Introduction

An allergy is an adverse reaction that the body has to a particular food or

substance in the environment.
Most substances that cause allergies are not harmful and have no effect on people
who are not allergic.
The allergic response
Any substance that triggers an allergic reaction is called an allergen. Some of the
most common allergens include:
grass and tree pollen (hay fever)
dust mites
animal dander (tiny flakes of skin or hair)
food allergy (particularly fruits, shellfish and nuts)
An allergy develops when the bodys immune system reacts to an allergen as
though it is a threat, like an infection. It produces antibodies to fight off the
allergen, in a reaction called the "immune response".
Symptoms of allergy
Symptoms of allergy include:
sneezing
shortness of breath
wheezing
runny nose and eyes
pain over the sinuses (at the bridge of the nose, near the eyes, over cheeks
and at the forehead)

 coughing
skin rashes (nettle rashes or hives)
swelling of the lips or face
itching eyes, ears, lips, throat and roof of the mouth
nausea
vomiting
abdominal cramps and diarrhoea
Anaphylaxis
When allergic reaction is life threatening of severe it is termed anaphylaxis or
anaphylactic shock. Anaphylaxis involves the whole body
Classification of allergies
Types of allergy are classified to denote cause, severity and possible management
and prevention. These include
Type I hypersensitivity
This is also known as immediate or anaphylactic-type reactions. This may be
caused due to pollen, foods and drugs and insect stings.
Type II hypersensitivity
This involves specific antibodies called the Immunoglobulin G (IgG) and IgM.
There is binding to and destroying the cell the antibody is bound on.
This type of reaction is seen after an organ transplant when the body refuses to see
the transplanted organ as its own.
Type III hypersensitivity
This is an Immune complex-mediated reaction. The immune complex is the bound
form of an antibody and an antigen.

This leads to a cascade of reactions in the body which goes on to destroy local
tissues. Examples of this condition include glomerulonephritis and systemic lupus
erythematous (lupus, SLE).
Type IV hypersensitivity
Delayed or cell-mediated reactions are mediated by special immune cells called the
T-cell lymphocytes.
The T cells take from a few hours to a few days to mount an allergic response.
Examples include contact dermatitises such as poison ivy rashes.

The term allergy is broadly defined and includes several different immune
diseases. Most allergic diseases can be categorised into four main types.
The category is assigned based on two criteria:
The first is the reaction mechanism; the second is the reaction time, i.e. the time
from contact with the allergen until the appearance of the first symptoms.
Type I - Immediate reaction (also known as anaphylactic reaction)
Type II - Cytotoxic
Type III - Immune complex allergies
Type IV - Delayed-onset allergies, cellular immune reaction
Type I: Immediate reaction, anaphylactic reaction
This type of allergy is characterised by the immediate onset of symptoms (within
seconds or minutes). Usually the skin or mucous membranes are affected. Almost
all Type I allergies are caused by proteins. Type I allergies are the most common
allergies.
Examples:

Hay fever (allergic rhinitis)

Animal hair allergy

Insect venom allergy

Latex allergy

Dust mite allergy

Food allergy

Medication allergy (local anaesthetics, antibiotics)

Allergic asthma

Urticaria (hives)

Angioedema

Anaphylactic shock

Type II: Cytotoxic

A type II allergy means that the bodys own cells have been damaged and are
treated as allergens by the immune system. Specific antibodies bind directly to the
cell surface, turning the cell into an antigen that must be attacked. Type II allergies
are rare.
Examples of Type II allergies:
Blood transfusion reactions
Autoimmune haemolytic anaemia
Myasthenia Gravis
Agranulocytosis
Blood group intolerance
Type III: Immune complex allergies
Medication allergies are often type III reactions. Foreign substances in the blood
such as medication bond to antibodies, and then to the blood vessel walls in the

