ATSU

Medical Faculty

Clinical Immunology
Topic: Allergy diagnostic and treatment
Prof. Nana Shavlakadze
2022
 Allergy –
XXI CENTURY DISEASES
 Allergy Tests
• There are three
forms of conducting
this tests:

• Blood test
• Skin prick test
• Diet changes
 Diagnostic Tools
• Blood tests
 Eosinophilia /Bazophilia
 IgE - total
 IgE – specific
 IgG - specific
 Phadiatop
• Allergy Skin test
Prick test
Patch test
PK procedure
 Allergy Immune Cells
Eosinophilia Basophilia
• Is a higher than normal
level of eosinophils. • Basophilic disorder, is when
Eosinophils are a type of your body produces too
disease-fighting white blood many basophils. Basophils
cell. This condition most are a white blood cell type
often indicates a parasitic that protects your body
infection, an allergic from infections. Basophilia
reaction or cancer. may be a sign you have an
Mast cells infection, or it may be a sign
Are immune cells of the myeloid of serious medical
lineage and are present in
conditions like leukemia or
connective tissues throughout the
body. The activation and autoimmune disease.
degranulation of mast cells
We count eosinophils &
significantly modulates many aspects
Basophils in the blood
of physiological and pathological
smear!!!
conditions in various settings
 What Is An IgE?
• IgE or Immunoglobulin E
is an antibody that acts
as a defence mechanism
against parasitic
infestation.
• Another key role is that
they help in very early
recognition of foreign
material or a general
potentiation of the
immune system response
by improved antigen
presentation. 
 What Does The IgE Allergy Test
Work?
• The Serum IgE test measures the level
of IgE antibody in the blood.
• These antibodies are present in small amount.
• When body overreacts to allergens, then
presence of these antibodies increase.
• This test helps in identification of allergic
disease, primary immunodeficiencies,
infections, malignancies, or other
inflammatory diseases.
IgE
 When To Get Tested?
• A person should get the IgE test as soon as
they observe the following symptoms-
• Periodic or persistent itching
• Hives
• Itchy eyes
• Eczema
• Nausea
• vomiting
• persistent diarrhoea
• Sneezing
• coughing
• congestion
• wheezing
• breathlessness
 Procedure And Time Taken To Conduct
The Test
• This test involves a blood test.
A professional collects the blood
sample.
• In this test, a part of your skin near
arms is cleaned thoroughly.
• An elastic band is then put so that
the vein swell with blood.
• A needle is inserted in that vein
and the blood sample is pulled in a
syringe.
• This test does not require much
time. It gets done as soon as the
blood sample is collected. Time
taken ranges from 4-5 mins or
even less because it is a simple
task.
 What Is IgG?
• IgG or Immunoglobulin G is
another type of antibody in
our body. They often persist
in life and are present in
large amount in our body.
• Also, they control infection of
body tissues. By binding to
many kinds of pathogens
such as viruses, bacteria, and
fungi, IgG protects the body
from infection.
 IgG Allergy Test
When To Get Tested?
What Does This Allergy Test
Measures? • One should opt for this test as
• The IgG test checks for the and when the following
symptoms arises-
amount of IgG antibodies in • bloating
the blood stream. This • fullness
 test diagnoses • belly pain
food sensitivities and is • gas
commonly available. • diarrhoea 
• Feeling of uneasiness after eating
some kind of food is clear
indication to opt for an IgG allergy
test. In this case there are clear
symptoms of food intolerance
from a substance that you often
consume in your everyday life.
 Phadiatop Allergy Test
• What Is It?
• The Phadiatop test is an allergy
screening test with excellent sensitivity
and specificity for inhalant allergy. It
uses an ImmunoCAP with a balanced
mixture of representative allergens,
including grasses, trees, weeds, cat,
dog, and mites.
 Phadiatop Allergy Test
• What Does It Measure?
• The test measures IgE antibodies to a
well-balanced mixture of common
When To Get Tested?
inhalant allergens and helps rule in or
Allergic asthma or rhinitis 
out atopic allergy, a tendency to
are major symptoms that
produce IgE mediated response to
indicate the need of this test.
protein(s) in the environment.
This test especially detects
• It also helps to identify patients who lung disease-related allergy.
need specific IgE testing with whole Phadiatop test efficiently
allergens to help identify the symptom- detect sensitization to
provoking allergens and determine common aeroallergen mixes.
appropriate patient. 
 Procedure And Result Of The Test
• Phadiatop test is a combination of results of SPT or Skin Prick
Test and allergen-specific IgE test.

