ALLERGY IN ALABAMAALLERGY IN ALABAMA

SPRING - FLOWERING GRASSES, SPRING - FLOWERING GRASSES, ORNAMENTAL FLOWERS, NOT PINE POLLENORNAMENTAL FLOWERS, NOT PINE POLLEN

FALL – RAGWEED NOT GOLDENRODFALL – RAGWEED NOT GOLDENROD YEAR ROUND-ANIMALYEAR ROUND-ANIMAL DANDER AND DANDER AND

SALIVASALIVA SUMMER/HUMIDITY -MOLDS/ FUNGUSSUMMER/HUMIDITY -MOLDS/ FUNGUS

RAGWEED GOLDENROD

Welcome to Alabama

Timothy Grass

Bermuda Grass

HYPERSENSITIVITY REACTIONSHYPERSENSITIVITY REACTIONS

TYPE I- ALLERGIC CONJUNCTIVITISTYPE I- ALLERGIC CONJUNCTIVITIS TYPE II- MYASTHENIA GRAVISTYPE II- MYASTHENIA GRAVIS TYPE III-UVEITIS? SJOGRENSTYPE III-UVEITIS? SJOGRENS TYPE IV- CONTACT DERMATITIS & TYPE IV- CONTACT DERMATITIS &

GPCGPC

Allergic conjunctivitis

Myasthenia Gravis

Sjogrens

Phlyctenular Conjunctivitis

ALLERGY CASCADEALLERGY CASCADE

IGE BINDS ANTIGENIGE BINDS ANTIGEN

FORMS DIMER AT SURFACE OF MAST CELLFORMS DIMER AT SURFACE OF MAST CELL

MAST CELL DEGRANULATESMAST CELL DEGRANULATESHISTAMINEHISTAMINEPROSTAGLANDINSPROSTAGLANDINSTHROMBOXANESTHROMBOXANESLEUKOTRIENESLEUKOTRIENESVASOACTIVE AMINESVASOACTIVE AMINESEOSINOPHIL ATTRACTING FACTOREOSINOPHIL ATTRACTING FACTOR

STAGES OF ALLERGIC DISEASESTAGES OF ALLERGIC DISEASE

EARLY PHASEEARLY PHASE MAST CELLS AND PRODUCTSMAST CELLS AND PRODUCTS

LATE PHASELATE PHASE LEUKOCYTESLEUKOCYTES T -LYMPHOCYTEST -LYMPHOCYTES

CHRONIC PHASECHRONIC PHASE T CELLS FACTORST CELLS FACTORS

MAST CELLSMAST CELLS

DIFFERENT TYPES OF MAST CELLSDIFFERENT TYPES OF MAST CELLS CHYMASE POSITIVECHYMASE POSITIVE TYPTASE POSITIVE (all mast cells, most TYPTASE POSITIVE (all mast cells, most

common ocular surface, prevents clotting) common ocular surface, prevents clotting) CHYMASE AND TYPTASE (most CHYMASE AND TYPTASE (most

common in non allergic)common in non allergic)

calcium

Inside Mast Cells

Increase synthesis of phosopholipase A-Increase synthesis of phosopholipase A-production of arachodonic acidproduction of arachodonic acid

Increase protein kinase production-Increase protein kinase production-necessary for degranulationnecessary for degranulation

Increase in intracellular calcium levelsIncrease in intracellular calcium levels 24-48 hours increase cytokine production24-48 hours increase cytokine production

CGMPCGMP

INCREASES MAST CELL INCREASES MAST CELL DEGRANULATIONDEGRANULATION

ALPHA AGONISTS INCREASEALPHA AGONISTS INCREASE BY DECREASING CAMPBY DECREASING CAMP

CHOLINERGICS INCREASE CGMPCHOLINERGICS INCREASE CGMP

CAMPCAMP

DECREASES DEGRANULATIONDECREASES DEGRANULATION HISTAMINE INCREASESHISTAMINE INCREASES BETA ADRENERGIC DRUGS BETA ADRENERGIC DRUGS