smaller blood vessels, for instance, in the skin or kidneys. This leads to local
inflammation which can manifest as a skin rash, often in conjunction with
haemorrhaging, skin damage and itching.
Typical type III allergies include:
Vasculitis (inflammation of the blood vessels)
Serum illness
Alveolitis, Farmers Lung
Nephritis (inflammation of the kidneys)
Arthritis (inflammation of the joints)
Type IV: Delayed-onset allergy, cellular immune reaction
Type IV allergies are characterised by a delayed allergic reaction.
As with type II allergies, allergens bind to cells, activating certain T lymphocytes,
which recognise and attack these cells. This leads to damage in the surrounding
tissues. This first contact sets off an immune reaction; whenever the T lymphocytes
encounter this allergen, it sets off a major allergic reaction. Because the
(re)activation of the T lymphocytes takes some time, the allergic reaction first
occurs 12 to 72 hours after contact with the allergen.
Typical type IV allergies:
Transplant rejection
Contact allergies (e.g. nickel allergy)
Tuberculin reaction (TBC test)
Rashes due to medication allergy

Treatment
Severe allergic reactions (anaphylaxis) need to be treated with a medicine called
epinephrine. It can be life-saving when given right away. If you use epinephrine,
call 911 and go straight to the hospital.
The best way to reduce symptoms is to avoid what causes your allergies. This is
especially important for food and drug allergies.
There are several types of medications to prevent and treat allergies. Which
medicine your doctor recommends depends on the type and severity of your
symptoms, your age, and overall health.
Illnesses that are caused by allergies (such as asthma, hay fever, and eczema) may
need other treatments.

Medications that can be used to treat allergies include:

ANTIHISTAMINES
Antihistamines are available over-the-counter and by prescription. They are
available in many forms, including:
Capsules and pills

 Eye drops
Injection
Liquid
Nasal spray
CORTICOSTEROIDS
These are anti-inflammatory medications. They are available in many forms,
including:
Creams and ointment for the skin
Eye drops
Nasal spray
Lung inhaler
Persons with severe allergic symptoms may be prescribed corticosteroid pills or
injections for short periods.
DECONGESTANTS
Decongestants help relieve a stuffy nose. Do not use decongestant nasal spray for
more than several days because they can cause a rebound effect and make the
congestion worse. Decongestants in pill form do not cause this problem. People
with high blood pressure, heart problems, or prostate enlargement should use
decongestants with caution.
OTHER MEDICINES
Leukotriene inhibitors are medicines that block the substances that trigger
allergies. Person with asthma and indoor and outdoor allergies may be prescribed
these medicines.
ALLERGY SHOTS

Allergy shots (immunotherapy) are sometimes recommended if you cannot avoid

the allergen and your symptoms are hard to control. Allergy shots keep your body
from over-reacting to the allergen. You will get regular injections of the allergen.
Each dose is slightly larger than the last dose until a maximum dose is reached.
These shots do not work for everybody and you will have to visit the doctor often.
SUBLINGUAL IMMUNOTHERAPY TREATMENT (SLIT)
Instead of shots, medicine put under the tongue may help for grass and ragweed
allergies.

Managing Your Allergy Involves Two Steps:

1. Reducing the risk of an allergic reaction by avoiding the allergen, wherever
possible.
2. Medical treatments to reduce symptoms including medications and
immunotherapy.
Avoiding allergens requires identifying the cause of your allergy and then taking
steps to reduce your exposure to the allergen. For instance, many people are
allergic to dust mites. Therefore, reducing dust mites in the house may help to
reduce symptoms.
However, allergic reactions will still happen. Sometimes, this will be due to
accidental consumption of the allergen (e.g. peanut). With many allergens,
particularly those in the air or environment, it is impossible to stop allergen
exposure altogether. Hopefully, avoidance techniques can improve symptoms, but
medicines are often needed (especially with eczema, atopic asthma and hay fever)
to provide symptom control.
Nonetheless, in almost all cases, a combination of these two approaches will result
in significant improvement in allergic symptoms.

