :LOW SEDATIVE , ANTICHOLINERGIC EFFECTS , GI EFFECTS COMMON,[object Object]
CLASSIC ANTIHISTAMINICS,[object Object],PIPERAZINES : HYDROXYZINE , MECLIZINE , CHLORCYCLIZINE,[object Object],GENERAL COMMENTS : DROWSINESS IS FREQUENT ,DRY ,[object Object],MOUTH A USUAL CHOLINERGIC EFFECT,[object Object]
CLASSIC ANTIHISTAMINICS,[object Object],PHENOTHAZINE : METHDILAZINE , PROMETHAZINE,[object Object],TRIMEPRAZINE,[object Object],GENERAL COMMENTS :  MARKED SEDATIVE EFFECT,[object Object],( USEFUL TREATMENT OF PRURITUS ),[object Object]
CLASSIC ANTIHISTAMINICS,[object Object],PIPERIDINES : CYPROHEPTADINE , BENZOCYCLOHEPTATHIPINE,[object Object],AZATADINE,[object Object],GENERAL COMMENTS : DROWSINESS IS COMMON,[object Object],USEFUL IN THE TREATMENT OF URTICARIA,[object Object]

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