ALLERGY

Samreen Tanveer
 Definition

 Allergy is defined as “ an
altered or unusual response in
body caused by certain
antigenic compounds, is called as
allergy”.

Or

 “An increased response of

immune system due to antigenic
challenges that leads to adverse
effects is called allergy and
individual showing allergy is
called allergic individual.”
Causes of Allergy
There are many factors that lead to allergy in an
individual.

 Hereditary factors: hereditary factors play an

important role in the transmission of allergy from
parent to offspring's. The allergic transfer tendency
is twice from female than male. If both parents are
allergic than children will be more allergic than
those children who have only one allergic parent.
Causes of Allergy
 Environmental factors:
dust, pollen, pollution

 Dietary factors: food allergy

 Disfunctioning of endocrine system:

due to increased or decreased production of
hormones.

 Psychiatric factors: stress, shock

 Symptoms of Allergy

Symptoms of allergy varies depending upon

1. Involved organ
2. Area affected by antigenic material
3. Antigens ‘s pathway to enter the circulatory
system.
Examples:
 if area affected is “nose” then symptoms may
include sneezing and hay fever.
 if affected area is blood circulation then there
may be serum sickness.
Predisposing factors
 These are the factors that make a person more
susceptible to a particular type of allergy, these
include
1. Psychiatric factor
2. Hereditary factor
3. Disfunctioning of endocrine system
4. Hepatic disfunctioning
5. Absorption of metabolic or catabolic compounds
Difference between toxic response
and allergic response
 Allergic responses are not produced rapidly, they need
exposure of antigens while toxic responses are produced
rapidly.
 Allergy include adverse effects that is produced due to
previous sensitization of a particular chemical.
 Allergy shows specificity for antigen and individuals
while toxic responses are produced in any individual
depending upon the dose.
 The amount of chemical required to produce allergy is
much less than the amount required to produce toxic
response.
Types of Allergenic reactions

Allergenic
reactions

Immediate Delayed
allergenic allergenic
reactions reactions
 a) Immediate allergenic reactions

It is also called antigen-antibody mediated allergy.

Symptoms of allergy appear relatively faster than
cell-mediated allergenic reactions.

It is further divided into three types;

 Anaphylactic shock
 Cytotoxicity
 Arthus reaction
 (i) Anaphylactic shock
Allergy is produced due to attack of allergen on mast
cells or basophil cells of body.

Examples are;
 Anaphylactic shock

 Bronchoconstriction

 Urticaria
 (ii) Cytotoxic reactions
The allergy is caused due to antigenic attack on
surface of blood vessels.

Examples are;
 Penicillin induced haemolytic anaemia

 Methyl dopa induced autoimmune haemolytic

anaemia
 (iii) Arthus reaction
 The reactions are mediated when allergen become
attached.
 This type of reaction is mostly related to the
inflammation of organs.
Delayed allergenic reactions
 These are also known as cell mediated reactions.
 Allergic symptoms appear later than the immediate
allergenic reactions and takes much time to show
symptoms.
 These reactions are mediated by the T-lymphocytes.
Comparison between Immediate
allergy and delayed allergy
 Both immediate allergy and delayed allergy show
specificity of a unique pattern present on the
surface of antigens.
 Each antibody and lymphocyte shows response due
to a specific antigen.
 Both types of allergy shows specificity for the
individuals.
Mechanism of allergenic reactions.

