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ALLERGIC MARCH Literature reading Wahyu Murtiono.

H Department of
Otorhinolaryngology-Head & Neck Surgery Faculty of Medicine Padjadjaran
University Hasan Sadikin General Hospital Bandung 2011 *
The ``allergic march': The natural history of atopic diseases. Characterized a
typical sequence of sensitization and manifestation of symptoms Certain age
period, persist over years or decades, tendency for spontaneous remission with
age. U. Wahn in:What drives the allergic march? Curr Opin Allergy Clin Immunol,
2002; 2: 55-560. *
The Allergic March EUGENE G WEINBERG, MB ChB, FCPaed, FAAAAIThe allergic
march *
Prenatal sensitization Multifactorial cause of allergy Genetic
constitutionEnvironmental Factors * Still in debate. Andrew H. Liu, MDThe
Allergic March of Childhood *
Immune response start in week 20th of pregnancy. Amniotic fluid (+) house
dust mite allergen Transplacental transport mechanism of different allergen.
Andrew H. Liu, MDThe Allergic March of Childhood *
Proposed mechanisms by which maternal exposure to bacteria protects against
allergies in offspring. Holt P G , Strickland D H J Exp Med 2009;206:2861-2864
2009 Holt and Strickland
Postnatal beginning Inhaled allergen and food allergen. Exposure to allergen in
early life in genetically predisposed individual. Airways allergic diseases (allergic
rhinitis and asthma) increased steadily in prevalence to age 7years. Andrew H.
Liu, MDThe Allergic March of Childhood *
Early atopic signs Dermatitis, Gastroesophageal reflux, Chronic rhinorrhea
Recurrent wheezing Lawrence D. Rosen, M.D. An Integrative Approach to Atopic
Disorders in Children DOI: 10.1089/act.2007.13201 *
U. Wahn - Curr Opin Allergy Clin Immunol, 2002; 2: 55-560 *
There may be areverse allergic march where some atopic children first present
with asthma and only later on develop eczema. EUGENE G WEINBERG, MB ChB,
FCPaed, FAAAAIThe allergic march *
Root of the Problem The development of atopy early in childhood is linked with
the later development of airways allergic disease. The problem of atopy begins
when the nascent immune system develops aberrant immune responses to
common ubiquitous, and unavoidable exposures. * Andrew H. Liu, MDThe Allergic
March of Childhood
Chronic ongoing exposures fuel inappropriate prolonged injury and
inflammation to the airways aberrant repair of injured tissues. Aberrant
processes through critical periods of postnatal lung growth and differentiation
fully developed lung may differ from the normal lung. This may underlie the

persistent asthma phenotype. * Andrew H. Liu, MDThe Allergic March of


Childhood
The Iceberg Model Understanding a new paradigm of care in children with atopic
disorders. The tip: The visible phenomena in atopic children (skin rashes,
vomiting, runny noses, and coughing). Beneath: Genomic predisposition (familial
and individual tendency to develop immune dysregulation under certain
environmental circumstances). Lawrence D. Rosen, M.D. An Integrative Approach
to Atopic Disorders in Children DOI: 10.1089/act.2007.13201 *
* Lawrence D. Rosen, M.D. An Integrative Approach to Atopic Disorders in
Children DOI: 10.1089/act.2007.13201
Genetic factors: During the first twenty years of life The risk of developing atopic
symptoms correlated to the existence of atopic disease in parents and siblings. *
Allergens: Food allergens Respiratory inhaled allergens (pollen, moulds, animal
dander, mites). *
The environment: Insufficient exposure to certain infectious agents in early
childhood increase the risk of developing allergy by disturbing the TH1/TH2
balance and favouring the TH2 allergic mechanism. Improved hygiene could be
partly responsible for this phenomenon. *
The hygiene theory Nature may immunize Against the development of allergic
diseases and asthma through : infections and microbial exposures of the 1.
Respiratory 2. Gastrointestinal tracts 3. The skin in early life. U. Wahn - Curr Opin
Allergy Clin Immunol, 2002; 2: 55-560 *
Skin sensitization lead to airway sensitization. Disturb balance between Th1 and
Th2 greater expression of Th2 and production of cytokines. * Induced IgE
production and activate Eosinophil. *
*
The hygiene theory * Andrew H. Liu, MDThe Allergic March of Childhood
The hygiene theory *
Protective Th1 immune responses to microbial exposures that begin immediately
after birth and after leaving the sterile environment of the mothers womb. When
this process goes well, Th1-based immune development prevents pro-allergic
Th2 immune development and atopy, thereby keeping environmental exposures
from becoming allergens. Andrew H. Liu, MDThe Allergic March of Childhood *
Th1 immune : Improve host defense by inducing antiviral mechanisms that keep
respiratory viruses from proliferating in respiratory epithelium and spreading
down the airways. Responses during airways injury and inflammation also inhibit
aberrant repair processes that underlie pathologic tissue changes in asthma. *
*

Leading to greater expression of the TH2 features resulting from the secretion of
the cytokines IL-4, IL-5,IL-10 and IL-14. These cytokines: Induce IgE production
activate eosinophils leading to allergic inflammation. Eugene G Weinberg, MB
ChB, FCPaedTHE ATOPIC MARCH *
*
Intervention and Prevention The basis for a stratified approach to early
interventions. Allergy testing is now recommended from infancy If food allergies
are suspected to cows milk, hens egg,peanut allergens should be tested for
specific allergies irrespective of their age Adrian Morris, MBChB, DCH, MFGPIS
ALLERGY TESTING COST EFFECTIVE? Current Allergy & Clinical Immunology,
March 2006 Vol 19, No.1 *
Prevention of atopy Primary prevention : The avoidance of early allergen
exposure to certain foods and inhalantsfrom birth. The ETAC (Early Treatment
of the Atopic Child): The role of cetirizine in delaying the atopic march. Eugene G
Weinberg, MB ChB, FCPaedTHE ATOPIC MARCH *
The use of probiotics Cultures of beneficial bacteria : Enhancing the microbial
balance Restore normal intestinal permeability and gut microecology. Improve
the immunological barrier function of the intestine. Reduce the generation of
proinflammatory cytokines characteristic of allergic inflammation. In the future
may be used in the primary prevention of the allergic march and asthma. Eugene
G Weinberg, MB ChB, FCPaedTHE ATOPIC MARCH *
CONCLUSIONS Allergic diseases have now become the most common group of
diseases among children.Treatment is mainly based on preventing and/or
controlling symptoms *
New promising treatments, such as the administration of sublingual
immunotherapy. In the future, it is anticipated that therapies that modify the
severity of atopic eczema in infants and young children will decrease the risk for
the eventual development of allergic disease and thus prevent the consequences
of the allergic march. *
Intensive research is still required before a potential cure for all allergic children
may eventually be developed. *
THANK YOU * * * * * . * * * * * * * * * * * * * * * * * * f * * * * * * * * * * *
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