Common Allergens in Allergic

• Pollens from grass, weeds, and trees

• Mold spores and mold fragments

• Animal danders (hair, skin and feathers) and saliva

• Dust mite feces

• Cockroach feces

• Food allergens: food preservatives like potassium bisulphate and sodium benzoate.

• Other food allergens are egg, milk, peanut, sesame and others.

 Other triggering agents in asthma

• Smokes from fire place, candles, fireworks, and incense sticks.

• Tobacco smoke

• Air pollution

• Cold air

• Strong chemical odors and perfumes

• Dusty work places

 Pathology in allergic asthma

• Following exposure to allergens, allergic reaction sets up in airways.

• There is a complex interaction btw mast cells, IgE, esinophils, T- lymphocytes, macrophages and dendritic cells.

• These cells release many mediators like Leukotriene C4, interferons and cytokines.

• These mediators cause constriction and spasm of bronchial airways, edema of bronchial walls and mucus plugging the airways.

• Long term changes in airways referred to as airway modeling, can lead to fibrosis and irreversible airway obstruction in some of the patients.CC

 Clinical signs and symptoms

• Cough with expectoration

• Wheezing

• Shortness of breathe

• Chest pain and tightening

• Rapid breathing

 Severity of asthma

To consider allergic immunotherapy in allergic patients

Tests and diagnosis

• Serum IgE levels

• Absolute esinophils

• Sputum examination

• Chest radiography

• Chest CT scan

• Echocardiogram

• Pulmonary function test

 Treatment

 Pharmacotherapy

Corticosteroids

• Inhaled steroids: Budesenoid, Fluticasone, Flunisolide, Betamethasone)

• Systemic steroids: Prednisolone, Hydrocortisone, and Methyl prednisolone.

Bronchodilators

• Short acting beta agonists: Salbutamol, Albuterol

• Long acting beta agonists: Salmetrol, Formoterol

• Methyl Xanthine: Theophylline, Deriphylline

• Anticholinergics: Ipratropium and Tiotropium bromide

Leukotriene-modifying agents

• Zakirlukast, Motelukast, and Zileuton

Mast cell stabilizing agents

• Sodium chromoglycate, Nedocromil and Ketotinfen

 Monoclonal antibodies

Omalizumab

• DNA derived human IgG monoclonal antibody that binds selectively to human IgE receptor on surface of mast cells and basophils.

• It down regulates the mediators of allergic response in asthma.

• Indicated in moderate to severe persistent asthma.

 Environmental control

Allergen avoidance- A multifaceted approach is necessary, as individual interventions are rarely successful.

Allergen immunotherapy

Allergen immunotherapy should be considered in those the specific allergens have a proven relationship to symptoms.