Allergy

ALLERGY, 4TH EDITION......Page 2
Cover......Page 1
Allergy......Page 4
Copyright......Page 5
preface......Page 8
list of contributors......Page 9
Overview of the allergic immune response......Page 12
Central role of IgE and mast cells......Page 13
IgE structure......Page 14
B-cell development and differentiation: generation of antibody diversity......Page 16
Immunoglobulin isotype switching: regulation of the B-cell switch to IgE......Page 17
T-cell help in IgE class switching......Page 19
IgE receptors......Page 20
Effector T-cell subsets......Page 22
Transcription factors and expression of Th2 cytokine responses......Page 23
Th9 cells......Page 24
Treg cells......Page 25
IL-25......Page 26
Eosinophils......Page 27
Macrophages......Page 28
Nerves......Page 29
What are cytokines?......Page 30
Cell adhesion molecules and leukocyte adhesion to endothelium......Page 32
Selectin ligands......Page 33
β1 integrins......Page 34
Chemokine families......Page 35
Chemokine function......Page 36
CCR3 antagonists and allergic inflammation......Page 38
Fibroblasts......Page 39
EPR and LPR in the lung......Page 40
EPR and LPR in the skin......Page 41
Acknowledgement......Page 42
Further reading......Page 43
Heritability of allergic disease......Page 44
Finding genes for allergic disease......Page 45
Candidate gene versus genome-wide analysis......Page 48
Insight into disease pathogenesis......Page 49
Gene–environment interaction......Page 50
Atopy......Page 51
Genetic studies of asthma increase understanding of disease pathogenesis......Page 52
Atopic dermatitis......Page 56
Predicting disease......Page 57
Pharmacogenetics......Page 58
Environmental effects on genes: epigenetics and allergic disease......Page 59
Further reading......Page 60
Types of studies used in genetics......Page 61
Animal model studies......Page 62
Th-cell studies......Page 63
Influence of the maternal environment: emerging epigenetic paradigms......Page 64
Other environmental exposures in pregnancy......Page 65
Maturation of adaptive immunity......Page 66
Development of innate immune function......Page 67
Infant diet......Page 68
Prenatal lung development......Page 69
Postnatal factors influencing lung growth and development......Page 70
Infections and allergy in the inductive phase of asthma......Page 71
Respiratory infections as triggers of acute severe asthma: emergency room admissions as a paradigm......Page 72
Further reading......Page 73
Atopy, asthma, and allergy......Page 74
The ‘hygiene hypothesis’......Page 75
Allergens......Page 77
Sources of protective exposures in farming environments......Page 78
Timing of farming exposures......Page 79
Racial disparities and asthma prevalence and morbidity in the USA......Page 80
Further reading......Page 83
Introduction......Page 84
Allergen nomenclature......Page 85
Intrinsic factors......Page 86
Extrinsic factors......Page 88
Origins of allergens......Page 89
Plant allergens......Page 91
Herbaceous dicotyledonous species pollen......Page 92
Tree pollen......Page 93
Non-pollen, plant-derived aeroallergens......Page 94
Fungal allergens......Page 95
Invertebrate-derived allergens......Page 96
Orally administered and injectable drug allergens......Page 98
Envenomated and salivary allergens......Page 99
In vitro diagnostic tests......Page 100
One- and two-dimensional SDS-PAGE and immunoblotting......Page 102
Allergen isolation......Page 103
Monitoring allergen exposure or allergen content......Page 104
Allergen avoidance and immunotherapy......Page 106
Introduction......Page 107
Non-biological pollutants......Page 108
Non-biological pollutants......Page 109
Humidity......Page 111
Mechanisms of toxicity......Page 112
Allergic diseases......Page 113
Allergens......Page 114
Climate change and allergic disease......Page 115
Clinical implications......Page 116
5.2 Physicochemical and biochemical characteristics of pollen-derived aeroallergens from herbaceous dicotyledons......Page 118
5.3 Physicochemical and biochemical characteristics of tree pollen aeroallergens......Page 120
5.5 Physicochemical and biochemical characteristics of domestic fungal aeroallergens......Page 122
5.6 Physicochemical and biochemical characteristics of occupational aeroallergens......Page 126
5.7 Physicochemical and biochemical characteristics of vertebrate aeroallergens......Page 128
5.8 Physicochemical and biochemical characteristics of invertebrate aeroallergens......Page 130
