Allergy and Allergens

Hema Harini, Biological Sciences (3rd year)

• Introduction

• Allergens-types and symptoms

• Pathophysiology

• Prognosis

• Diagnostic Tests

• Treatments
 Allergy occurs when a person's immune system reacts to substances (foreign protein) in the
environment which tend to be harmless to most people.

These foreign proteins are known as allergens and are found in dust mites, pets, pollen, insects,
ticks, moulds, foods, and drugs (medications).

Allergens can affect anybody but people with genetic history for allergies are more susceptible to
develop one.

Atopy is the genetic tendency to develop allergic diseases.

When people allergic are exposed to allergens, they can develop an immune reaction that leads
to allergic in ammation (redness and swelling).

This can cause symptoms in the:

1. Nose and/or eyes, resulting in allergic rhinitis (hay fever) and/or conjunctivitis.

2. Skin resulting in eczema, or hives (urticaria).

3. Lungs resulting in asthma.

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 Allergens
Allergens can be inhaled, ingested, or enter through the
skin.

Symptoms of an allergic reaction will vary depending on

the type and amount of allergen encountered and the
manner in which the body's immune system reacts to that
allergen.

Allergies can affect anyone, regardless of age, gender, race.

Generally, allergies are more common in children.
However, a rst-time occurrence can happen at any age, or
recur after many years of remission.

Hormones, stress, smoke, perfume, or environmental

irritants may also play a role in the development or severity
of allergies.
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 Types of llergens Symptoms/A ected org ns

Gener lised nd loc lised itching, N use nd

Cert in foods like Milk nd D iry products, Eggs,
vomiting, Hives, Swelling round mouth thro t,
Whe t, Soy, Pe nuts etc.,
tongue or f ce

Inh l nts/Air borne subst nces Runny, Stu y nd Itchy nose, sneezing, Itchy nd
(Perenni l: Pets, Dustmites, Cockro ches, Molds W tery eyes, R sh, Hives, Itching, Shortness of
Se son l: Pollens) bre th, Swelling

L tex Cont ct derm titis, R sh, Hives, Runny nose,

(Rubber gloves, B lloons, B nd ges, Rubber B lls) Di iculty bre thing

Venom/Stinging insects Di iculty bre thing, Hives, Swelling, Wheezing,

(Bees, Fire nts, Hornets, W sps) Dizziness, Low BP

Additionally; drugs, cosmetics, perfumes, elements and chemicals can also act as allergens.
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 Pathophysiology
When immune system reacts in a way that’s detrimental to an encountered substance instead of
providing protection is called a hypersensitivity reaction. (four types)

Allergies are a part of type 1 hypersensitivity reactions. Also known as immediate (less than a hour
after exposure to antigen)/ IgE mediated (exaggerated immune response by production of IgE
antibodies) hypersensitivity.

When the person is exposed to the antigen causing allergic reactions (allergen), the immune
response occurs in two steps:

1. First exposure/sensitisation

2. Subsequent exposure

Allergy usually occurs due to complex genetic, environmental and site speci c factors. People
with genetic predisposition to allergies have genes that make helper T cells hypersensitive to
certain antigens/allergens.

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Sensitisation phase
Allergens are picked up by immune cells present along the contact surface/entry organ.

They then migrate to lymph nodes where helper T cells are present. (regardless the person is allergic or
not)

These are known as Antigen presenting cells (APC’s), as they carry allergens and present it to Th cells.
Eg: Dendritic cells, Macrophages

If the person is allergic to the antigen, the APC’s produce stimulatory molecules which helps the
allergens to mount with Th cells to produce effective immune response.

Th cells modi es into primed Th cells upon bounding with Ag and stimulatory molecules. In type 1
hypersensitivity reactions this further differentiates into Th2 cells, in response to certain interleukins.

Release of interleukin leads the B cells to undergo antibody class switching to produce IgE antibody
instead of IgM, along with signalling eosinophils to degranulate which damages both host/invading
cells.

