ALTERED IMMUNE RESPINSE.pptx

for study purpose

1. ALTERED IMMUNE RESPINSE By Garima srivastava

2. DEFINITION IgE mediated hypersensitivity disease of mucous membranes of nasal airways characterized by sneezing, watery nasal discharge , itching and nasal obstruction” 

3. RISK FACTORS 1.Genetic susceptibility 2.Family history of atopy: e.g. asthma,eczema,hay fever,urticaria 3 . Environmental factors • Pollution •Irritants eg . fumes, tobacco smoke, diesel exhaust, mosquito repellents, perfumes, scented sticks, domestic sprays, bleaches

4. Cont… 4. Exposure to allergens: •Seasonal : Pollen, Fungus •Perennial: Dust mite, domestic pets, cockroaches

5. Cont…. 5.Hygiene hypothesis •Increased exposure to various allergens. •Early environmental exposure to infectious agents, protects against development of atopy. •Early nursery attendance also reduces subsequent atopy. •Lack of immune maturation (understimulated immune system) in infancy allergic responses.

6. RESPONSE OF IMMUNE SYSTEM Acute or early phase response • Occurs 5–30 min after antigen exposure • Release of inflammatory mediators · Increased nasal gland secretion R unny nose Mucosal edema & Vasodilation nose block · Nerve irritation sneezing & itching  

7. Cont… Late or delayed phase response • Occurs 2-8 hours after antigen exposure. • Infiltration by inflammatory cells (eosinophils, neutrophils, basophils, monocytes & CD4+ T lymphocytes. • Edema, congestion & thick nasal secretion. • Sneezing & itching decreases.

8. SYMPTOMS Running Blocking Sneezing Itching

9. Cont… SIGNS Nasal crease Pale turbinate Face : Bunny nose-frequent twitching of face, Dannie-Morgan creases (in lower eyelid skin), Allergic shiners (dark discoloration below lower eyelids) Eye : Conjunctiva is congested, increased lacrimation Ear: Aural fullness(ET dysfunction) Throat: Chronic pharyngitis, laryngitis

10. TYPES OF ALLERGIC RHINITIS Seasonal allegic rhinitis- symptoms appear in or around a particular season. And is caused by pollen grains Perennial allergic rhinitis- symptoms are present throughput year and is caused by dust miles, insect, cockroaches, animal danders.

11. DIAGNOSIS 1.History 2.Physical exam 3.Allergy diagnosis (I) Skin prick test (SPT ). ( II) Blood tests for allergy: Total IgE, Specific IgE. ( III) Nasal allergen challenge test. (IV) Radio- allergosorbent test (RAST) (V) Nasal endoscopy CT scan-Nose

12. MANAGMENT Management of allergic rhinitis 1. Environmental control measures (Avoidance of allergens) 2 . Patient education 3 . Nasal douching 4. Medical therapy 5. Immunotherapy 6. Surgery

13. Cont… Antihistamines: 1. Topical :Cetirizine,Levocetirizine,Fexofenadine,Loratadine , Desloratadine 2. Nasal Decongestants : Topical: Oxymetazoline, Xylometazoline Systemic: Phenylephrine, Pseudoephedrine 3. Mast cell stabilizers : Sodium cromoglycate nasal drop

14. Cont… 4. Anticholinergics : Ipratropium bromide nasal spray 5. Corticosteroids:Topical :Beclomethasone,Budesonide,Mometasone,Fluticasone Systemic: Prednisolone 6. Leukotriene receptor antagonists : Montelukast, Zafirlukast

15. GENERAL INSTRUCTIONS Environmental control measures (Avoidance of allergens) Patient education Nasal douching Medical therapy Immunotherapy Surgery Removing allergen from the indoor environment should be a primary strategy

16. Cont… Avoid irritants: smoke, dust, vehicular & other atmospheric pollutants, Physical factors – extreme changes in temperature Avoid foods & drugs to which you are allergic Avoid occupational irritants or change profession Avoidance of indoor allergens

17. Cont… Avoidance of animal allergen Remove pet animals (cats, dogs) from bedroom Wash the pet weekly Measures to avoid house dust mite Mattress covers Covers for pillows & bedding Regulation of ventilation & humidity at home Protein denaturating agents- Tannic acid

18. Cont… Pollen avoidance measures Avoid walking in open grassy spaces during hot, dry days Keep windows closed Wear facemask & sunglasses when moving out Nasal douching Saline irrigation Improves quality of life