HAY-FEVER AND ITS SUCCESSFUL TREATMENT
CONTENTS 1 OVERVIEW OF THE HUMAN IMMUNE RESPONSE 11 INTRODUCTION 12 INNATE IMMUNE SYSTEM 13 ACQUIRED IMMUNE SYSTEM 131 IMMUNOGENS AND ALLERGENS 132 ANTIGEN-PRESENTING CELLS 133 MAJOR HISTOCOMPATIBILITY COMPLEX 14 T- AND B-CELLS IN THE ACQUIRED IMMUNE RESPONSE 141 T-LYMPHOCYTES 142 B-LYMPHOCYTES AND IMMUNOGLOBULINS 15 LYMPHOID TISSUES 16 TOLERANCE: DISTINGUISHING SELF FROM NONSELF 17 CYTOKINES 171 CYTOKINES PRODUCED BY ANTIGEN-PRESENTING CELLS 172 CYTOKINES IN THE HUMORAL IMMUNE RESPONSE 173 CYTOKINES IN THE CELLULAR AND CYTOTOXIC IMMUNE RESPONSE 174 CYTOKINES IN THE ALLERGIC IMMUNE RESPONSE 175 ANTI-INFLAMMATORY CYTOKINES 18 CHEMOKINES 19 COMPLEMENT 110 INFLAMMATORY CELLS 1101 EOSINOPHILS 1102 MAST CELLS 1103 BASOPHILS 111 PRIMARY MEDIATORS OF INFLAMMATION 1111 HISTAMINE 1112 ARACHIDONIC ACID METABOLISM 1113 CYCLOOXYGENASE PRODUCTS: PROSTAGLANDINS 1114 LIPOOXYGENASE PRODUCTS: LEUKOTRIENES 112 ALLERGIC RESPONSE TO AN ALLERGEN: SUMMARY 113 IMMUNE-MODULATING MEDICATIONS IN ALLERGIC DISEASE 1131 CPG-DNA 1132 OMALIZUMAB 1133 ANTI-TNF 1134 IMMUNOTHERAPY 1135 CORTICOSTEROIDS 1136 IMMUNOPHILINS 114 SUMMARY SUGGESTED READING 2 ENVIRONMENTAL ALLERGENS 21 OVERVIEW OF ALLERGENS 22 POLLENS 221 POLLEN COUNTS 222 TREE POLLENS 223 GRASS POLLENS 224 WEED POLLENS 225 ENVIRONMENTAL CONTROL: OUTDOOR POLLENS 23 FUNGAL ALLERGENS 231 CLASSIFICATION 232 ALTERNARIA ALTERNATA 233 ASPERGILLUS 234 CLADOSPORIUM HERBARUM 235 PENICILLIUM 236 BASIDIOMYCETES 237 OTHER FUNGI 238 AVOIDANCE OF FUNGAL ALLERGENS 24 INDOOR ALLERGENS 241 MITE ALLERGENS 242 MITE ALLERGEN AVOIDANCE 25 ANIMAL ALLERGENS 251 CAT ALLERGEN 252 DOG ALLERGEN 253 HORSE ALLERGEN 254 COW ALLERGEN 255 MOUSE ALLERGEN 256 RAT ALLERGEN 257 GUINEA PIG ALLERGEN 258 RABBIT ALLERGEN 259 ANIMAL ALLERGEN ENVIRONMENTAL CONTROL 26 COCKROACH ALLERGEN 261 COCKROACH ENVIRONMENTAL CONTROL 27 CLINICAL VIGNETTES 271 VIGNETTE 272 VIGNETTE 273 VIGNETTE 3 ALLERGEN TESTING AND ALLERGEN IMMUNOTHERAPY 31 ALLERGEN TESTING 311 SKIN PRICK TESTING 312 SKIN INTRADERMAL TESTING 313 IN VITRO TESTING 32 ALLERGEN IMMUNOTHERAPY 321 CLINICAL EFFECTIVENESS OF ALLERGEN IMMUNOTHERAPY 322 IMMUNOLOGIC CHANGES IN IMMUNOTHERAPY 323 PRACTICAL CONSIDERATIONS IN ALLERGEN IMMUNOTHERAPY 324 DURATION OF IMMUNOTHERAPY 325 SAFETY OF ALLERGEN IMMUNOTHERAPY 326 ALLERGEN IMMUNOTHERAPY IN CHILDREN 