INCREASEINCREASE ADENYL ADENYL

CYCLASE(PROSTAGLANDINS)CYCLASE(PROSTAGLANDINS)

CAMP CGMP

cAMP cGMP Balance

PROSTAGLANDIN D2PROSTAGLANDIN D2

PRIMARY OCULAR PG IN PRIMARY OCULAR PG IN HYPERSENSITIVITYHYPERSENSITIVITY

CHEMOSISCHEMOSIS REDNESSREDNESS DISCHARGEDISCHARGE EOSINOPHIL CHEMOTAXISEOSINOPHIL CHEMOTAXIS

BIOLOGIC ACTIVITY OF BIOLOGIC ACTIVITY OF PROSTAGLANDINSPROSTAGLANDINS

PGFPGF22 & PGD & PGD22- BRONCHOSPASM- BRONCHOSPASM PGIPGI22- PULMONARY DILATION & < - PULMONARY DILATION & <

PLATELET AGGREGATIONPLATELET AGGREGATION PGEPGE2 2 BRONCHODILATORBRONCHODILATOR PGEPGE11 &PGE &PGE22 -> NERVE SENSITIVITY -> NERVE SENSITIVITY

VASODILATIONVASODILATION TXATXA22-VASOCONSTRICTION-VASOCONSTRICTION

BIOLOGIC ACTIVITY OF BIOLOGIC ACTIVITY OF LEUKOTRIENESLEUKOTRIENES

LTBLTB44 PMN ATTRACTANTPMN ATTRACTANT EOSINOPHIL ATTRACTANTEOSINOPHIL ATTRACTANT > > VASCULAR PERMEABILITYVASCULAR PERMEABILITY >.>.EDEMAEDEMA COFACTOR W/ PGECOFACTOR W/ PGE22 & PGD & PGD22

LTCLTC44, LTD, LTD44, LTE, LTE44 BRONCHOCONSTRICTORSBRONCHOCONSTRICTORS MYOCARDIAL DEPRESSANTSMYOCARDIAL DEPRESSANTS

EOSINOPHILS-ACTIVATIONEOSINOPHILS-ACTIVATION

EOSINOPHIL CHEMOTACTIC EOSINOPHIL CHEMOTACTIC FACTOR(LTBFACTOR(LTB44))

HISTAMINASE DECREASESHISTAMINASE DECREASES PHOSPHOLIPASE DECREASESPHOSPHOLIPASE DECREASES ARYL SULFATASE DECREASESARYL SULFATASE DECREASES PLATELET ACTIVATING FACTOR PLATELET ACTIVATING FACTOR

STRONGLYATTRACTSSTRONGLYATTRACTS

EOSINOPHILSEOSINOPHILS

MAJOR BASIC PROTEIN (anti-parasite)MAJOR BASIC PROTEIN (anti-parasite) HIGHLY TOXIC TO EPITHELIUMHIGHLY TOXIC TO EPITHELIUM INCREASES MAST CELL INCREASES MAST CELL

DEGRANULATIONDEGRANULATION EOSINOPHIL CATIONIC PROTEINEOSINOPHIL CATIONIC PROTEIN EOSINOPHIL PEROXIDASE EOSINOPHIL PEROXIDASE

