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ALLERGY IN ALABAMA. SPRING - FLOWERING GRASSES, ORNAMENTAL FLOWERS, NOT PINE POLLEN FALL – RAGWEED NOT GOLDENROD YEAR ROUND-ANIMAL DANDER AND SALIVA SUMMER/HUMIDITY -MOLDS/ FUNGUS. RAGWEED GOLDENROD. Welcome to Alabama. Timothy Grass. Bermuda Grass. HYPERSENSITIVITY REACTIONS.
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ALLERGY IN ALABAMA • SPRING - FLOWERING GRASSES, ORNAMENTAL FLOWERS, NOT PINE POLLEN • FALL – RAGWEED NOT GOLDENROD • YEAR ROUND-ANIMALDANDER AND SALIVA • SUMMER/HUMIDITY -MOLDS/ FUNGUS
HYPERSENSITIVITY REACTIONS • TYPE I- ALLERGIC CONJUNCTIVITIS • TYPE II- MYASTHENIA GRAVIS • TYPE III-UVEITIS? SJOGRENS • TYPE IV- CONTACT DERMATITIS & GPC
ALLERGY CASCADE • IGE BINDS ANTIGEN • FORMS DIMER AT SURFACE OF MAST CELL • MAST CELL DEGRANULATES HISTAMINE PROSTAGLANDINS THROMBOXANES LEUKOTRIENES VASOACTIVE AMINES EOSINOPHIL ATTRACTING FACTOR
STAGES OF ALLERGIC DISEASE • EARLY PHASE • MAST CELLS AND PRODUCTS • LATE PHASE • LEUKOCYTES • T -LYMPHOCYTES • CHRONIC PHASE • T CELLS FACTORS
MAST CELLS • DIFFERENT TYPES OF MAST CELLS • CHYMASE POSITIVE • TYPTASE POSITIVE (all mast cells, most common ocular surface, prevents clotting) • CHYMASE AND TYPTASE (most common in non allergic)
Inside Mast Cells • Increase synthesis of phosopholipase A-production of arachodonic acid • Increase protein kinase production-necessary for degranulation • Increase in intracellular calcium levels • 24-48 hours increase cytokine production
CGMP • INCREASES MAST CELL DEGRANULATION • ALPHA AGONISTS INCREASE • BY DECREASING CAMP • CHOLINERGICS INCREASE CGMP
CAMP • DECREASES DEGRANULATION • HISTAMINE INCREASES • BETA ADRENERGIC DRUGS INCREASE • ADENYL CYCLASE(PROSTAGLANDINS)
cAMP cGMP Balance CAMP CGMP
PROSTAGLANDIN D2 • PRIMARY OCULAR PG IN HYPERSENSITIVITY • CHEMOSIS • REDNESS • DISCHARGE • EOSINOPHIL CHEMOTAXIS
BIOLOGIC ACTIVITY OF PROSTAGLANDINS • PGF2 & PGD2- BRONCHOSPASM • PGI2- PULMONARY DILATION & < PLATELET AGGREGATION • PGE2 BRONCHODILATOR • PGE1 &PGE2 -> NERVE SENSITIVITY VASODILATION • TXA2-VASOCONSTRICTION
BIOLOGIC ACTIVITY OF LEUKOTRIENES • LTB4 • PMN ATTRACTANT • EOSINOPHIL ATTRACTANT • > VASCULAR PERMEABILITY • >.EDEMA • COFACTOR W/ PGE2 & PGD2 • LTC4, LTD4, LTE4 • BRONCHOCONSTRICTORS • MYOCARDIAL DEPRESSANTS
EOSINOPHILS-ACTIVATION • EOSINOPHIL CHEMOTACTIC FACTOR(LTB4) • HISTAMINASE DECREASES • PHOSPHOLIPASE DECREASES • ARYL SULFATASE DECREASES • PLATELET ACTIVATING FACTOR STRONGLYATTRACTS