327 ALLERGEN IMMUNOTHERAPY IN PREGNANCY 328 FUTURE ALLERGEN IMMUNOTHERAPY 33 SUMMARY 34 CLINICAL VIGNETTES 341 VIGNETTE 342 VIGNETTE 343 VIGNETTE 344 VIGNETTE 4 ALLERGIC RHINITIS AND RHINOSINUSITIS 41 OVERVIEW 42 NASAL ANATOMY AND FUNCTION 43 CLINICAL OVERVIEW 44 ALLERGIC RHINITIS 441 PATHOPHYSIOLOGY 442 HISTORY 443 PHYSICAL EXAMINATION 444 TESTING 445 TREATMENT 45 NONALLERGIC RHINITIS AND RHINOSINUSITIS 46 INFECTIOUS-ACUTE RHINOSINUSITIS 461 PHYSICAL EXAMINATION 462 MICROBIOLOGY 463 TESTING 464 TREATMENT 47 CHRONIC RHINOSINUSITIS INFECTIOUS CHRONIC RHINOSINUSITIS 481 TESTING 482 TREATMENT 49 ALLERGIC FUNGAL RHINOSINUSITIS 410 CHRONIC EOSINOPHILIC (FUNGAL OR HYPERPLASTIC) RHINOSINUSITIS 411 SYSTEMIC DISEASE 412 NONINFECTIOUS STRUCTURAL RHINOSINUSITIS 4121 NASAL AND SINUS POLYPOSIS 4122 TUMORS 4123 FOREIGN BODY 4124 ADENOIDAL HYPERTROPHY 4125 CEREBROSPINAL FLUID RHINORRHEA 4126 SEPTAL DEVIATION 413 NONINFECTIOUS NONSTRUCTURAL RHINITIS AND RHINOSINUSITIS 4131 VASOMOTOR RHINITIS 4132 NONALLERGIC RHINITIS WITH EOSINOPHILIA SYNDROME 4133 ATROPHIC RHINITIS 4134 HORMONAL RHINITIS 4135 MEDICATION-INDUCED RHINITIS 4136 RHINITIS FROM FOOD INGESTION 414 CLINICAL VIGNETTES 4141 VIGNETTE 4142 VIGNETTE 4143 VIGNETTE 4144 VIGNETTE 4145 VIGNETTE 5 ALLERGIC EYE DISEASE 51 OVERVIEW 52 BASIC EYE ANATOMY 53 APPROACH TO THE PATIENT 54 ALLERGIC AND ALLERGIC-LIKE EYE DISEASE 541 SEASONAL ALLERGIC CONJUNCTIVITIS 542 PERENNIAL ALLERGIC CONJUNCTIVITIS 543 ATOPIC KERATOCONJUNCTIVITIS 544 VERNAL CONJUNCTIVITIS 545 GIANT PAPILLARY CONJUNCTIVITIS 546 INFECTIOUS CONJUNCTIVITIS 547 CONTACT DERMATOCONJUNCTIVITIS 548 BLEPHAROCONJUNCTIVITIS 549 DRY EYE SYNDROME 55 CLINICAL VIGNETTES 551 VIGNETTE 552 VIGNETTE 553 VIGNETTE 554 VIGNETTE 6 ASTHMA 61 OVERVIEW 62 EPIDEMIOLOGY 63 PATHOPHYSIOLOGY 631 GENETICS 632 AIRWAY OBSTRUCTION 633 AIRWAY HYPERRESPONSIVENESS 634 FATAL ASTHMA 64 CLINICAL PRESENTATION AND DIFFERENTIAL DIAGNOSIS 641 DIFFERENTIAL DIAGNOSIS IN CHILDREN 642 DIFFERENTIAL DIAGNOSIS IN ADULTS 643 TESTING 65 CLASSIFICATION OF ASTHMA 651 TYPES 652 INITIAL EVALUATION OF CHRONIC ASTHMA SEVERITY 66 EVALUATION OF FACTORS CONTRIBUTING TO ASTHMA SEVERITY 661 ALLERGENS 662 INFECTIONS 663 EXERCISE 664 VOCAL CORD DYSFUNCTION 665 IRRITANTS AND POLLUTANTS 666 RHINOSINUSITIS (UNITED AIRWAY HYPOTHESIS) 667 SMOKING 668 MEDICATIONS 669 OCCUPATIONAL 6610 OBSTRUCTIVE