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Allergy march from atopic dermatitis to lifelong allergy
1. Allergy March: from Atopic
Dermatitis to Lifelong Allergy
Prof DR Dr Ariyanto Harsono SpA(K)
2. INTRODUCTION
Prof DR Dr Ariyanto Harsono SpA(K)
The term “allergic march” refers to the natural history of
atopic manifestations, which is characterized by a typical se
quence of IgE antibody responses and clinical symptoms that
appear early in life, persist over years or decades,
even lifelong.
1. Once IgE mediated allergy occurs, the
process continues in a baby's life
2. Sensitization to another food proteins that
would otherwise occur
2
Usually the first sensitization to cow's milk
4. 4 Sorts of allergens
Prof DR Dr Ariyanto Harsono SpA(K)
4
5. SensitizSensitizaattiionon in Uteroin Utero
T cells has been responding to the fetus at
22 weeks.
T cells have been responding navel at
birth:
mite ~ 47%
eggs, cow’s milk ~ 75%
Low level of IFNγ and high level of IL4
& 10
IgE at birth to Cow's milk, wheat, eggs.
Prof DR Dr Ariyanto Harsono SpA(K)
5
6. Aktivasi
selsel
Imuno
kompeten
•Sel T
•Sel B
•Sel Mast
•Sel
Langer
hans
Aktivasi
selsel
struk
tural
•Sel
endotel
•Sel
epitel
Aktivasi dan
Rekruitmen
•Sel Mast
•Eosinofil
•Neutrofil
•Basofil
Pelepasan
mediator
Kerusakan
epitel
Stimulasi
neural
Dilatasi &
peningkatan
permeabilitas
vaskulerl
Bronkokonstriksi
Perbaikan
epitel
•Proliferasi
fibroblast
•Deposisi
kolagen
•Hipertropi/hiper
plasia otot polos
•Ekspansi
vaskuler
Penyempitan
saluran nafas
bawah
Symptom
alergi
Bronkus
hiper-reaktif
A
L
E
R
G
E
N
A B C D E
Imunopathology of allergy
Airway
remodelling
6
Trigger
31. CE
Prof DR Dr Ariyanto Harsono
SpA(K)
31
Unusual ManifestationAbdominal Colic
32. Prof DR Dr Ariyanto Harsono SpA(K)
Unusual Manifestation
32
Abdominal Colic
33. Sensitization to environmental
allergens from indoor and
outdoor sources requires more
time and is generally observed
between the first and tenth
years of life.
Prof DR Dr Ariyanto Harsono SpA(K) 33
34. THE FIRST STEP OF THE ATOPIC
MARCH: ATOPIC DERMATITIS
Prof DR Dr Ariyanto Harsono SpA(K) 34
AD starts early in the first few years in life. Of the
affected children,
45% of them had the condition during the first 6
months of life,
60% during the first year of life and
up to 85% suffered AD before 5 years of age.
Less than half of the patients with AD have complete
resolution by 7 years of age and
only 60% of them have resolution by adulthood,
indicating the chronic nature of AD.
35. Several studies have demonstrated the allergic
march from atopic eczema to the development
of asthma and allergic rhinitis.
• In general, atopic dermatitis is the first
clinical manifestation of the IgE response,
with the highest incidence during the first
three months of life and the highest period
prevalence during the first three years of
life.
Prof DR Dr Ariyanto Harsono
SpA(K)
35
36. Factrors Influencing Allergy
March
Expsure to Endotoxine
Pollutants and Tobacco Smoke as
Adjuvant Factors
Bowel flora, vaccinations, antibiotics
and allergy
Lifestyle and the Development of
Atopic Disease
Prof DR Dr Ariyanto Harsono
SpA(K)
36
37. Exposure to endotoxin
Prof DR Dr Ariyanto Harsono SpA(K) 37
Endotoxin exposure is another possible protective
factor against allergy in early life. Endotoxins consist of
a family of molecules called lipopolysaccharides (LPS)
and are an intrinsic part of the outer membrane of
Gram-negative bacteria. It has been suggested that
increased exposure to endotoxins on farms or in
homes with animals could modify immune responses
to reduce the prevalence of atopic diseases.
38. Pollutants and Tobacco
Smoke as Adjuvant Factors
Prof DR Dr Ariyanto Harsono SpA(K) 38
Pollutants and Tobacco smoke, though not
serving as allergens, are capable of
upregulating existing IgE responses, leading
either to disease manifestation or to an
aggravation of symptoms.
39. Bowel flora, vaccinations,
antibiotics and allergy
Prof DR Dr Ariyanto Harsono SpA(K) 39
The intestinal microflora might well be the major source of
microbial stimulation of the immune system in early childhood.
The intestinal microflora can enhance Th1-type responses.
Observations from Japan have suggested that positive
tuberculin responses in children predict a lower incidence of
asthma, lower serum IgE levels and a cytokine profile biased
toward the Th1 type.
A few reports have described an association between the use
of antibiotics during the first two years of life and an increased
risk of asthma.
40. Lifestyle and the Development of Atopic
Disease
Prof DR Dr Ariyanto Harsono SpA(K) 40
Observations from Germany suggest that within the population
of an industrialized country with a Western lifestyle, high
socioeconomic status is a risk factor for early sensitization and
symptomatic manifestation of atopic dermatitis and allergic
airway disease.
45. Prof DR Dr Ariyanto Harsono SpA(K) 45
THE END POINTS (PROGRESSION) OF THE
ATOPIC MARCH: ALLERGIC RHINITIS AND
ASTHMA
It is important to identify infants at risk for developing
lifelong chronic atopic diseases to provide a critical
window of opportunity early in life for therapeutic
intervention.
46. Early markers of increased risk for allergic
disease
Prof DR Dr Ariyanto Harsono SpA(K) 46
A number of early markers for atopy indicating an
increased risk for the development of subsequent
allergy have been identified.
elevated cord-blood IgE level (high specificity but low
sensitivity),
a positive skin-prick test to egg or to house-dust mite
in the first year of life and
the detection of specific IgE to common food and
inhalant allergens during early infancy.
47. Natural History of Food Allergy
• Most children with allergies become tolerant to
cow's milk, soy, and eggs in a few years.
• Older children (15 years old) and adults
generally do not experience immune tolerance.
• Peanut allergy, fish, and shellfish more
persistent.
• Food hypersensitivity at an early age (ie cow's
milk, eggs, peanuts) is a risk factor for additional
food allergies, Atopic Dermatitis, and asthma.
Prof DR Dr Ariyanto Harsono SpA(K)
47
48. Conclusion
Allergy is a hypersensitivity type I
Cow's Milk is usually the first sensitization then
other foods.
Allergy March begins with Atopic Dermatitis,
continues to Gasrointestinal Allergy, Allergic
Rhinitis and Bronchial Asthma.
Prof DR Dr Ariyanto Harsono SpA(K) 48
49. Prof DR Dr Ariyanto Harsono
SpA(K)
49
Thank You
Hinweis der Redaktion
CYTOKONES PROFILE IN LONG-TERM USE OF CORTICOSTEROID INHALATION IN CHILDHOOD ASTHMA RECEIVING IMMUNOTHERAPY