• The test gives a qualitative result, either positive or negative

depending on the fluorescence response.
• A positive test result is when the patient’s sample gives a
fluorescence response higher than or equal to that of the
reference serum.
• On the contrary, a patient sample with a lower fluorescence
response indicates a negative test result.
Skin Tests
Prick test
Skin Test
Patch test?!
Patch test results?!
 Treatment Principles

• Elimination of etiological factors

• Neutralization of mediators
• Prophylactics of immune disorders ...
• Allergy vaccination

                        
 Treatment of
Anaphylactic Shock

• EPINEPHRINE – FIRST TIME

• Banadryl – H1 antagonist
• Tagamet – H2 antagonist
• Corticosteroid therapy
 Epi-pen
 Remove the hat

 The black end suppress hip from above

 Power is needed
 Top of the clothes

 15 sec. delay

 The patient is in bed condition

 Allergy Treatment
• Restriction on contact with allergen
• Allergen is eliminated from the organism

• H1 / H2 antagonists
• Corticosteroids
The form of medication depends on the type of
allergies
 ALLERGY TREATMENT

Antihistamine Nasal spray Eye drop Cetirizine Loratadine

Levocetirizine omalizumab Olopatadine  Anti- Diphenhydramine

leukotriene

Decongestant Montelukast Desensibilization Mast cell Pseudoephedrine

stabilizer

Cromoglicic Immunotherapy Allergen Elimination Vaccinations

acid (INN) Immunotherapy Diet
 ALLERGY MEDICINE
• Antihistamines
• Decongestant
• Nasal Spray
• Allergy Relief Without Drugs
• Allergy Shots
• Leukotriene Modifiers
 Allergy Medicine
Over-the-counter
Antihistamines • Cetirizine (Zyrtec), 
• fexofenadine (Allegra), 
• Antihistamines have been used for
years to treat allergy symptoms. • levocetirizine (Xyzal),
• They can be taken as pills, liquid, • loratadine (Alavert, Claritin) are taken
nasal spray, or eye drops. by mouth. 
• Over-the-counter (OTC) • Brompheniramine (Dimetapp allergy,
antihistamine eye drops can relieve Nasahist B), chlorpheniramine (
red itchy eyes, while nasal sprays can Chlor-Trimeton), clemastine (Tavist),
be used to treat the symptoms of and diphenhydramine (Benadryl) can
seasonal or year-round allergies. make you drowsy. 
• Tablets can be used when other • Ketotifen (Zaditor) and 
allergy symptoms appear in: naphazoline and pheniramine 
respiratory s, gastrointestinal s, skin combination ophthalmic (OcuHist)
and anaphylactic shock… are eye drops.
 Allergy Medicine
How Do Antihistamines What Are the Side Effects of
Work? Antihistamines?
• People with allergies have an • Many older over-the-
exaggerated immune response. counter antihistamines may
Immune system cells known as
"mast cells" release a substance
cause drowsiness.
called histamine, which attaches • Newer antihistamines that
to receptors in blood vessels, don’t make you drowsy are
causing them to enlarge. available over-the-counter
Histamine also binds to other
receptors causing redness,
and by prescription.
swelling, itching, and changes in
secretions. By blocking histamine
and keeping it from binding to
receptors, antihistamines prevent
these symptoms.
 Allergy Medicine
Decongestants Some examples of
• Decongestants relieve congestion decongestants
and are often prescribed along • Pseudoephedrine (Sudafed 
with antihistamines for allergies.
They can come in nasal sprays, tablets or liquid)
eye drops, liquids, and pills. Nasal • Phenylephrine (Neo-
spray and eye drop
Synephrine) and 
decongestants should be used for
only a few days at a time because oxymetazoline (Afrin) nasal
long-term use can make sprays
symptoms worse. Pills and liquid • Some Visine eye drops
