Allergy overview

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Allergy overview
Allergy and atopy

• Response to foreign substances need immune system
• Immune response is normal in healthy people
• Immune system response is exaggerated in allergic
  patients which lead to damage body tissues

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Allergy overview
Allergy and atopy Exaggerated immune response in
allergic patients produce ? IgEs (type 1
hypersensitivity)
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Allergy overview

• Allergy and atopy
• Atopy is the tendency to develop an exaggerated
  IgE response, as reflected by ve SPT to one or
  more common allergens (i.e. a predisposition to
  develop allergic disease)
• Allergy is the clinical expression of atopy (i.e.
  the symptoms). Symptoms depend on the target
  organ. For example, allergy affecting the lungs
  causes allergic asthma, allergy affecting the
  nose causes AR

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Allergy overview
Allergy and atopy

• Many people are atopics but dont have allergic
  symptoms
• Atopics may or may not develop allergic symptoms
  later

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Allergy overview
Allergy and atopy

• We dont know how atopics become allergics
• If we know it will be easy to interrupt this
  process to avoid atopics to develop allergy but
  we dont

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Allergy overview
Types of allergy Allergic manifestations are
several according to the system involved like

• asthma
• rhinitis
• atopic dermatitis (eczema)
• acute Urticaria Angioedema
• food allergy
• anaphylaxis

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Allergy overview
Types of allergy asthma - 4 cardinal symptoms

• Cough
• chest tightness
• wheeze
• breathlessness

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Allergy overview
Types of allergy rhinitis

• sneezing, runny and itchy nose
• seasonal (hay fever)
• perennial (all the year)
• often together with allergic conjunctivitis (red
  itchy watery eyes)

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Allergy overview
Types of allergy AD (eczema)

• allergy in skin
• itching redness scaling, weeping and
  thickening of the skin
• anywhere but more in face, scalp, flexures of
  (elbows, knees and wrists)

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Allergy overview
Types of allergy Acute urticaria

• allergy in skin
• skin redness and itch followed by hives (red
  swollen area)
• hives initially red then pale

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Allergy overview
Types of allergy Acute urticaria

• this reaction is called "nettle rash" as it
  resemble a nettle sting
• Angioedema is form of urticaria that manifests as
  swelling
• of face and mouth

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Allergy overview
Types of allergy food allergy

• GIT ? diarrhea, nausea, vomiting
• out side GIT ? Urticaria, eczema, asthma and
  anaphylaxis

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Allergy overview
Types of allergy anaphylaxis

• Sudden, sever, generalized allergic reaction
• Itching, angioedema, bronchospasm, sever drop in
  BP with vascular collapse and shock

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Allergy overview
Allergens Wide spectrum of allergens
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Allergy overview
Allergens

1. airborne (aeroallergens)
2. contact allergens
3. ingested allergens

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Allergy overview
Allergens HDM

• tiny, spider-like (its not insect)
• live on flakes of
• human skin
• house dust
• fungal spores
• pollen grains
• plant fibers and insect scales

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Allergy overview
Allergens HDM

• invisible to naked eye
• People become allergic to its protein in their
  droppings

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Allergy overview
Allergens HDM

• All houses are infested
• Highest concentration in

1. mattress
2. pillows

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Allergy overview
Allergens - HDM People are exposed to
high levels because

• most of them spend most of their time indoor
  (poor ventilation)
• many hours in bed

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Allergy overview
Allergens pollen

• small size pollens distributed by wind to great
  distances
• So.symptoms can be caused by local exposure or
  even great distance away

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Allergy overview
Allergens pollen

• grass (timothy grass, ryegrass)
• tree (birch, hazel, London plan)
• weed pollen (mugwort)

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Allergy overview
Allergens pets Allergen exposure either

• airborne allergy
• contact allergy

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Allergy overview
Allergens cats

• commonest cause of pet allergy
• allergens mostly found in saliva ? so allergen
  reach fur during grooming and licking ? when dry
  can shed to air for hours or days

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Allergy overview
Allergens dogs

• cause allergy in similar way
• dog allergy less common than cats

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Allergy overview
Allergens moulds

• aspergillus fumigatus, cladosporium and
  alternaria alternata
• less common cause of allergy
• types

- indoor moulds in damp house - outdoor moulds
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Allergy overview
Allergens true food allergy

