1. ALLERGY DR. MA. TERESA S. FAJARDO PEDIATRICS HEMATOLOGY / ONCOLOGY

2. IMMUNOLOGIC BASISOF ALLERGIC DISEASE TO DETECT AND ELIMINATE ANYTHING FOREIGN TO THE BODY BENEFICIAL (IMMUNITY) OR HARMFUL (ALLERGY)

3. COMPONENTS IN HOST'S RESPONSE TO THE ALLERGEN ENVIRONMENT TARGET CELLS B AND T LYMPHOCYTES

4. IMMUNOLOGIC CAPABILITIES OF THE HOST PRIMARY ( NON- SPECIFIC ) SECONDARY (SPECIFIC) TERTIARY ( TISSUE DAMAGING RESPONSE)

5. PRIMARY RESPONSE MOST PRIMITIVE PHAGOCYTOSIS / INFLAMMATION

6. SECONDARY RESPONSE SPECIFIC RESPONSE MECHANISMS : B CELL / T CELL RESPONSE COMPLEMENT SYSTEM COAGULATIPON SYSTEM

7. TERTIARY RESPONSE TISSUE – DAMAGING RESPONSES ( TYPES I, II, III, IV ) PROPOSED BY GELL AND COOMBS

8. MEDIATORS OF ALLERGY PREFORMED MAST CELL MEDIATORS RAPIDLY FORMED MAST CELL MEDIATORS

9. PREFORMED MAST CELLMEDIATORS VASOACTIVE MEDIATORS CHEMOTACTIC MEDIATORS ENZYMES PROTEOGLYCANS

10. PREFORMED MAST CELLMEDIATORS ( VASOACTIVE MEDIATORS) HISTAMINE BRONCHOSPASM AND VASCULAR PERMEABILITY ADENOSINE INHIBIT PLATELET AGGREGATION STIMULATE IRRITANT RECEPTORS

11. PREFORMED MAST CELLMEDIATOR (CHEMOTACTIC MEDIATORS ) 1. NEUTROPHIL FACTOR RECRUITMENT / ACTIVATION OF NEUTROPHIL 2. EOSINOPHIL FACTOR RECRUITMENT /ACTIVATION OF EOSINOPHIL

12. PREFORMED MAST CELLMEDIATOR ( ENZYMES) 1. NEUTRAL PROTEASES ( TRYPTASE , CHYMASE ) COMPLEMENT/ KININ ACTIVATION 2. ACID HYDROLASES ( BETA- GLUCORONIDASE) INFLAMMATION

13. PREFORMED MAST CELLMEDIATOR (PROTEOGLYCANS) HEPARIN ANTICOAGULANT ANTICOMPLEMENT ACTIVITY

14. RAPIDLY FORMED MAST CELL MEDIATORS PLATELET- ACTIVATING FACTOR PROSTAGLANDIN LEUKOTRIENES

15. RAPIDLY FORMED MASTCELL MEDIATORS BIOLOGIC ACTIVITY : VASODILATATION VASCULAR LEAKAGE SMOOTH MUSCLE CONTRACTION GLANDULAR SECRETION STIMULATION OF THE IRRITANT ( ITCH / SNEEZE ) RECEPTORS PRO –ANTI-INFLAMMATORY MEDIATOR

16. CYTOKINES NEWLY SYNTHESIZED PROTEINS THAT REGULATE IMMUNE RESPONSE POTENT PRO- INFLAMMATORY MEDIATORS GROWTH / DIFFERENTIATION OF EOSINOPHILS AND MAST CELLS

