Transcript aeuae_ic_iae_aioeae

Diagnostic approach to
the allergic patient
Allergic conditions in Israel
Total
Asthma
Allergic
Skin
Insect
Food
Drug
population
(%)
rhinitis
allergy
bite/sting
allergy
allergy
(%)
(%)
(%)
(%)
(%)
14
8
3
6
8
(n)
Total
1637
14
Allergy
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

1906
von Pirquet
immunity (a
beneficial effect)
or allergic disease
(a harmful effect).
Atopy
(from the Greek atopos, meaning out of
place) is often used to describe IgEmediated diseases.
The Role of Cytokines Produced by Th2 Cells in Chronic Allergic Inflammation
Kay, A.B. N Engl J Med 2001;344:30-37
Pathways Leading to Acute and Chronic Allergic Reactions
Kay, A.B. N Engl J Med 2001;344:30-37
Taking a history
Patient's account of symptoms
How long has the condition been present?
Impact on lifestyle: how frequent and severe is it?
Does it affect work, school, leisure time, sleep?
Seasonal or perennial?
Trigger factors: allergic or non-allergic?
Exposure to allergens through occupation or hobbies?
Allergens in the home
Does patient have history of asthma, eczema, rhinitis?
Drug or food induced?
Family history
Treatment: compliance, efficacy, side effects
What is the main symptom?
Chronic Rhinitis
Non- Allergic





Idiopathic
rhinitis
NARES
Hormonal
Rhinitis
Drug induced
Rhinitis
Food induced
Rhinitis
Allergic

Seasonal Rhinitis

Perennial Rhinitis

Occupational
Rhinitis
‫גישה‬
‫• מניעת חשיפה‬
‫טיפולית‬
‫• טיפול תרופתי‬
corticosteroids•
Antileukotrienes •
Antihistamines •
‫• חיסונים‬
Effect of drug treatment
Itching Rhinorrhea
Nasal
sneezing
obstruction
Oral
antihistamines
+++
++
+
+++
+++
++
Decongestant
-
-
+++
Ipatropium
-
+++
-
Cromoglycate
+
+
-
Topical
corticosteroids
Rapidity of Symptom Relief
Time (minutes)
Mean Symptom Score
(change from baseline)
0
40
80
120
160
200
240
280
0
-0.5
-1
-1.5
-2
-2.5
-3
-3.5
PLACEBO
60 mg
120 mg
300
Antiallergic and Anti-inflammatory Effects
of Antihistamines
• Blocking anti H1 receptors
• Decreased released of some chemical mediators of
inflammation from mast cells
• Decreased migration, accumulation and activation
of cells
• Decreased production and activation of
inflammatory products
First generation of Antihistamines
Onset of Sedative
action (h) Effects
Possible
Cardiac
effect
Chlorpheniramine
Maleate (Ahiston)
2-3
Yes
No
Hydroxizine
(Otarex)
1-2
Yes
No
Dimethidine
maleate (Fenistil)
2-3
Yes
No
Second generation of Antihistamines
Onset of Sedative
action (h) Effects
Cetrizine
(Zytrec)
Loratidine
(Lorastine)
Fexofenadine
(Telfast)
Astemizole
(Hismanal)
Terfenadine
(Ternalin)
Possible
Cardiac
effect
1-2
NO
NO
1-2
NO
NO
1-2
NO
NO
1-2
NO
YES
1-2
NO
YES
Effects of Fexofenadine, Diphenhydramine, and Alcohol
on Driving Performance
A Randomized, Placebo-Controlled Trial in the Iowa
Driving Simulator
John M. Weiler, MD; John R. Bloomfield, PhD; George G.
Woodworth, PhD; Angela R. Grant, BS; Teresa A. Layton, BSN;
Timothy L. Brown, MS; David R. McKenzie, MS; Thomas W. Baker,
MS; and Ginger S. Watson, PhD
Annals of Internal Medicine. 2000; 132: 354-363
Median Weekly Pollen Counts and Symptom, Rescue-Medication, and Visual-Analogue Scores
for the Initial Placebo Trial (1989) and for the Current Trial (1993 through 1995)
Durham S et al. N Engl J Med 1999;341:468-475
FUTURE THERAPIES



Recombinant
allergens
immunotherapy
Anti-IgE therapy
Anticytokine
treatment