• Rare
• milk, wheat, egg, peanut and shellfish

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Allergy overview

• Epidemiology of allergic diseases
• Epidemiology the study of the occurrence,
  distribution and causes of diseases
• Prevalence number of cases present at a given
  time per 1000 or 100000 of population
• Incidence number of new cases occurring within a
  defined time period (eg. A year) per 1000 or
  100000 of the population

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Allergy overview
Epidemiology prevalence

• 15 20 in UK
• More in younger people
• gt50 y the prevalence is lower

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Allergy overview
Epidemiology prevalence Hayfever prevalence
is - 16 in 15 24 years - then
decline after this age (Wuthrich 1998, LAIA
1998)
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Allergy overview
Epidemiology prevalence Prevalence of allergic
diseases is increasing (asthma, eczema,
hayfever)
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Allergy overview
Epidemiology prevalence of atopy

• Prevalence of atopy is increasing
• there is increasing prevalence of sIgE to common
  aeroallergens in children (in 2 studies in
  Switzerland and Japan)
• Increase ve SPT in adults living in London in
  1974 compared with those in 1988 (sibbald et al
  1990)

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Allergy overview
Epidemiology prevalence of hayfever Four-fold
increase number of summer consultations
(seasonal) between 1950 - 1980
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Allergy overview
Epidemiology prevalence of asthma Prevalence
is increasing about 70 from 1974 to 1986 (Lewis
et al 1996)
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Allergy overview
Epidemiology prevalence of eczema Substantial
increase in reporting mothers that their child (5
-7 years) had eczema since 1964 (Taylor et al
1984)
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Allergy overview
Epidemiology prevalence of allergic contact
dermatitis Prevalence constantly changes as the
allergen come and go
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Allergy overview
Epidemiology prevalence of food allergy

• Prevalence difficult to determine because of
  population misbelieve
• 20 of population think they have food allergy
  BUT lt2 of adults have it

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Allergy overview
Epidemiology prevalence of food
allergy Increased prevalence of peanut prevalence
in UK

• 1,2 had ve SPT to food at 4 years (Tariq et al
  1996)
• Sampson 1997
• 44 of children with moderate to sever atopic
  dermatitis have ve SPT to peanut between 1981 to
  1985
• but in 1994 increases to 68

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Allergy overview
Epidemiology prevalence of anaphylaxis

• At 1940s it was mainly to penicillin
• Recently its mainly to latex (gloves) in medical
  procedures (Dillard and McCollum 1992)

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Allergy overview
Risk factors

• FH of allergy or atopy

- if one parent has allergy there is 25 30
chance the child will have - if both parents
have allergies chance increase to 50 80

• smoking

- maternal smoking during pregnancy - paternal
smoking during childhood
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Allergy overview
Risk factors

• lifestyle (diet, socioeconomic status and housing
  environment)

- lower prevalence in eastern than western
countries in adults (Jogi et al 1998) - lower
prevalence of asthma and atopy in children in
east Germany compared to west Germany (Braback et
al 1994, Nowak et al 1996)
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Allergy overview
Risk factors

• age and environmental factors

- lt3years ? childhood asthma -later in
childhood ? other atopic disorders
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Allergy overview
Risk factors factors which decrease risk

• Being breastfed for at least 16 weeks
• Some infections

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Allergy overview
Mortality Inspite allergy isnt fatal disease
but mortality still present

• 1600 die from asthma each year in UK
• anaphylaxis, urticaria, angioedema can be fatal
  (very rare)

- death due to penicillin anaphylaxis only 1/7.5
million injections (Idose et al 1968) - venom
anaphylaxis 1/6.5 million stings (Parrish 1965) -
4 death's/year due to peanut
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Allergy overview
Mortality Improvement in population awareness
of anaphylaxis and its management is necessary
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Allergy overview

• Morbidity
• Allergies cause
• considerable suffering
• and medical treatment costs

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Allergy overview
Morbidity rhinitis We think its trivial
problem but it causes considerable morbidity
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Allergy overview
Morbidity rhinitis

1. widespread morbidity
2. reduced work productivity
3. lost school days

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Allergy overview
Morbidity rhinitis

1. significant effect on life quality

• Fatigue
• - headache
• - impaired thought process
• - discomfort from itchy, watery eyes and nose