EOSINOPHILS • MAJOR BASIC PROTEIN (anti-parasite) • HIGHLY TOXIC TO EPITHELIUM • INCREASES MAST CELL DEGRANULATION • EOSINOPHIL CATIONIC PROTEIN • EOSINOPHIL PEROXIDASE
HISTAMINE • BRONCHOSPASM • VASODILATOR • INCREASES VASCULAR PERMEABILITY • ACTIVATES NERVE TERMINALS
PLATELET ACTIVATING FACTOR RELEASING CELLS • BASOPHILS • MAST CELLS • EOSINOPHILS • MONOCYTES/MACROPHAGES • PMN’S
T CELL MEDIATED FACTORS • IL-3 INDUCES MAST CELL DEGRANULATION • IL-4 FACILITATES IGE PRODUCTION BY B LYMPHOCYTES • IL-5 STIMULATES EOSINOPHIL PROLIFERATION
OCULAR RESPONSE IN ARACHADONIC ACID PATHWAY • CYCLO-OXYGENASE PATHWAY • LID SWELLING • CHEMOSIS • VASODILATION • LIPO-OXYGENASE PATHWAY • CHRONIC INFLAMMATION
OCULAR SURFACE HISTAMINE RECEPTORS • H1 RECEPTORS- NEURONAL • PRODUCES ITCHING • H2 RECEPTORS- VASCULAR • PRODUCES REDNESS
DIAGNOSIS OF ALLERGY • RAST (RADIOALLERGOSORBANT ASSAY) • PRICK TESTS • INDERATION TESTS • DIRECT CHALLENGE • CONJUNCTIVAL CHALLENGE
CONJUNCTIVAL CHALLENGE • FDA REQUIREMENT FOR NEW DRUGS • ALLERGEN APPLIED TO CONJ • REDNESS,WATERING,CHEMOSIS GRADED • RETEST WITH PRETREATMENT
DRUG ACTIONS • MAST CELL STABILIZERS • STEROIDS • ANTIHISTAMINES • ASPIRIN • NONSTEROIDALS • VASOCONSTRICTORS • THEOPHYLLINE
STEROID ACTIONS • DECREASE mRNA • INHIBITS PHOSPHOLIPASE A • POTENTIATES B ADRENERGICS • CONSTRICTS BLOOD VESSELS • DECREASES CHEMOTAXIS • LYMPHOPENIA • DECREASES MACROPHAGE FUNCTION • GI, RENAL, PLATELET, MACROPHAGE DIFFERENTIATION
STEROID EFFECTS • DECREASE MESSENGER RNA • INHIBITS PHOSPHOLIPASE A PRODUCTION • INCREASES CAMP • POTENTIATES B ADRENERGIC DRUGS • CONSTRICTS BLOOD VESSELS • DECREASES CHEMOTAXIS • LYMPHOPENIA • DECREASED MACROPHAGE FUNCTION
DRUG ACTIONS • STEROIDS-MULIPLE EFFECTS • MAST CELL STABILIZERS-INHIBIT CALCIUM ENTRY INTO CELL • ANTIHISTIMINES- EFFECT AFTER RELEASE • ASPIRIN - INHIBITS CYCLO-OXYGENASE PATHWAY • NONSTEROIDALS- INHIBIT CYCLO-OXYGENASE PATHWAY
COX 1 AND COX 2 • COX 1 PRESENT AT STEADY STATE LEVELS • HOMEOSTATIC FUNCTIONS • COX 2 ASSOCIATED WITH INFLAMMATION • VIOXX, CELEBREX, BEXTRA • PREFERENTIAL VS SPECIFIC
DRUG EFFECTS • VASOCONSTRICTORS -REVERSE VASODILATION • THEOPHYLLINE- INCREASE CAMP
FOOD ALLERGY • VARIABLE EFFECT DUE TO ABSORBTION • USUALLY LOCAL GI EFFECT • CAN BE IDIOSYNCRATIC
ALLERGIC SKIN REACTIONS • ERYTHEMA-REDNESS • FLARE-DIFFUSE REDNESS AROUND WHEAL • WHEAL-LOCALIZED EDEMA,TYPICAL LID • ANGIOEDEMA
DRUG ALLERGY • TOXICITY • INTOLERANCE • IDIOSYNCRATIC • ALLERGIC