5.9 Physicochemical and biochemical characteristics of ingested, vertebrate-derived food allergens......Page 132
5.10 Physicochemical and biochemical characteristics of ingested seed and fruit allergens......Page 133
5.11 Physicochemical and biochemical characteristics of envenomated and salivary invertebrate allergens......Page 135
5.12 Physicochemical and biochemical characteristics of human autoallergens......Page 137
5.13 Physicochemical and biochemical characteristics of parasite allergens......Page 138
Further reading......Page 117
Introduction......Page 140
Definitions and basic pathophysiology......Page 141
Personal history – the patient’s account......Page 142
Measuring disease control and quality of life......Page 143
Occupational allergy......Page 144
Food allergy and intolerance......Page 145
Physical examination......Page 146
Chest......Page 147
Skin testing......Page 148
Basophil histamine release test......Page 151
Measurement of environmental allergens......Page 152
Golden rules of allergy diagnosis (Box 6.9)......Page 153
Conclusion – diagnostic approach......Page 154
6.1 Allergy-specific health related quality of life measures......Page 157
Further reading......Page 156
Adrenaline......Page 158
β2-Adrenoceptor stimulants......Page 159
Asthma......Page 160
Allergic rhinitis......Page 161
Asthma......Page 162
Asthma and chronic obstructive pulmonary disease (COPD)......Page 163
Corticosteroids......Page 164
Mechanism of action......Page 165
Allergic rhinitis......Page 167
H1-Antihistamines......Page 168
Mechanism of action......Page 169
Urticaria and atopic dermatitis......Page 171
Leukotriene synthesis inhibitors and receptor antagonists......Page 172
Mechanism of action......Page 173
Asthma......Page 174
Cromolyn sodium and nedocromil sodium......Page 175
Non-steroidal anti-inflammatory drugs......Page 176
Strategies aimed at T cells......Page 177
Anti-eosinophil strategies......Page 178
Mast cell mediator antagonists......Page 179
Further reading......Page 180
Overall approach to respiratory allergy......Page 182
Mechanisms of immunotherapy (Fig. 8.1)......Page 183
Hymenoptera venom allergy......Page 184
Sublingual immunotherapy in allergic rhinitis and asthma......Page 185
Indications and contraindications for immunotherapy in respiratory allergy......Page 186
Safety of allergen-specific immunotherapy......Page 187
Allergen products......Page 188
Peptide immunotherapy......Page 189
Further reading......Page 190
Introduction......Page 192
Allergic asthma in children......Page 193
Allergic bronchopulmonary aspergillosis......Page 195
Chronic obstructive lung disease......Page 197
Innervation of the bronchi......Page 198
Diagnosis of asthma......Page 199
Nasal or sinus symptoms......Page 200
Evaluation of lung function......Page 201
Cold air challenge......Page 202
Methacholine challenge......Page 203
Management of asthma......Page 204
β2-Adrenergic agonists......Page 205
Management plans......Page 206
Allergen avoidance......Page 207
Outcomes of asthma – natural course and the impact of management......Page 209
Pharmaceutical management: agonists and antagonists......Page 210
Altering the immune response: immune deviation versus immunotherapy......Page 211
Further reading......Page 212
Functions of the nose and sinuses......Page 214
Anatomy and physiology of the nose......Page 215
Vascular innervation......Page 216
Priming......Page 217
Inflammatory cells and mediators......Page 218
Epidemiology......Page 219
Comorbidity of asthma and allergic rhinitis......Page 221
Differential diagnosis......Page 222
Rhinoscopy......Page 223
Examination of extranasal regions......Page 224
Nasal challenge......Page 225
Cytological studies......Page 227
Intranasal steroids (INS)......Page 228
α-Adrenoceptor stimulant drugs (nasal decongestants)......Page 230
Sublingual immunotherapy (SLIT)......Page 231
Acute rhinosinusitis (ARS)......Page 232
Eosinophilic rhinosinusitis......Page 233
Aspirin-exacerbated respiratory disease......Page 234
Churg–Strauss syndrome......Page 235
Further reading......Page 237
Anatomy and physiology......Page 238
Disease mechanisms......Page 239
General clinical presentation......Page 242
Seasonal and perennial allergic conjunctivitis......Page 243
Vernal keratoconjunctivitis (VKC)......Page 244
Differential diagnosis......Page 246
History......Page 247
Physical examination......Page 250