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Allergy overview
Morbidity rhinitis
5. sedating antihistamines (Vuuman et al 1993,
O'Hanlon and Ramaekers 1995)
- affect mental performance - car accidents
- accidents at work - ? work productivity -
impaired school performance
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Allergy overview
Morbidity asthma in children

• many hospital admissions
• absence from school (NAC 2000)

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Allergy overview
Morbidity asthma

• in elderly more likely to report poor general
  health, depression, limitation of daily
  activities (Enright et al 1999)
• physical and emotional distress
• occupational asthma ? change job
• affect career, sport enjoyment, sexual relations

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Allergy overview
Morbidity eczema

• particular problem in children
• 90 before 5years
• Considerable distress due to (itching, soreness)
• Constant scratching leave skin open to infection

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Allergy overview
Morbidity acute urticaria

• Nettle rash cover large areas
• In sever reactions ? dramatic drop in BP, loos
  consciousness

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Allergy overview
Morbidity acute urticaria Physical urticaria
lead to sever limitation in lifestyle like

• Prevent them leaving house on hot or cold days
• swimming in cold water
• bathing in hot water
• wearing tight cloth

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Allergy overview
Morbidity chronic Urticaria Cause mostly
unknown
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Allergy overview
Morbidity food allergy

• serious life restriction because its difficult to
  identify which food contain the trigger
• full food components (list) usually not clear in
  many places (ex restaurants, take away shops)

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Allergy overview
Morbidity food allergy Peanut allergy

• small amount can cause anaphylaxis
• this cause life distress

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Allergy overview
Gap in provision of allergy care in UK

• inspite large numbers of cases the service is
  very little
• allergy isnt part of any undergraduate
  curriculum in medical schools
• limited postgraduate opportunity

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Allergy overview
Gap in provision of allergy care in UK

• few specialist allergy clinics
• mostly in south east (Respiratory alliance 2003)
• referrals and waiting lists to these centers vary
  
• (3month 2 years)
• one allergist/2.1 million while one chest
  physician/100,000

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Allergy overview
Gap in provision of allergy care in UK

• allergy treated according to organ most affected
  inspite allergics suffer from more than one
  system

• children with sever rhinitis usually associated
  with wheezing
• - children with eczema may suffer asthma or
  anaphylaxis to peanut

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Allergy overview
Gap in provision of allergy care in UK charities
must fill the gap

• British allergy foundation
• NAC
• Anaphylaxis campaign
• National eczema society

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Allergy overview
Gap in provision of allergy care in UK

• These charities provide helplines and information
  for allergy sufferers
• Unfortunately there is "alternative practice"
  with no evidence tests (ex analysis from hair
  sample) by unqualified people with high prices

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Allergy overview
Gap in provision of allergy care in UK

• NHS developed guidelines, setting out the
  standards of allergy care (RCP et al 1995)

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Allergy overview
Gap in provision of allergy care in UK
Contents of this guideline - It shows which
conditions need allergy care - allergic child
should be under pediatrician care because
progression in this age is different from
adults - the pre-requisites of allergy clinics
in hospitals
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Allergy overview
Improving standards of patient care in UK

• BSACI distribute one specialist allergy clinic
  for each region

• Each clinic have

- 2 full time allergists - full time specialist
nurse - half-time dietician with interest in
allergy - one full time specialist registrar in
allergy
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Allergy overview
Improving standards of patient care in UK

• improving the allergy practice in primary care
• using modern management approaches which can
  control most types
• giving more time for (patients assessment, full
  history, education, FU)
• training health professionals

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Allergy overview
Improving standards of patient care in UK

• SPT is under-used because of

- many health professionals think its time
consuming -historical reasons of decline of
immunotherapy -perceived lack of need for
accurate allergy diagnosis
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Allergy overview
Improving standards of patient care in UK

• Medications care

- how to use (inhalers, nasal spray) - written
notes

• setting up allergy clinics

- by expanding existing asthma clinic
- or open new allergy clinic
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Allergy overview
Improving standards of patient care in UK

• appreciate regional considerations like increase
  of occupational allergy in certain region because
  of the presence of factory in that area

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Allergy overview
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Gap in provision of allergy care in Saudi

• Allergists have to do something to cover this
  gap!!!
• Tell now there is no Saudi allergy society??!
• One of the most important missions of AAG is to
  try to cover this gap

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Allergy overview

• Saudi allergy and clinical immunology society
  (SACIS)

Is it Possible ??
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