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ALLERGY IN ALABAMA

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

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  1. ALLERGY IN ALABAMA • SPRING - FLOWERING GRASSES, ORNAMENTAL FLOWERS, NOT PINE POLLEN • FALL – RAGWEED NOT GOLDENROD • YEAR ROUND-ANIMALDANDER AND SALIVA • SUMMER/HUMIDITY -MOLDS/ FUNGUS

  2. RAGWEED GOLDENROD

  3. Welcome to Alabama

  4. Timothy Grass

  5. Bermuda Grass

  6. HYPERSENSITIVITY REACTIONS • TYPE I- ALLERGIC CONJUNCTIVITIS • TYPE II- MYASTHENIA GRAVIS • TYPE III-UVEITIS? SJOGRENS • TYPE IV- CONTACT DERMATITIS & GPC

  7. Allergic conjunctivitis

  8. Myasthenia Gravis

  9. Sjogrens

  10. Phlyctenular Conjunctivitis

  11. ALLERGY CASCADE • IGE BINDS ANTIGEN • FORMS DIMER AT SURFACE OF MAST CELL • MAST CELL DEGRANULATES HISTAMINE PROSTAGLANDINS THROMBOXANES LEUKOTRIENES VASOACTIVE AMINES EOSINOPHIL ATTRACTING FACTOR

  12. STAGES OF ALLERGIC DISEASE • EARLY PHASE • MAST CELLS AND PRODUCTS • LATE PHASE • LEUKOCYTES • T -LYMPHOCYTES • CHRONIC PHASE • T CELLS FACTORS

  13. 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)

  14. calcium

  15. 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

  16. CGMP • INCREASES MAST CELL DEGRANULATION • ALPHA AGONISTS INCREASE • BY DECREASING CAMP • CHOLINERGICS INCREASE CGMP

  17. CAMP • DECREASES DEGRANULATION • HISTAMINE INCREASES • BETA ADRENERGIC DRUGS INCREASE • ADENYL CYCLASE(PROSTAGLANDINS)

  18. cAMP cGMP Balance CAMP CGMP

  19. PROSTAGLANDIN D2 • PRIMARY OCULAR PG IN HYPERSENSITIVITY • CHEMOSIS • REDNESS • DISCHARGE • EOSINOPHIL CHEMOTAXIS

  20. BIOLOGIC ACTIVITY OF PROSTAGLANDINS • PGF2 & PGD2- BRONCHOSPASM • PGI2- PULMONARY DILATION & < PLATELET AGGREGATION • PGE2 BRONCHODILATOR • PGE1 &PGE2 -> NERVE SENSITIVITY VASODILATION • TXA2-VASOCONSTRICTION

  21. BIOLOGIC ACTIVITY OF LEUKOTRIENES • LTB4 • PMN ATTRACTANT • EOSINOPHIL ATTRACTANT • > VASCULAR PERMEABILITY • >.EDEMA • COFACTOR W/ PGE2 & PGD2 • LTC4, LTD4, LTE4 • BRONCHOCONSTRICTORS • MYOCARDIAL DEPRESSANTS

  22. EOSINOPHILS-ACTIVATION • EOSINOPHIL CHEMOTACTIC FACTOR(LTB4) • HISTAMINASE DECREASES • PHOSPHOLIPASE DECREASES • ARYL SULFATASE DECREASES • PLATELET ACTIVATING FACTOR STRONGLYATTRACTS

  23. EOSINOPHILS • MAJOR BASIC PROTEIN (anti-parasite) • HIGHLY TOXIC TO EPITHELIUM • INCREASES MAST CELL DEGRANULATION • EOSINOPHIL CATIONIC PROTEIN • EOSINOPHIL PEROXIDASE

  24. HISTAMINE • BRONCHOSPASM • VASODILATOR • INCREASES VASCULAR PERMEABILITY • ACTIVATES NERVE TERMINALS

  25. PLATELET ACTIVATING FACTOR RELEASING CELLS • BASOPHILS • MAST CELLS • EOSINOPHILS • MONOCYTES/MACROPHAGES • PMN’S

  26. T CELL MEDIATED FACTORS • IL-3 INDUCES MAST CELL DEGRANULATION • IL-4 FACILITATES IGE PRODUCTION BY B LYMPHOCYTES • IL-5 STIMULATES EOSINOPHIL PROLIFERATION

  27. OCULAR RESPONSE IN ARACHADONIC ACID PATHWAY • CYCLO-OXYGENASE PATHWAY • LID SWELLING • CHEMOSIS • VASODILATION • LIPO-OXYGENASE PATHWAY • CHRONIC INFLAMMATION

  28. OCULAR SURFACE HISTAMINE RECEPTORS • H1 RECEPTORS- NEURONAL • PRODUCES ITCHING • H2 RECEPTORS- VASCULAR • PRODUCES REDNESS

  29. DIAGNOSIS OF ALLERGY • RAST (RADIOALLERGOSORBANT ASSAY) • PRICK TESTS • INDERATION TESTS • DIRECT CHALLENGE • CONJUNCTIVAL CHALLENGE

  30. CONJUNCTIVAL CHALLENGE • FDA REQUIREMENT FOR NEW DRUGS • ALLERGEN APPLIED TO CONJ • REDNESS,WATERING,CHEMOSIS GRADED • RETEST WITH PRETREATMENT

  31. DRUG ACTIONS • MAST CELL STABILIZERS • STEROIDS • ANTIHISTAMINES • ASPIRIN • NONSTEROIDALS • VASOCONSTRICTORS • THEOPHYLLINE

  32. STEROID ACTIONS • DECREASE mRNA • INHIBITS PHOSPHOLIPASE A • POTENTIATES B ADRENERGICS • CONSTRICTS BLOOD VESSELS • DECREASES CHEMOTAXIS • LYMPHOPENIA • DECREASES MACROPHAGE FUNCTION • GI, RENAL, PLATELET, MACROPHAGE DIFFERENTIATION

  33. STEROID EFFECTS • DECREASE MESSENGER RNA • INHIBITS PHOSPHOLIPASE A PRODUCTION • INCREASES CAMP • POTENTIATES B ADRENERGIC DRUGS • CONSTRICTS BLOOD VESSELS • DECREASES CHEMOTAXIS • LYMPHOPENIA • DECREASED MACROPHAGE FUNCTION

  34. 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

  35. 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

  36. DRUG EFFECTS • VASOCONSTRICTORS -REVERSE VASODILATION • THEOPHYLLINE- INCREASE CAMP

  37. FOOD ALLERGY • VARIABLE EFFECT DUE TO ABSORBTION • USUALLY LOCAL GI EFFECT • CAN BE IDIOSYNCRATIC

  38. ALLERGIC SKIN REACTIONS • ERYTHEMA-REDNESS • FLARE-DIFFUSE REDNESS AROUND WHEAL • WHEAL-LOCALIZED EDEMA,TYPICAL LID • ANGIOEDEMA

  39. DRUG ALLERGY • TOXICITY • INTOLERANCE • IDIOSYNCRATIC • ALLERGIC

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