IgE are cytotrophic antibodies meaning it binds on surface of mast cells with help of receptors.
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 Second Exposure
When the person is exposed to the speci c allergen once again, then the Ag binds to IgE which is bound
to the surface of mast cells. (which are now identi able for the Ag)

The binding of Ag with the IgE antibodies signals mast cells to degranulate which releases pro-
in ammatory molecules/mediators which produces allergic reactions.

Allergic reactions are of two types:

1. Early phase reactions:

• This results in the major release of Histamine which leads to smooth muscle contraction and blood
vessel dilation. This gives raise to symptoms like runny nose, watery eyes, mucus production, oedema,
hives.

• Other mediators activate eosinophils and proteases. These make up early phase reactions.

2. Late phase reactions:

• The affected cells further recruit more Th2 cells, Basophils and Eosinophils to further produce more
symptoms like eczema, allergic rhinitis, asthma etc,.
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 Anaphylactic Shock
• When a person is encountered with large load of speci c allergen it
leads to severe cases of allergic reactions which can even pose threat
to life.

• It leads to severe symptoms like increased vascular permeability and

airway/broncho constriction.

• This makes oxygen supply to vital organs such as brain more dif cult.

• Hence it leads to a condition called anaphylactic shock - part of late

phase allergic reaction.

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 Diagnosis
• A look into patient’s history and clinical evaluation.

• Non-speci c tests - tests that can suggest but not con rm an allergic origin of
symptoms.

1. Complete blood count (CBC) may be done to detect eosinophilia if patients

are not taking medications which reduce the eosinophil count.

2. Serum IgE levels can be evaluated as they are elevated in allergic disorders but
are of little help in diagnosis because they may also be elevated in various
other infectious conditions.
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 Diagnosis
• Speci c tests - identi es the speci c allergy

1. Skin testing uses standardised concentrations of Ag introduced directly into skin and is
indicated when a detailed history and physical examination do not identify the cause and
triggers for symptoms.

• Two skin test techniques can be used:

A. Percutaneous (prick)

B. Intradermal

2. Allergen-speci c serum IgE tests use an enzyme-labeled anti-IgE antibody to detect binding
of serum IgE to a known allergen. These tests are done when skin testing might be ineffective
or risky.

• Allergen-speci c IgE tests have replaced radioallergosorbent testing (RAST), which used 125-I-
labeled anti-IgE antibody. Although the allergen-speci c serum IgE tests are not radioactive,
they are still sometimes referred to as RAST.
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 Treatment
• Removal or avoidance of allergic triggers.

• H1 blockers/Anti histamines - Antihistamines block histamine receptors; they do not affect

histamine production or metabolism.

• This leads to lowering of vascular permeability and broncho constriction.

• Oral/ocular corticosteroids/anti in ammatory drugs and leukotriene inhibitors help lower

in ammatory response.

• Mast cells stabiliser - block release of mediators.

• Epinephrine - constricts blood vessels

1. Intramuscular injection through Epipen

2. Intravenous injection

• Immunotherapy - de sensitisation/exposure to gradually increasing doses of allergen.

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References
• Allergies and the immune system. (2024, May 23). Johns Hopkins Medicine. https://
www.hopkinsmedicine.org/health/conditions-and-diseases/allergies-and-the-immune-
system#:~:text=Allergens%20can%20be%20inhaled%2C%20ingested,certain%20pollens%20and%20othe
r%20allergens.

• Professional, C. C. M. (n.d.). Allergies. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/

8610-allergies

• Fernandez, J. (2022, October 7). Allergic rhinitis. MSD Manual Professional Edition. https://
www.msdmanuals.com/en-in/professional/immunology-allergic-disorders/allergic,-autoimmune,-and-other-
hypersensitivity-disorders/allergic-rhinitis#Prevention_v26620898

• Grainger, S. (n.d.). What is allergy? - Australasian Society of Clinical Immunology and Allergy (ASCIA).
https://www.allergy.org.au/patients/about-allergy/what-is-
allergy#:~:text=Allergy%20occurs%20when%20a%20person's,tendency%20to%20develop%20allergic%
20diseases.
Thank You