17. CYTOKINES AND ALLERGY IgE REGULATION EOSINOPHILIA MAST CELL DEV ‘T AND ACTIVATION INFLAMMATION

18. IMMUNOLOGIC MECHANISM IN ALLERGIC INFLAMMATION ALLERGEN EXPOSURE ----MAST CELL ACTIVATION---- VASOACTIVE AMINE ACTIVATION ---- IMMEDIATE REACTIONS ( VASODILATATION, EDEMA, SM CONTRACTION, MUCUS SECRETION) ------------ 3 -8 HRS LATE PHASE RESPONSE (INFILTRATION OF EOSINOPHILS MONONUCLEARS AND NEUTROPHILS) ----------- AFTER 24 -48 HRS ------ T- CELL ACTIVATION --------- CHEMOTACTIC MEDIATORS -------- CELLULAR INFILTRATION ------ INFLAMMATORY MEDIATORS ------------ EDEMA, DESQUAMATION, CELLULAR INFI;LTRATION AND MUCUS SECRETION

19. ALLERGIC RHINITIS SYMPTOMS: “ SNEEZERS AND RUNNERS” -- PAROXYSMAL SNEEZING -- WATERY RHINORRHEA -- ITCHY NOSE ---NASAL BLOCKAGE (VARIABLE) -- DIURNAL RHYTHM (WORST DAYTIME IMPROVES AT NIGHT -- OFTEN ASSOCIATED WITHJ CONJUNCTIVITIS

20. ALLERGIC RHINITIS SYMPTOMS: BLOCKERS -- LITTLE OR NO SNEEZING -- THICK NASAL MUCUS (CATARRH) MORE OFTEN POSTERIOR (POST NASAL DRIP) -- NO ITCH -- NASAL BLOCKAGE OFTEN SEVERE -- CONSTANT BUT MAYBE WORST AT NIGHT

21. RHINITIS DEFINITION NASAL DISCHARGE BLOCKAGE SNEEZE/ ITCH TWO OR MORE SYMPTOMS FOR MORE THAN ONE HOUR ON MOST DAYS

22. ALLERGIC RHINITIS TREATMENT ENVIRONMENTAL CONTROL IMMUNOTHERAPY PHARMACOTHERAPY PARENT/PATIENT EDUCATION

23. ASTHMA CHRONIC, RECURRENT , OCCASIONALLY FATAL CHRONIC INFLAMMATORY DISORDER OF THE AIRWAYS IN WHICH CELLS PLAY A ROLE, INCLUDING M MAST CELLS AND EOSINOPHILS WIDESPREAD BUT VARIABLE AIRFLOW OBSTRUCTION THAT IS OFTEN REVERSIBLE EITHER SPONTANEOUSLY OR WITH TREATMENT ASSSOCIATED WITH AIRWAY RESPONSIVENESS

24. PRECIPITANT OF ASTHMA RESPIRATORY INFECTION (VIRAL) ALLERGENS FOOD HOUSEHOLD INHALANTS OUTDOOR INHALANTS IRRITANTS EXERCISE EMOTIONAL FACTORS

25. PATHOPHYSIOLOGY OFASTHMA ,SEVERE ASTHMA -- MUCUS SECRETION , BRONCHOSPASM ,EDEMA ---INCREASED RESISTANCE TO AIRFLOW---HYPERINFLATION, ATELECTASIS , CNS DEPRESSION-- PULMONARY VASOCONSTRICTION--CARDIAC FAILURE AND COMA

26. ASTHMA CLINICAL MS: WHEEZING , A HIGH- PITCHED OR SQUEAKING EXPIRATORY SOUND ONSET , ACUTE /INSIDIOUS COUGH , TACHYPNEA , DYSPNEA HYPERINFLATION OF THE CHEST, TACHYCARDIS ABDOMINAL PAIN WITH VOMITING LOW GRADE FEVER HUNCHED- OVER SITTING POSITIUON

27. MANAGEMENT OFASTHMA ACHIEVE AND MAINTAIN CONTROL OF SYMPTOMS PREVENT ASTHMA EXACERBATIONS MAINTAIN PULMONARY FUNCTIONS AS CLOSE TO NORMAL LEVELS AVOID ADVERSE EFFECTS FROM ASTHMA MEDICATIONS PREVENT IRREVERSIBLE AIRWAY OBSTRUCTION PREVENT ASTHMA MORBIDITY