HISTAMINEHISTAMINE

BRONCHOSPASM BRONCHOSPASM VASODILATORVASODILATOR INCREASES VASCULAR INCREASES VASCULAR

PERMEABILITYPERMEABILITY ACTIVATES NERVE TERMINALSACTIVATES NERVE TERMINALS

PLATELET ACTIVATING FACTOR PLATELET ACTIVATING FACTOR RELEASING CELLSRELEASING CELLS

BASOPHILSBASOPHILS MAST CELLSMAST CELLS EOSINOPHILSEOSINOPHILS MONOCYTES/MACROPHAGESMONOCYTES/MACROPHAGES PMN’SPMN’S

T CELL MEDIATED FACTORST CELL MEDIATED FACTORS

IL-3 INDUCES MAST CELL IL-3 INDUCES MAST CELL DEGRANULATIONDEGRANULATION

IL-4 FACILITATES IIL-4 FACILITATES IGGE PRODUCTION E PRODUCTION BY B LYMPHOCYTESBY B LYMPHOCYTES

IL-5 STIMULATES EOSINOPHIL IL-5 STIMULATES EOSINOPHIL PROLIFERATIONPROLIFERATION

OCULAR RESPONSE IN ARACHADONIC OCULAR RESPONSE IN ARACHADONIC ACID PATHWAYACID PATHWAY

CYCLO-OXYGENASE PATHWAYCYCLO-OXYGENASE PATHWAY LID SWELLINGLID SWELLING CHEMOSISCHEMOSIS VASODILATIONVASODILATION

LIPO-OXYGENASE PATHWAYLIPO-OXYGENASE PATHWAY CHRONIC INFLAMMATIONCHRONIC INFLAMMATION

OCULAR SURFACE HISTAMINE OCULAR SURFACE HISTAMINE RECEPTORSRECEPTORS

HH1 1 RECEPTORS- NEURONAL RECEPTORS- NEURONAL PRODUCES ITCHING PRODUCES ITCHING

HH2 2 RECEPTORS- VASCULAR RECEPTORS- VASCULAR

PRODUCES REDNESSPRODUCES REDNESS

DIAGNOSIS OF ALLERGYDIAGNOSIS OF ALLERGY

RAST (RADIOALLERGOSORBANT RAST (RADIOALLERGOSORBANT ASSAY)ASSAY)

PRICK TESTSPRICK TESTS INDERATION TESTSINDERATION TESTS DIRECT CHALLENGEDIRECT CHALLENGE CONJUNCTIVAL CHALLENGECONJUNCTIVAL CHALLENGE

CONJUNCTIVAL CHALLENGE FDA REQUIREMENT FOR NEW DRUGSFDA REQUIREMENT FOR NEW DRUGS ALLERGEN APPLIED TO CONJALLERGEN APPLIED TO CONJ REDNESS,WATERING,CHEMOSIS REDNESS,WATERING,CHEMOSIS

GRADEDGRADED RETEST WITH PRETREATMENTRETEST WITH PRETREATMENT

DRUG ACTIONS

MAST CELL STABILIZERSMAST CELL STABILIZERS STEROIDSSTEROIDS ANTIHISTAMINESANTIHISTAMINES ASPIRINASPIRIN NONSTEROIDALSNONSTEROIDALS VASOCONSTRICTORSVASOCONSTRICTORS THEOPHYLLINETHEOPHYLLINE

STEROID ACTIONS DECREASE mRNADECREASE mRNA INHIBITS PHOSPHOLIPASE AINHIBITS PHOSPHOLIPASE A POTENTIATES B ADRENERGICSPOTENTIATES B ADRENERGICS CONSTRICTS BLOOD VESSELSCONSTRICTS BLOOD VESSELS DECREASES CHEMOTAXISDECREASES CHEMOTAXIS LYMPHOPENIALYMPHOPENIA DECREASES MACROPHAGE FUNCTIONDECREASES MACROPHAGE FUNCTION

