Pathophysiology of Allergy

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Pathophysiology of Allergy/Hypersensitivity

In many allergic reactions, the immune system, when first exposed to an allergen, produces a type of
antibody called immunoglobulin E (IgE). IgE binds to a type of white blood cell called basophils in the
bloodstream and to a similar type of cell called mast cells in the tissues.

Allergic reactions (hypersensitivity reactions) are inappropriate responses of the immune system to a
normally harmless substance.

 Usually, allergies make people sneeze; the eyes water and itch, the nose runs, the skin itches,
and rashes develop.
 Some allergic reactions, called anaphylactic reactions, are life threatening.
 Symptoms suggest the diagnosis, and skin tests can help identify the substance that triggers the
allergy.
 Avoiding the trigger is best, but if it is impossible, allergy shots, when given long before the
exposure occurs, can sometimes desensitize the person.
 People who have had severe allergic reactions should always carry a self-injecting syringe of
epinephrine and antihistamine pills.
 Severe reactions require emergency treatment in the hospital.

Management of Allergy
Strategies to manage reactions have included patient desensitization, alteration of infusion rates, skin
testing, and the use of premedication. Baseline comprehensive assessments, including allergy history,
are important in reducing or preventing hypersensitivity reactions.

Allergy treatments include:

 Allergen avoidance. The doctor will help take steps to identify and avoid allergy triggers. This is
generally the most important step in preventing allergic reactions and reducing symptoms.
 Medications. Depending on allergy, medications can help reduce immune system reaction and
ease symptoms. The doctor might suggest over-the-counter or prescription medication in the
form of pills or liquid, nasal sprays, or eyedrops.
 Immunotherapy. For severe allergies or allergies not completely relieved by other treatment,
doctor might recommend allergen immunotherapy. This treatment involves a series of injections
of purified allergen extracts, usually given over a period of a few years.
 Another form of immunotherapy is a tablet that's placed under the tongue (sublingual) until it
dissolves. Sublingual drugs are used to treat some pollen allergies.
 Emergency epinephrine. If you have a severe allergy, you might need to carry an emergency
epinephrine shot at all times. Given for severe allergic reactions, an epinephrine shot (Auvi-Q,
EpiPen, others) can reduce symptoms until you get emergency treatment.

Management of Allergy

The first and most important step in the management of Allergy is allergen avoidance. Preventing
exposure to allergens is the key to managing allergies. A health professional can advise on avoiding
allergens specific to your situation.

Drugs are effective in the control and treatment of allergic diseases but do not cure the underlying
allergy. Mostly a combination of two approaches will result in significant improvement in allergic
symptoms.

1. Reducing the risk of an allergic reaction by avoiding the allergen, wherever possible.
2. Medical treatments to reduce symptoms including medications and immunotherapy.

Most allergic reactions are mild and do not cause life-threatening reactions, although they can be very
troublesome for the patient. A small number of people may experience a severe allergic reaction called
anaphylaxis.

When you cannot avoid allergens, there are many medicines that can help control allergy symptoms.
Decongestants and antihistamines are the most common allergy medications. They help to reduce a
stuffy nose, runny nose, sneezing and itching. Other medications work by preventing the release of the
chemicals that cause allergic reactions. Corticosteroids are effective in treating inflammation in your
nose. These treatments control the symptoms and reactions; they do not cure the condition.

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