28. MANAGEMENT PROGRAMS FOR ASTHMA EDUCATE PATIENTS/PARENTS ASSESS AND MONITOR SEVERITY AVOID OR CONTROL TRIGGERS MEDICATION PLANS FOR CHRONIC ASTHMA PLANS FOR EXACERBATIONS PROVIDE REGULAR FOLLOW-UP

29. STATUS ASTHMATICUS SEVERE ACUTE ASTHMA LIFE-THREATENING EPISODE UNRESPONSIVE TO THE USUAL APPROPRIATE THERAPY WITH ADRENERGIC AGENT AND THEOPHYLINE LEADS TO ACUTE RESPIRATORY INSUFFICIENCY

30. ATOPIC DERMATITIS CHRONIC ,HERITABLE, DISTINCTIVE CUTANEOUS INFLAMMATORY DISEASE CHARACTERIZED BY EARLY AGE OF ONSET AND INTENSE PRURITUS SKIN LESION: DRY, IRRITATED, WEEPING, EXCORIATED LICHENIFIED LESIONS ON THE FLEXURAL AREAS IN LATE CHILDHOOD AND ADOLESCENSE WIIH GENETIC PREDISPOSITION RELAPSING CAN DEVELOP ALLERGIC RHINITIS AND ASTHMA

31. STAGES OF ATOPIC DERMATITIS INFANTILE STAGE 4TH -6TH MONTH OF AGE ERYTHEMATOUS, PRURITIC, WEEPING DERMATITIS IN THE CHEEKS WHICH SPREADS TO THE FOREHEAD AND EXTENSOR SURFACES OF THE ARMS AND LEGS CIRCUMORAL AREA AND EYELIDS ARE USUALLY SPARED

32. STAGES OF ATOPIC DERMATITIS CHILDHOOD STAGE: 2-4 YRS OF AGE PRURITIC, EXCORIATED PAPULESON THE FLEXURAL SURFACES OF EXTREMITIES AND FACE LICHENIFICATION IN THE POPLITEAL AND ANTECUBITAL FOSSAE AND ANKLES MAY DISAPPEAR BEFORE 10 YRS

33. STAGES OF ATOPIC DERMATITIS ADULT STAGE : HIGHLY PRURITIC , CONFLUENT PAPULES ON THE DORSAL ASPECT OF THE HANDS, UPPER EYELIDS AND FLEXURAL AREAS OF THE EXTREMITIES

34. STIGMAS OF ATOPICDERMATITIS LICHENIFICATION DENNIE ‘S LINE ATOPIC PALMS BUFFED NAILS WHITE DERMOGRAPHISM DELAYED BLANCHED PHENOMENON DRYNESS XEROSIS ATOPIC PERSONALITY HOUSEWIFE’S ECZEMA ATOPIC FOOT ALLERGIC SHINERS

35. CRITERIA FOR THE DIAGNOSISOF ATOPIC DERMATITIS MUST HAVE 3 OR MORE BASIC FEATURES : 1.PRURITUS 2.TYPICAL MORPHOLOGY /DISTRIBUTION 3.TENDENCY TO RECURRENCES 4.PERSONAL OR FAMILY HISTORY

36. CRITERIA FOR THE DIAGNOSIS OF ATOPIC DERMATITIS PLUS ANY THREE OR MORE OF THE FF FEATURES: ICHTHYOSIS, ELEVATED SERUM IgE , EARLY AGE ONSET CUTANEOUS INFECTION, IMPAIRED T- CELL IMMUNITY HAND/FOOT DERMATITIS , NIPPLE ECZEMA, , CHEILITIS, RECURRENT CONJUNCTIVITIS, DENNIE MORGAN INFRAORBITAL FOLD CATARACT, ORBITAL DARKENING, PITYRIASIS ALBA FOOD HYPERSENSITIVITY

37. ATOPIC DERMATITIS TREATMENT AVOID ENVIRONMENTAL FACTORS GOOD HYDRATION OF THE AFFECTED AREAS MOISTURIZERS CORTICOSTEROIDS IN THE SUBACUTE PHASE

