Allergic reactions – Nova Makedonija

Author: Dr. Ivana Stojceska Dimeska

Allergy is an inappropriate immune response to the immune system, or immune reaction to exogenous substances (antigens and allergens), is also known as a reaction to hypersensitivity.
Hypersensitivity reactions are classified to four types: Type 1 – immediate reactions to food allergies, pollen, asthma, anaphylaxis.
Type 2 – cytotoxic that include antibodies that are specific to certain tissues and cause the destruction of cells in these tissues (eg Autoimuna hemolytic anemia).
Type 3-is mediated by immune complexes, with tissue damage caused by the accumulation of the antigen-antibody complex for example in glomerulonephrites and vasculites.
Type 4-processes are delayed and the only reaction that includes sensitized T-lymphocytes (contact dermatitis).

Type 1 hypersensitivity reactions are conditioned by IGE-antithylate and sensitized mast cells. Ige-antibodies are
form as a result of previous sensitization (ie previous contact with the antigen and bind to the specific mast cell receptors. Re-antigen encounter will result in an IGE-mediated reaction from the previously sensibilated Ige-antibodies. Free antigen is binding to two adjacent IgE antibodies.

Then we have the release of histamine and other mediators (eg prostaglandins, platelet activation factor, leukotrienes, heparin, triptase) will lead to increased contraction of smooth muscles, peripheral vasodilation, increased vascular permeability, interstitial space. Prostaglandins and leukraine are powerful bronchospastic agents that can cause temporary
respiratory insufficiency in anaphylaxis. Production of cytokines such as TNF-α, IL-1, IL-3 and IL-5 results in a constant inflammatory response, while IL-4 facilitates IgE production by B-cells.

The immediate allergic reaction is manifested within minutes of contact with the antigen, while the reaction of the late stage occurs several hours after an immediate reaction of 24 to 72 hours.

Clinical manifestations of this type of allergic reaction are: urticaria, anaphylactic shock, angioedema, allergic rhinitis, allergic asthma, bronchospasm, abdominal pain.

In my practice I had many cases of urticaria whose cause was food allergens, bacterial infection with helicobacter pylori, insect stings and drug allergy. Also a case of angioedema (circular edema of the deep dermis and/or subcutaneous tissues. Predictive sites for its appearance represent the face, eyelids, lips, larynx and pharynx. The edema is usually localized to the subcutaneous tissue

Clinical urticaria is manifested by itching, redness, edematous plaques along the upper derma.

First -choice therapy for the treatment of urticaria are antihistamines (TBL levocetirizine), corticosteroid cream, Council for Hygieneodetics and Symptomatic Therapy for Primary Disease that caused urticaria.