 Mechanism of allergy is different for both antigen-

antibody reaction and cell mediated reactions.
Mechanism of immediate allergy
 Example :
1. Anaphylactic shock
2. Cytotoxicity
3. Arthus reaction
Mechanism of delayed allergy
 In this type of allergy, response occurs very late as
compared to immediate allergy.
 Mechanism of allergic reaction in this type involves
the activation of cells rather than antibodies that’s
why allergic response occurs after long duration.
 Mechanism involves two steps
1. induction phase
2. Eliciting phase
Induction phase
 It involves primary exposure of antigen. The
mechanism and symptoms takes 15-20 days to
appear completely. It involves various steps

1. Preparatory phase
2. Recognition phase
3. Poliferation phase
4. Propagation
Preparatory phase

 Chemicals that have molecular weight less than

8000µ are inactive antigens that are also called
as“ Heptanes”
 Heptanes are not able to produce allergy as they
are inactive and are so small that they are
phagocytized and combine with proteins to form
heptane-proteins complex.
 After complex formation, this heptane is complete
antigen and it can now induce allergy.
Recognition phase
 These antigen goes to langerhen’s cells of the body.
 Langerhen’s cells were named by the name of a
scientist “ Langerhen” who discovered these cells.
 The antigens surrounds langerhen’s cells and they
appear like a sandwich between antigens.
 Now this information is passed to lymphocytes.
 Poliferation phase
 The lymphocytes after taking information from
langerhen’s cells enter into the lymph nodes.
 From lymph nodes they reach paracortical region
and causes the formation of bast cells.
 Propagation : in this phase bast cells leave lymph
nodes by efferent tubules. Now these cells are
divided into two types of cells
1. memory cells
2. Effector cells.
Eliciting phase
Primary exposure do not cause the appearance of
allergic symptoms.
Re-exposure of allergens increases the number of
effector cells.
Due to this increase mediators are released
( lymphokinins) that are responsible for the
appearance of allergic symptoms e.g. erythmia ,
inflammation.
 Allergen
 An antigenic substance that is capable of sensitizing
an individual in such a way that show altered or
unusual responses occurs in the body of susceptible
individual.
 Or
 A substance that is capable of producing allergic
symptoms and resulting appearance of allergic
reactions is called as allergen.
 Most of the allergens are proteins or protein-
carbohydrate complexes e.g. dust, pollen grains,
feathers, certain types of food, milk, chocolates, oils
etc.
 Allergen must have following properties.
1. An allergen must be antigenic in nature i.e. it
should sensitize the body in such a way that
allergic symptoms must appear.
2. Allergen must show the specificity for producing
specific antibodies that’s why one allergy differs
from other allergy.
3. Allergy show specificity for allergens as well
susceptible individuals.
Allergen sensitizes body after primary exposure but
allergy is produced when second exposure occurs
at sensitized cells.
Types of allergens
1) Inhalant allergens
2) Contactant allergens
3) Ingestant allergens
4) Injectant allergens
5) Infestant allergens
6) Infectant allergens
Inhalant allergens
The allergens which are present in the air or
atmosphere and cause allergy by contacting with
nasal membrane or mucous membrane of
bronchioles.
They become attached to these membranes and cause
allergy e.g. cold air, hot air, grains, cotton, feathers,
volatile oils etc.
Symptoms : sneezing, itching, lacrimation , swelling of
nose and eye.
Allergy caused by pollen grains
 Sinusitis:- it is the most common allergy produced by
inhalant allergen.
 It is also known as “ hay fever”
 The term hey fever was coined in consideration with the
thought that dry cut grass( hay) is responsible for
causing this fever.
 There are two types of this fever
1. Non-seasonal hay fever
2. Seasonal hay fever
Seasonal hey fever
 The allergy that occurs during certain months of a
year is called seasonal hay fever.
 Main reason for this fever are the pollen grains that
are liberated from plants.
 Pollen grains are produced in the ovary of flowers
and are responsible for pollination.
 Structure :- pollen grain consist of two main
structures.
1. exine
2. intine
 Exine is useful in differentiating the pollens of
plants.
 Their shape may vary from smooth appearance to
spiny.
 Usually pollens are single ( apcolpate) but may be
two (dicolpate), three (tricolpate) or more
( multicolpate).
Factors affecting seasonal hay fever

 There are three factors that affect this fever.