SLEEP APNEA 6611 GASTROESOPHAGEAL REFLUX DISEASE 67 TREATMENT 671 PATIENT EDUCATION 672 PHARMACOLOGIC THERAPY 673 TREATMENT OF AN ACUTE ASTHMATIC ATTACK 674 STATUS ASTHMATICUS TREATMENT 675 GENERAL APPROACH 676 TREATMENT OF PERSISTENT SEVERE OR INTRACTABLE ASTHMA 677 SPECIAL GROUPS 68 CLINICAL VIGNETTES 681 VIGNETTE 682 VIGNETTE 683 VIGNETTE 684 VIGNETTE 685 VIGNETTE 7 URTICARIA AND ANGIOEDEMA 71 DESCRIPTION AND EPIDEMIOLOGY 72 PATHOPHYSIOLOGY 73 ACUTE URTICARIA: ETIOLOGIES 731 MEDICATIONS 732 FOODS 733 INSECT STINGS AND BITES 734 INFECTION 74 CHRONIC URTICARIA 741 AUTOIMMUNE AND IDIOPATHIC URTICARIA 742 PHYSICAL URTICARIA 743 UNDERLYING CAUSES OF CHRONIC URTICARIA 75 URTICARIA-ANGIOEDEMA-ASSOCIATED DISORDERS 751 URTICARIAL VASCULITIS 752 C1 ESTERASE INHIBITOR DEFICIENCY 753 MASTOCYTOSIS 754 PRURITIC URTICARIAL PAPULES AND PLAQUES OF PREGNANCY 76 PATIENT EVALUATION 761 ACUTE URTICARIA 762 CHRONIC URTICARIA 77 MEDICATIONS USED IN THE TREATMENT OF ACUTE AND CHRONIC URTICARIA 771 ANTIHISTAMINES (H1 BLOCKERS) 772 H2 BLOCKERS 773 LEUKOTRIENE MODIFIERS 774 TRICYCLIC ANTIDEPRESSANTS (DOXEPIN) 775 CORTICOSTEROIDS 776 THYROXINE 777 IMMUNOMODULATORY AGENTS 78 THERAPY RECOMMENDATIONS 79 CLINICAL VIGNETTES 791 VIGNETTE 792 VIGNETTE 793 VIGNETTE 8 ATOPIC AND CONTACT DERMATITIS 81 ATOPIC DERMATITIS 811 EPIDEMIOLOGY 812 PATHOGENESIS 813 CLINICAL MANIFESTATIONS AND DIAGNOSIS 814 TRIGGERS OF ATOPIC DERMATITIS 815 EVALUATION 816 MANAGEMENT 817 GUIDELINES FOR MANAGEMENT 82 CONTACT DERMATITIS 821 OVERVIEW 822 PATHOGENESIS 823 CLINICAL MANIFESTATIONS AND DIAGNOSIS 824 EVALUATION 825 SPECIAL EXPOSURES ASSOCIATED WITH CONTACT DERMATITIS 826 TREATMENT 83 CLINICAL VIGNETTES 831 VIGNETTE 832 VIGNETTE 833 VIGNETTE 9 DRUG ALLERGY 91 EPIDEMIOLOGY 92 DEFINITIONS 93 PATHOPHYSIOLOGY AND CLINICAL MANIFESTATIONS 931 TYPE 1 IMMEDIATE HYPERSENSITIVITY (IGE MEDIATED) 932 TYPE 2 HYPERSENSITIVITY 933 TYPE 3 HYPERSENSITIVITY 934 TYPE 4 HYPERSENSITIVITY 935 EXANTHEMATOUS (MORBILLIFORM) DRUG ERUPTIONS 936 ERYTHEMA MULTIFORME 937 FIXED DRUG ERUPTIONS 938 PHOTOSENSITIVE DRUG ERUPTIONS 939 ERYTHEMA MULTIFORME MAJOR, STEVENS–JOHNSON SYNDROME, AND TOXIC EPIDERMAL NECROLYSIS 9310 ANAPHYLACTOID DRUG REACTIONS 9311 HYPERSENSITIVITY SYNDROME/DRUG RASH WITH EOSINOPHILIA AND SYSTEMIC SYMPTOMS 94 CLINICAL EVALUATION OF SUSPECTED DRUG SENSITIVITY 941 HISTORY 942 