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Allergic asthma

Allergic asthma . Done by : Mohammad Da’as p.s. please read the notes under the slides. و جرّنا الحرام لحرام فحرام. IL-4 drives B cells to produce lgE in response to pollen antigens. Pollen-specific lgE binds to mast cell. First exposure to pollen. Second exposure to pollen.

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Allergic asthma

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  1. Allergic asthma Done by : Mohammad Da’as p.s. please read the notes under the slides

  2. و جرّنا الحرام لحرام فحرام IL-4 drives B cells to produce lgE in response to pollen antigens Pollen-specific lgE binds to mast cell First exposure to pollen Second exposure to pollen Acute release of mast-cell contents causes allergic rhinitis (hay fever)

  3. Acute responses Inflammatory mediators cause increased mucus secretion & smooth muscle contraction leading to airway obstruction Recruitment of cells from the circulation airway airway blood vessel

  4. Chronic response Chronic response caused by cytokines and eosinophil products eosinophil granule proteins cytokines

  5. Obstruction of Airways in Chronic Asthma

  6. هلأ جدّ بدنا نحكي عن ال Asthma - One of the most common allergies - Caused by inhaled particles containing foreign proteins “allergen”  Allergic rhinitis & allergic asthma. - The allergic inflammatory response  increase hypersensitivity of the airways not only to re-exposure to allergen but also to non-specific agents. A) Intrinsic asthma “without allergies” B) Extrinsic asthma “ Allergic asthma”

  7. The case of Frank Morgan A 14 year old boy Persistent wheezing for 2 weeks No response to frequent inhalation treatment. History of Chronic asthma & rhinitis.

  8. When he was 3 years old • First attack of wheezing. • Similar attack of varying severity on subsequent visits

  9. History (1) 4 years old 5 years old Sweat test to rule out cystic fibrosis . It was within normal range. • Attacks of coughing and wheezing . • every spring& end of the summer • During the past 10 years  admitted 3 times to hospital for the treating of asthma“Bronchodilators and intravenous steroids” • -Many emergency visits with SEVERE ASTHMA ATTACKS • Maxillary sinusitis X3 “showed on radiograph” associated with exacerbation of his asthma & green nasal discharge

  10. History (2) 4 years old As a baby Eczema. Cleared up by age 5 • Intermittent sneezing, nasal discharge & nasal congestion (rhinitis). • Worsen upon exposure to Cats & dogs. • Nasal symptoms  oral Anti histamine “moderate success”

  11. Family HistoryGenetic predisposition “Atopy” • Asthma • Allergic rhinitis

  12. Arrival • Thin & unable to breath easily. • No fever. • Nasal mucosa  severely congested • Wheezing heard all over the lung fields. • Normal CBC but “high# eosinophils & high serum IgE” • Lung function tests  obstructive lung disease + reduced peak flow rate PFR + reduced expiratory volume in the first second of expiration FEV1.

  13. Hyperinflation

  14. More & more tests • RAST “ antigen specific IgE” • Histological examination of frank’s nasal fluid  presence of Eosinophils. “أكيد لازم يطلع هيك” Don’t press

  15. Treatment • Immediate inhalation of bronchodilator ventolin “albuterol sulfate” at the clinic  felt better & PFR rose ♥ • Sent home on 1-week course of corticosteroid prednisone “orally” • Inhale albuterol 3 times a day , with extra dose if needed but not more than every 4 hours. • Inhaled Disodium cromoglycate • Oral antihistamine + beclomethasone “inhaled”  to relieve his nasal congestion

  16. Ragweed Saline control Hypersensitivity skin tests“skin prick test” -This test was done After 2 weeks. - Type 1 hyper sensitivity positive. - He was advised to avoid contact with allergens. - Started immunotherapy with injection of (grass, trees , ragweed pollen, dust mite antigens) - A year and a half later his asthma is stable , Rhinitis require much less medication Histamine control

  17. AND HE LIVES ♥♥ Thank you  Hala madrid

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