1. Season of liberation of pollen grain

2. Shape of pollen grain.
3. Types of pollen grain
1.season
 Depending upon the pollen grains there are three
season responsible for hey fever.
1. Tree season: it starts at February and lasts till June
2. Grass season: it ranges from April to August.
3. Ragweed season: it starts at early summer and
remains till early autumn ( August-October).
2. shape
 Shape vary from oval, round, angular to
rectangular.

 3. Types:
1. Anemophillus
2. Entomophillius
3. Hydrophillus
4. Zoophillus
Anemophillus
 These are also called as wind pollinated plants and
their pollination is carried out by wind.
 Their important characteristics are as follows
1. Small
2. Smooth
3. Non-adhesive
4. Light in weight e.g. pollen of oak and wallnut,
ragweed pollen,
Entomophillus
 The pollination is caused by insects.
 The pollen grains are also called as insect pollen
grains while the plants are said “insect pollinated”.
 Some characteristics of insect pollinated plants are
as
1. They are larger in size than wind pollinated
2. They are spiny and adhesive in nature.
3. They are heavier in weight than wind pollinated
e.g. rose and clover.
Hydrophillus
 In this type pollens are dispersed by means of
water.
 Some characteristics are as follows e.g.
1. They are much heavier than previous two types
2. Larger in size
3. Ability to float.
Zoophillus
 The pollens that are dispersed by animals.
 These are dispersed anywhere , where animals sit,
eat or excrete.
 The pollens are small and spiny

Non-seasonal hay fever
 This type of allergic reaction occurs anytime during
the year regardless the season.
 Main factors are odour and perfumes, volatile oils.
Allergens other than pollen grains.

1.volatile oils:- as the demand of perfumes is

increased, manufacturers started using different
perfuming agents.
 there are many reports submitted that volatile oils

are responsible for allergies.

Feather or danders
 Feathers and dander are also responsible for
allergies.
 People having pets and animals like cats and dogs
are more prone to allergic reactions.
 Allergic symptoms may include usually, sneezing,
cough , wheezing and in severe cases asthmatic
attacks may precipitate.
Molds
 Fungal spores especially the spores of penicillins
and aspergillus are considered more responsible for
allergy.
 This allergy depends upon dust.
 People having dust allergy must have this allergy as
spores are attcahed to dust particles in the air.
Air
 It is the major factor that causes inhalation allergy.
 As most of the allergens are present in the air but
air itself can also induce allergy e.g.
 During extreme summer when body is dehydrated,
the dry and warm air causes itching and redness in
nostrils .
 Similarly in winter cold air causes swelling of nostrils
and throat.
Ingestant allergens
 The allergens that are present in food material and are
responsible for allergy in mouth, stomach, intestine.
 The allergens are not localized but produce their effect
in whole body by entering the blood circulation.
 Example:- milk, coffee, chocolates , cod liver oil.
 Symptoms :- colic, skin rashes, puffing of lips and
tongue, bronchitis and asthma, eczema, migraine.
Milk allergy
 Milk may cause allergy by involving specific
immunological antigen-antibody reaction.
 The allergy occurs due to presence of “lactalbumin”
 Some studies indicate that over heating the milk can
alter the protein structure that can produce allergic
response.
 Evaporated milk causes more allergic reaction as
compare to fresh milk.
 Allergic symptoms include dermititis, rhinitis, bronchitis
and asthma.
Coffee:
 The water extractable allergenic compound of
coffee is chlorogenic acid.
 Symptoms of toxicity include
 Migraine and gastroenteritis

 Cod liver oil:- cod liver oil also causes allergy. its
bitter taste and unpleasant odour are the major
cause.
Injectant allergens
 The allergens that are present in parenteral
preparations and cause allergies are called
injectant allergens e.g. penicilline injection,
glandular preparations, antitoxins and biting insects.