Introduction

Tuberculosis (TB) is a bacterial infection spread through inhaling tiny

droplets from the coughs or sneezes of an infected person.
It is a serious condition, but can be cured with proper treatment.
TB mainly affects the lungs. However, it can affect any part of the body, including
the glands, bones, and nervous system.
Typical symptoms of TB include:
a persistent cough that lasts more than three weeks and usually brings up
phlegm, which may be bloody
weight loss
night sweats
high temperature (fever)
tiredness and fatigue
loss of appetite
new swellings that haven't gone away after a few weeks
You should see a GP if you have a cough that lasts more than three weeks or if you
cough up blood.
Read more about the symptoms of tuberculosis and diagnosing tuberculosis.
What causes tuberculosis?
TB is caused by a bacterium called Mycobacterium tuberculosis.
TB that affects the lungs is the most contagious type, but it usually only spreads
after prolonged exposure to someone with the illness. For example, it often spreads
within a family who live in the same house.
In most healthy people the immune system (the body's natural defence against
infection and illness) kills the bacteria and you have no symptoms.

Sometimes the immune system cannot kill the bacteria, but manages to prevent it
spreading in the body. This means you will not have any symptoms, but the
bacteria will remain in your body. This is known as latent TB.
If the immune system fails to kill or contain the infection, it can spread within the
lungs or other parts of the body and symptoms will develop within a few weeks or
months. This is known as active TB.
Latent TB could develop into an active TB infection at a later date, particularly if
your immune system becomes weakened.

Types of TB
Tuberculosis (TB) is divided into two categories: pulmonary and extrapulmonary.
Pulmonary Tuberculosis Types
Primary Tuberculosis Pneumonia
Tuberculosis Pleurisy
Cavitary Tuberculosis
Miliary TB
Laryngeal Tuberculosis

Primary Tuberculosis Pneumonia

This uncommon type of TB presents as pneumonia and is very infectious.
Patients have a high fever and productive cough. It occurs most often in extremely
young children and the elderly. It is also seen in patients with immunosuppression,
such as people with HIV/AIDS, and in patients on long term corticosteroid therapy.
Tuberculosis Pleurisy

This usually develops soon after initial infection. A granuloma located at the edge
of the lung ruptures into the pleural space, the space between the lungs and the
chest wall. Usually, a couple of tablespoons of fluid can be found in the pleural
space.
Once the bacteria invade the space, the amount of fluid increases dramatically and
compresses the lung, causing shortness of breath (dyspnea) and sharp chest
pain that worsens with a deep breath (pleurisy). A chest x-ray shows significant
amounts of fluid. Mild- or low-grade fever commonly is present. Tuberculosis
pleurisy generally resolves without treatment; however, two-thirds of patients with
tuberculosis pleurisy develop active pulmonary TB within 5 years.
Cavitary TB
Cavitary TB involves the upper lobes of the lung. The bacteria cause progressive
lung destruction by forming cavities, or enlarged air spaces. This type of TB
occurs in reactivation disease. The upper lobes of the lung are affected because
they are highly oxygenated (an environment in which M. tuberculosis thrives).
Cavitary TB can, rarely, occur soon after primary infection.

Symptoms include productive cough, night sweats, fever, weight loss, and
weakness. There may be hemoptysis (coughing up blood). Patients with cavitary
TB are highly contagious. Occasionally, disease spreads into the pleural space and
causes TB empyema (pus in the pleural fluid).
Miliary TB
Miliary TB is disseminated TB. "Miliary" describes the appearance on chest x-ray
of very small nodules throughout the lungs that look like millet seeds. Miliary TB
can occur shortly after primary infection. The patient becomes acutely ill with high
fever and is in danger of dying. The disease also may lead to chronic illness and
slow decline.
Symptoms may include fever, night sweats, and weight loss. It can be difficult to
diagnose because the initial chest x-ray may be normal. Patients who are
immunosuppressed and children who have been exposed to the bacteria are at high
risk for developing miliary TB.
Laryngeal TB