decongestants can be taken
longer safely.
 Allergy Medicine
How Do Antihistamines What Are the Side Effects of
Work? Antihistamines?
• Decongestants work by shrinking • Decongestants may raise
swollen nasal tissues and blood blood pressure, so they
vessels, relieving the symptoms
of nasal swelling, congestion,
typically are not
mucus secretion, and redness. recommended for people
who have blood pressure
problems or glaucoma. They
may also cause insomnia or
irritability and restrict
urinary flow.
 Combination Allergy Drugs
• Some allergy drugs
contain both an
antihistamine and a • Cetirizine
• Pseudoephedrine (Zyrtec-D), 
decongestant to relieve • Fexofenadine and pseudoephedrine (
multiple allergy Allegra-D),
• Diphenhydramine and pseudoephedrine
symptoms. Other drugs (Benadryl Allergy and Sinus), 
have multiple effects • Loratadine and Pseudoephedrine (
Claritin-D),
aside from just blocking • Pseudoephedrine/triprolidine (Actifed)
the effects of histamine, for nasal allergies;
•  Naphazoline/pheniramine (Naphcon A)
such as preventing mast for allergic conjunctivitis
cells from releasing other
allergy-inducing
chemicals.
 Allergy Medicine
Steroids
What Are the Side Effects of
Steroids?
• Steroids, known medically as • Side effects of systemic steroids with
corticosteroids, can reduce short-term use include:
inflammation associated with • Weight gain
allergies. They prevent and treat • Fluid retention
nasal stuffiness, sneezing, and • High blood pressure
itchy, runny nose due to seasonal • Side effects with long-term use
or year-round allergies. They can include:
also decrease inflammation and • Growth suppression
swelling from other types of • Diabetes
allergic reactions. • Cataracts of the eyes
• Bone-thinning osteoporosis
• Muscle weakness
 Allergy Medicine
How Do Leukotriene
Leukotriene Modifiers Modifiers Work?

• Leukotriene modifiers treat Leukotriene modifiers block the

asthma and nasal allergy effects of leukotrienes, chemicals
produced in the body in response
symptoms. They can be to an allergic reaction.
prescribed along with other
drugs.
• These medications are available
only with a doctor's prescription
and come as pills, chewable
tablets, and oral granules.
• The only leukotriene modifier
that has FDA approval is
montelukast  (Singulair).
 Allergy Treatment
• Allergy shots are regular injections over a
period of time — generally around three to
five years — to stop or reduce allergy attacks.
• Allergy shots are a form of treatment called
immunotherapy.
• Each allergy shot contains a tiny amount of
the specific substance or substances that
trigger your allergic reactions.
 Immunotherapy

• Immunotherapy may be one of the most effective forms of treatment if

you suffer from allergies more than 3 months of the year. Allergy shots
expose you to gradually increasing levels of the offending allergen to help
your immune system build tolerance.
• The FDA has approved several under-the-tongue immunotherapy tablets
that can be taken at home.
• The prescription tablets, called Grastek, Oralair, and Ragwitek, treat hay
fever and work the same way as shots.
• The goal is to boost a patient’s tolerance of allergy triggers. 
• Odactra is an under-the-tongue medication that can relieve symptoms of
allergies to dust mites.
• Palforzia treats peanut allergy.
 Modern Allergy Treatment
• Omalizumab (Xolair®) is the anti-IgE medicine
now available. Xolair is made to be similar to
natural antibodies and is designed specifically
to capture most of the IgE and block the allergic
response.
 Allergy
-
Challenges of XXI Century!!!
• Thank for your attention!