 Symptoms include: swelling, pain, irritation to skin,

pruritis, blisters and shock.
Penicillin induced allergy
 Penicillin sensitive individuals may suffer from
anaphylactic shock if penicillin injection is
administered to them.
 To counter this effect penicillin derivatives are used
now a days for sensitive individuals.
 Exapmles of penicilline derivatives are as
1. 6-aminopenicillinic acid
2. 7-aminopenicillinic acid
Insect injections
 Some insects like bees and wasps inject instead of
biting.
 They transfer the injecting toxins through their
needle in the body of host.
 The treatment for both injections is different e.g.
Bees
 Bees are the honey flies.
 Their injection/sting is alkaline
in nature.
 Substances acidic in nature can
be used for their injection e.g.
1. Vinegar
2. Lemon juice
3. Garlic
Wasps
 Yellow and brown flies that do not produce any
economical product.
 Their sting/ injection contain acidic material.
 To neutralize their action bases are used e.g.
1. NH3
2. NaCl+H2O
3. NaHCO3+H2O
4. Oils
Contactant allergens
 The allergens that produce allergy on coming in contact
with the skin and producing hypersensitivity reactions
are called contactant allergens e.g. certain plants ,
pollen grains some clothes.
 Symptoms: include
1. blisters
2. Erythma
3. Inflammation
4. Pruritis
5. Rashes
Toxicodenderons
 Genus toxicodenderons is responsible for causing
allergy.
 Whole specie of this individual is responsible for
allergy in hypersensitive individuals e.g. poison ivy.
Plants
 Certain plants also cause allergy e.g. marigold,
daffodils, english ivy, sunflower.
 Certain plant tissues also cause allergies especially
when they are cut e.g. when grass and different
plants are dried after cutting become a part of
dust attached particles.
 When these particles come in contact with skin cause
allergy.
 Pollen grains are also included in this category
Cosmetics
 Certain chemicals used in cosmetic industry are also
a major source of allergy e.g. in violet talcum
powder “orris root” is used that is source of allergy.
 In lipsticks: dibromoflourorecein is allergic
ingredient.
 Shampoos: detergents
 Nail polish
 Perfumes
Infectant allergens
 The allergens that produce their effect by releasing
their metabolic waste and growth products inside
the host body are called as infectant allergens.
 Different types of pathogenic microrganisms e.g.
platihelminthes , protozoa, molds , nematodes and
bacterias produce their effect inside the body by
releasing their waste products and don not directly
produce allergic symptoms.
Infestant allergens
 The pathogenic organisms that release metabolic
waste and their growth products directly on the
surface of an individual are called as infestant
allergens.
 Such pathogenic organisms directly attach to skin
and release their metabolic waste appearing to the
allergic symptoms.
 Organism include hookworm, ringworm, protozoa,
bacteria and molds
 infection include ring worm.
Diagnostic tests for allergy
 After gathering complete information of allergic
patients several skin tests are carried out for
confirmation that include
1. blotting paper test
2. Scratch test
3. Open test
4. Patch test
5. Lymphocyte transformation test
6. Intra dermal test
Blotting paper test
 This test was performed in 1874 by “staedler” on
the sap of mango species to observe the specific
cause of allergic reaction by the sap of mango tip.
 The sap was directly applied to the lower thorax
portion at area of 1cm2 .
 A blotting paper strip soaked in the same material
was placed on the same site and symptoms were
noted.
 Burning sensations after 15min of blotting paper
application and continued to increase upto its
maximum after 30minutes.
 Area under the strip appears white while redness is
observed around it.
 Vesicles are observed after passage of night.
 Allergy is treated with in 2 weeks
Scratch test
 This test is used to determine immediate
hypersensitivity reaction.
 Test is performed after scratching and puncturing
the skin.
 Suspected allergenic preparations are made by
dissolving antigen in acetone or ethanol.
 The skin is scratched and antigenic material is
poured into it.
 If arrhythmia or swelling occurs then test is positive
Disadvantage
1. Puncture may cause spread in infection.
2. If antigens do not show positive result then they
will enter into blood circulation.
3. Special skills are required to perform this test
Open test
 This test is performed to asses the effect of unknown
antigen especially in case of contactant allergens
e.g. cosmetics, medicaments and household
substances.
 In this test preparation is applied to forearm of
allergic individual and a boundary is marked
around the portion applied.
 Material to be tested is applied for two days or
more.
 If symptoms appear like burning sensation, swelling
and redness then test is positive.
Patch test
 This test is also performed to determine conatctant
allergens.
 Antigenic preparations are made and applied in
the form of patches to the skin.
 Symptoms are produced after 48 hours.
 If burning and itching develops earlier then patch is
removed.
 Positive test is indicated with erythma and necrosis.
1. Advantages : no further spread of allergy
2. Many patches are applied at a time and more
than one results can be obtained.
3. Not painful
4. Disadvantages: take more time to appear
symptoms.
Lymphocytic transformation test
 This test gives result for both types of tests i.e.
immediate and delayed allergy.
 Antigen in particular concentration is taken and is
dissolved in acetone or ethanol.
 The preparation is applied on outer upper arm and
left uncovered.
 Blood samples are drawn and it is observed that if
lymphokines or other mediators are produced then
allergy is positive.
Intradermal test
 It is most quick method and is being used frequently
now a days.
 In this test antigenic preparations are given
parenterally.
 Antigenic preparations are prepared at maintained
concentration and administered intradermally.
 Symptoms appear very rapidly e.g. redness,
swelling, itching.
 Mostly pollen grain preparations are tested by this
method.
Treatment of allergy
 Allergy can be treated by many ways.
 After complete patient history and performing skin
tests, causative agent for allergy is treated.
 following are the methods by which allergy can be
used.
1. Hyposensitivity treatment
2. Food elimination
3. Anti-histaminic treatment
4. Environmental substitution
Hyposensitive treatment
 In this treatment person is made immunologically
strong so allergens can not produce disease.
 Two methods are adapted for this treatment