GI, RENAL, PLATELET, MACROPHAGE GI, RENAL, PLATELET, MACROPHAGE DIFFERENTIATIONDIFFERENTIATION

STEROID EFFECTS DECREASE MESSENGER RNADECREASE MESSENGER RNA

INHIBITS PHOSPHOLIPASE A PRODUCTIONINHIBITS PHOSPHOLIPASE A PRODUCTION

INCREASES CAMPINCREASES CAMP

POTENTIATES B ADRENERGIC DRUGSPOTENTIATES B ADRENERGIC DRUGS

CONSTRICTS BLOOD VESSELSCONSTRICTS BLOOD VESSELS

DECREASES CHEMOTAXISDECREASES CHEMOTAXIS

LYMPHOPENIALYMPHOPENIA

DECREASED MACROPHAGE FUNCTIONDECREASED MACROPHAGE FUNCTION

DRUG ACTIONS STEROIDS-MULIPLE EFFECTSSTEROIDS-MULIPLE EFFECTS

MAST CELL STABILIZERS-INHIBIT CALCIUM MAST CELL STABILIZERS-INHIBIT CALCIUM ENTRY INTO CELLENTRY INTO CELL

ANTIHISTIMINES- EFFECT AFTER RELEASEANTIHISTIMINES- EFFECT AFTER RELEASE

ASPIRIN - INHIBITS CYCLO-OXYGENASE ASPIRIN - INHIBITS CYCLO-OXYGENASE PATHWAYPATHWAY

NONSTEROIDALS- INHIBIT CYCLO-NONSTEROIDALS- INHIBIT CYCLO-OXYGENASE PATHWAYOXYGENASE PATHWAY

COX 1 AND COX 2

COX 1 PRESENT AT STEADY STATE COX 1 PRESENT AT STEADY STATE LEVELSLEVELS HOMEOSTATIC FUNCTIONSHOMEOSTATIC FUNCTIONS

COX 2 ASSOCIATED WITH COX 2 ASSOCIATED WITH INFLAMMATIONINFLAMMATION

VIOXX, CELEBREX, BEXTRAVIOXX, CELEBREX, BEXTRA PREFERENTIAL VS SPECIFICPREFERENTIAL VS SPECIFIC

DRUG EFFECTS

VASOCONSTRICTORS -REVERSE VASOCONSTRICTORS -REVERSE VASODILATIONVASODILATION

THEOPHYLLINE- INCREASE CAMPTHEOPHYLLINE- INCREASE CAMP

FOOD ALLERGYFOOD ALLERGY

VARIABLE EFFECT DUE TO VARIABLE EFFECT DUE TO ABSORBTIONABSORBTION

USUALLY LOCAL GI EFFECTUSUALLY LOCAL GI EFFECT CAN BE IDIOSYNCRATICCAN BE IDIOSYNCRATIC

ALLERGIC SKIN REACTIONSALLERGIC SKIN REACTIONS

ERYTHEMA-REDNESSERYTHEMA-REDNESS FLARE-DIFFUSE REDNESS AROUND FLARE-DIFFUSE REDNESS AROUND

WHEALWHEAL WHEAL-LOCALIZED WHEAL-LOCALIZED

EDEMA,TYPICAL LIDEDEMA,TYPICAL LID ANGIOEDEMAANGIOEDEMA

DRUG ALLERGYDRUG ALLERGY

TOXICITYTOXICITY INTOLERANCEINTOLERANCE IDIOSYNCRATICIDIOSYNCRATIC ALLERGICALLERGIC

IDIOSYNCRATIC REACTIONSIDIOSYNCRATIC REACTIONS

DIRECT MEDIATOR RELEASEDIRECT MEDIATOR RELEASE DIRECT ACTIVATION OF BIOLOGIC DIRECT ACTIVATION OF BIOLOGIC

SYSTEMSYSTEM ENZYME DEFECTENZYME DEFECT UNDERLYING DISEASEUNDERLYING DISEASE SIMILAR TO ANAPHYLAXIS?SIMILAR TO ANAPHYLAXIS?

Anaphylaxis

TREATMENT OF ALLERGYTREATMENT OF ALLERGY

AVOIDANCEAVOIDANCE THERAPEUTIC AGENTSTHERAPEUTIC AGENTS

CHRONICCHRONIC ACUTEACUTE

IMMUNOTHERAPYIMMUNOTHERAPY

Effects of Immune Therapy