PHYSICAL EXAMINATION 943 LABORATORY TESTING OF SUSPECTED DRUG SENSITIVITY 95 THERAPY AND MANAGEMENT 951 TYPE 1 REACTIONS 952 TYPES 2, 3, AND 4 REACTIONS 953 MORBILLIFORM REACTION 954 ERYTHEMA MULTIFORME 955 ERYTHEMA MULTIFORME MAJOR, STEVENS–JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS 956 HYPERSENSITIVITY SYNDROME/DRUG RASH WITH EOSINOPHILIA AND SYSTEMIC SYMPTOMS SYNDROME 96 SPECIAL MEDICATION REACTIONS 961 RADIOCONTRAST MEDIA REACTIONS 962 SULFA REACTIONS SULFONAMIDE AND HIV ASPIRIN AND NSAIDS INTRAOPERATIVE ANAPHYLAXIS VACCINE ALLERGY CLINICAL VIGNETTES VIGNETTE 1: IMMEDIATE HYPERSENSITIVITY TYPE 1 REACTION VIGNETTE 2: EXANTHEMATOUS (MORBILLIFORM) REACTION VIGNETTE 3: DRESS SYNDROME VIGNETTE 4: ASPIRIN SENSITIVITY 10 FOOD ALLERGY DEFINITIONS EPIDEMIOLOGY PATHOPHYSIOLOGY FOOD ALLERGENS 1041 COW’S MILK 1042 HEN’S EGG 1043 SOY 1044 PEANUT 1045 FISH 1046 SHELLFISH 1047 WHEAT 1048 TREE NUTS APPROACH TO PATIENTS CLINICAL DISORDERS 1061 IGE-MEDIATED DISORDERS 1062 IGE-ASSOCIATED–CELL-MEDIATED DISORDERS 1063 IMMUNOLOGIC-CELL-MEDIATED (NON-IGE) DISORDERS 1064 NON-IGE-NONIMMUNOLOGIC FOOD INTOLERANCE MANAGEMENT FOOD ADDITIVE REACTIONS SUMMARY 10101 VIGNETTE 10102 VIGNETTE 10103 VIGNETTE 10104 VIGNETTE 10105 VIGNETTE 11 ANAPHYLAXIS AND ANAPHYLACTOID REACTIONS DEFINITION AND EPIDEMIOLOGY HISTORY AND PHYSICAL EXAMINATION RISK FACTORS COMMON CAUSES OF ANAPHYLACTIC AND ANAPHYLACTOID REACTIONS 1151 FOODS 1152 MEDICATIONS 1153 RADIOCONTRAST MEDIA 1154 LATEX 1155 GENERAL ANESTHESIA AND INTRAOPERATIVE ANAPHYLAXIS 1156 HYMENOPTERA 1157 EXERCISE INDUCED 1158 BLOOD AND BLOOD PRODUCTS 1159 SEMINAL FLUID-INDUCED ANAPHYLAXIS IDIOPATHIC ANAPHYLAXIS DIFFERENTIAL DIAGNOSIS 118 DIAGNOSIS AND DIAGNOSTIC TESTING 1181 IDENTIFICATION OF A SPECIFIC ALLERGEN 1182 TESTS PERFORMED IN THE EVALUATION OF CONDITIONS THAT MIMIC ANAPHYLAXIS OR IDIOPATHIC ANAPHYLAXIS 1191 ACUTE MANAGEMENT 1192 FURTHER MANAGEMENT 11101 VIGNETTE 11102 VIGNETTE 11103 VIGNETTE 12 STINGING INSECT ALLERGY INTRODUCTION IDENTIFICATION OF STINGING INSECTS REACTIONS TO STINGING INSECTS 1231 LARGE LOCAL REACTION 1232 SYSTEMIC REACTION 1233 TOXIC REACTION 1234 NON-IGE REACTIONS DIAGNOSTIC TESTING 125 MANAGEMENT 1251 ACUTE MANAGEMENT 1252 AVOIDANCE MEASURES 1253 VENOM IMMUNOTHERAPY FOR HYMENOPTERA 126 CONCLUSION 127 CLINICAL VIGNETTES 1271 VIGNETTE 1272 VIGNETTE 1273 VIGNETTE