TB can infect the larynx, or the vocal chord area. It is extremely infectious.
Extrapulmonary Tuberculosis
This type of tuberculosis occurs primarily in immunocompromised patients.
Lymph Node Disease
Tuberculosis Peritonitis
Tuberculosis Pericarditis
Osteal Tuberculosis
Renal Tuberculosis
Adrenal Tuberculosis
Tuberculosis Meningitis
Lymph Node Disease
Lymph nodes contain macrophages that capture the bacteria. Any lymph node can
harbor uncontrolled replication of bacteria, causing the lymph node to become
enlarged. The infection can develop a fistula (passageway) from the lymph node to
the skin.
Tuberculosis Peritonitis
M. tuberculosis can involve the outer linings of the intestines and the linings inside
the abdominal wall, producing increased fluid, as in tuberculosis pleuritis.
Increased fluid leads to abdominal distention and pain. Patients are moderately
ill and have fever.
Tuberculosis Pericarditis
The membrane surrounding the heart (the pericardium) is affected in this
condition. This causes the space between the pericardium and the heart to fill with
fluid, impeding the heart's ability to fill with blood and beat efficiently.
Osteal Tuberculosis

Infection of any bone can occur, but one of the most common sites is the spine.
Spinal infection can lead to compression fractures and deformity of the back.
Renal Tuberculosis
This can cause asymptomatic pyuria (white blood cells in the urine) and can spread
to the reproductive organs and affect reproduction. In men, epididymitis
(inflammation of the epididymis) may occur.
Adrenal Tuberculosis
TB of the adrenal glands can lead to adrenal insufficiency. Adrenal insufficiency
is the inability to increase steroid production in times of stress, causing weakness
and collapse.
TB Meningitis
M. tuberculosis can infect the meninges (the main membrane surrounding the
brain and spinal cord). This can be devastating, leading to permanent impairment
and death. TB can be difficult to discern from a brain tumor because it may present
as a focal mass in the brain with focal neurological signs.
Headache, sleepiness, and coma are typical symptoms. The patient may appear to
have had a stroke.
- See more at:
http://www.healthcommunities.com/tuberculosis/types.shtml#sthash.wFAyxCSa.dp
uf

Management
Respiratory TB
1. Drug treatment with standard regimen (6 months of isoniazid and rifampicin
supplemented in the first 2 months with pyrazinamide and ethambutol)
2. Infection control and isolation procedures in hospital settings (e.g., negativepressure rooms, single rooms vented to outside, wards)

Non-respiratory TB
1. Drug treatment with standard or alternative regimen
2. Adjunctive glucocorticoid treatment in patients with meningeal and
pericardial TB
3. Consideration of dosing schedules and combination tablets
4. Spinal fusion for spinal TB in specific cases
5. Testing for central nervous system involvement (brain scan, lumbar
puncture) in patients with disseminated (including miliary) TB
Monitoring and Risk Assessment
1. Monitoring for adherence and treatment completion and interventions to
improve adherence, such as reminder letters, counselling, and home visits
2. Use of directly observed therapy
3. Risk assessment of patients for drug resistance and tests for rifampicin
resistance
Latent TB
1. Consideration of drug treatment in specific populations based on results of
screening tests
2. Drug treatment for latent TB (regimens consisting of isoniazid and
rifampicin)
3. Provision of "inform and advise" information in people eligible for treatment
who decline treatment
4. Special considerations for neonates and children in close contact with people
with sputum smear-positive TB
Prevention/Screening
1. Bacille Calmette-Guerin (BCG) vaccination

2. Active case finding through contact tracing

3. Screening of people at increased risk, including street homeless, new
entrants to the country, healthcare workers, and prisoners and prison staff