Skin prick test......Page 251
Measurement of specific IgE in tears......Page 252
Introduction and goals of management......Page 253
Allergen avoidance......Page 254
Steroids......Page 255
Conclusions......Page 256
Further reading......Page 257
Introduction......Page 258
Classification......Page 259
Spontaneous urticaria......Page 260
Physical urticaria......Page 261
Non-pharmacological interventions......Page 263
Disease-modifying treatments......Page 264
Hereditary angioedema with normal C1 inhibitor......Page 265
Non-histaminergic idiopathic angioedema......Page 266
Hereditary angioedema with C1 inhibitor deficiency......Page 267
Diagnosis......Page 268
Hereditary angioedema with C1 inhibitor deficiency......Page 269
Non-histaminergic idiopathic angioedema......Page 271
Further reading......Page 272
Introduction......Page 274
Anatomy and physiology......Page 275
Disease mechanisms......Page 276
Provocation factors in atopic dermatitis......Page 277
Infections......Page 279
Food......Page 280
Differential diagnosis......Page 281
Symptom presentation......Page 282
Management of atopic dermatitis......Page 284
Allergen avoidance......Page 285
Treatment with systemic drugs......Page 286
Anatomy and physiology......Page 287
Inflammatory cells and mediators......Page 288
Symptom presentation......Page 291
Patch testing......Page 292
Metal allergies......Page 294
Plant dermatitis......Page 295
General principles......Page 296
Further reading......Page 297
Introduction......Page 298
Lymphoid tissue......Page 299
Pathophysiology of food allergy manifesting in the GI tract......Page 301
Food allergy manifesting in the GI tract......Page 303
Food allergy manifesting at other body sites......Page 306
History......Page 307
Tests for the presence of IgE-mediated food allergy......Page 308
Provocation studies......Page 309
Introduction......Page 310
Drug treatment......Page 312
Further reading......Page 313
Disease mechanisms......Page 316
Epidemiology......Page 318
Occupational rhinitis......Page 319
Work-related asthma......Page 320
Environmental assessment......Page 323
Skin tests......Page 324
Physiological assessment in suspected asthma......Page 325
Management......Page 326
Secondary prevention......Page 327
Medicolegal aspects: assessment of disability and compensation......Page 328
Conclusions......Page 329
Further reading......Page 330
Introduction......Page 332
Delayed hypersensitivity reactions......Page 333
Chemical basis of drug hypersensitivity......Page 334
Sulfonamides......Page 336
Risk factors......Page 337
Skin tests......Page 338
Biological tests......Page 339
Further reading......Page 340
Epidemiology......Page 342
Mast cell and basophil......Page 343
Classical clinical presentation......Page 344
Anaphylaxis with bradycardia......Page 346
Flushing syndromes......Page 347
Scombroidosis......Page 348
Immediate tests; at the time of the reaction......Page 349
Pheochromocytoma......Page 350
Prevention of anaphylactic episodes......Page 351
Approach to the patient who presents for diagnosis and a management plan after having experienced an anaphylactic episode......Page 353
Treatment of the acute event......Page 354
Further reading......Page 357
Historical introduction......Page 358
The allergic march......Page 359
Eczema and allergen avoidance......Page 361
Asthma......Page 362
Viruses and asthma......Page 363
Allergen immunotherapy......Page 365
Allergic rhinitis and the united airway......Page 367
Food allergy......Page 368
Prevention of food allergy......Page 369
Education and allergic disease......Page 370
Further reading......Page 371
Hypereosinophilic syndrome......Page 372
Allergic bronchopulmonary aspergillosis......Page 374
Eosinophil-associated gastrointestinal disorders......Page 375
Churg–Strauss syndrome......Page 377
Immunodeficiency......Page 378
Further reading......Page 379
Disease mechanisms......Page 380
General clinical presentation......Page 381
Classification of mastocytosis......Page 383
Diagnosis......Page 384
Treatment of emergencies......Page 387
Conclusions......Page 388
Further reading......Page 389
C......Page 390
E......Page 391
I......Page 392
M......Page 393
Q......Page 394
V......Page 395
W......Page 396
A......Page 398
B......Page 400
C......Page 401
E......Page 402
F......Page 403
I......Page 404
K......Page 405
N......Page 406
P......Page 407
R......Page 408
T......Page 409
Z......Page 410