1. Water extract treatment

2. Alum pyridine method
Water extract method
 Pollen extracts are made by collecting pollen w/v
basis then following steps should be performed.
 defattation :the extract is defatted by dissolving
some non-polar solvent.
 Standardization: then it is standardized according
to number of pollen units.
 Dilution: then it is diluted and dose is injected.
Alum-pyridine method
 In this method non-defatted pollens are mixed with
pyridine that results in the extraction of lipid
material.
 Then alum is added in this solution and antigen
complex is precipitated.
 pyridine and alum are removed by warming and
precipitates are suspended in buffer solution.
 Allergic extracts are administered subcutaneously.
Food elimination
 In this type of treatment food material causing
allergy is removed from the diet e.g.
 Milk
 Cod liver oil etc.
Environmental substitution

 If patient is sick to a specific surroundings then the

environment should be changed and such a loaction
should be selected where allergic substances are
not produced.
 This method can also be done when seasonal
changes occur e.g. pollen season.
Anti-histamine treatment
 Anti histaminic drugs should be administered alone
or in combination with allergenic extracts.
 Anti-histamines do not prevent antigen-antibody
reaction but prevent the damage caused by
histamines.
 Difference between

Allergy irritation

 An altered or unusual  A localized superfacial

response due to antigenic inflammation on skin is
compound. called irritation.
 Irritation is caused by
 Symptoms include exaudating fluid or the
erythma, swelling, itching material excreted from the
and burning sensation. walls of epidermis that
 Symptoms are not lead ro degenration of cells.
produced during first  If sufficient dose is
exposure administered, irritation is
produced to any individual
 High amount of chemical  Small amount of
is required to produce
allergy. irritants cause
 Allergy is specific to irritation.
allergen as well as  It does not show
individual.
specificity.
 It occurs after previous
sensitization to a  It does not require
chemical sensitization history.
 It is affected by  It does not show any
hereditary and dependance.
environmental factors.
 It shows immediate or  Only immediate
delayed reactions. reaction.
 It may localized or  Only localized effects.
systemic
 Mediators are  No mediators are
produced during involved.
reaction.