38. URTICARIA ( HIVES) RAISED ERYTHEMATOUS SKIN LESIONS ASSOCIATED WITH MARKED PRURITUS DUE TO VASODILATATION OF SMALL VENULES AND CAPILLARIES AND EXUDATION OF FLUID INTO THE SUPERFICIAL DERMIS ANGIOEDEMA IS URTICARIA INVOLVING THE DEEPER SUBCUTANEOUS TISSUES

39. CLASSIFICATION OF URTICARIA IMMUNOLOGIC ANAPHYLACTIC / CYTOTOXIC/ IMMUNE COMPLEX ANAPHYLACTOID HEREDITARY ANGIOEDEMA/ CHEMICAL/ ASPIRIN SENSITIVITY PHYSICAL DERMATODRAPHIA/ COLD/ CHOLINERGIC/ SOLAR/PRESSURE MISC INFECTION/ PIGMENTOSA/ PSYCHOGENIC/IDIOPATHIC

40. URTICARIA TREATMENT SYMPATHOMIMETIC AGENTS : EPINEPHRINE ANTIHISTAMINICS CORTICOSTEROIDS

41. ALLERGIC CONTACT DERMATITIS COMMON DISORDER IN CHILDHOOD ERYTHEMA, PAPULES, VESICLES, SWELLING WEEPING ANG ITCHING 24 -48 HRS AFTER EXPOSURE TYPE IV

42. CAUSES OF CONTACTDERMATITIS IRRITANTS ANIMALS PLANTS CLOTHING NICKEL DRUGS CHROMATE MERCURY COSMETICS

43. ADVERSE FOOD REACTION IMMUNOLOGIC REACTION RESULTING FROM INGESTION OF FOOD PRODUCTS AND ADDITIVES I

44. FOOD ALLERGY(HYPERSENSITIVITY) IMMUNOLOGIC REACTION RESULTING FROM INGESTION OF FOOD ADDITIVE , IgE MEDIATED

45. FOOD ANAPHYLAXIS CLASSIC ALLERGIC HYPERSENSITIVITY REACTION TO FOOD OR FOOD ADDITIVES INVOLVING IgE AND THE RELEASE OF CHEMICAL MEDIATORS

46. FOOD INTOLERANCE ABNORMAL NON-IMMUNOLOGIC PHYSIOLOGIC RESPONSE TO FOOD OR FOOD ADDITIVES

47. FOOD IDIOSYNCRASY HYPERSENSITIVITY WITHOUT IMMUNE RESPONSE

48. FOOD TOXICITY ADVERSE REACTION CAUSED BY DIRECT ACTION OF FOOD ADDITIVE/ FOOD ON THE HOST RECIPIENT WITHOUT IMMUNE MECHANISM FOUND NATURALLY IN FOOD OR SECONDARY TO CONTAMINATION BY MICROORGANISM OR PARASITES

49. RISK OF MANIFESTINGATOPY BASED ON FAMILYHISTORY OF ATOPY FAMILY HISTORY OF ATOPY RISK OF ATOPY BIPARENTAL( SAME ALLERGY) 50-80 % BIPARENTAL OR UNIPARENTAL 40-60% PLUS ONE SIBLING UNIPARENTAL OR SIBLING 20-49% NEGATIVE 5-15 %

50. MANIFESTATIONS OFFOOD ALLERGY GASTROINTESTINAL:: VOMITING, ENTEROCOLITIS,MALABSORPTION, BLEEDING RESPIRATORY : RHINITIS, ASTHMA, OTITIS MEDIA DERMATOLOGY : URTICARIA, ATOPIC DERMATITIS, ALOPECIA NEUROLOGIC : SEIZURE, LETHARGY HEMATOLOGY : ANEMIA ANAPHYLACTIC SHOCK

51. ADVERSE DRUG REACTION “ AN EFFECT WHICH IS UNINTENDED AND OCCURS AT DOSES NORMALLY USED IN MAN FOR PROPHYLAXIS DIAGNOSIS AND THERAPY “ OCCURS WITHIN A REASONABLE TIME FOLLOWING ADMINISTRATION OF THE DRUG REACTIONS : INTOLERANCE, IDIOSYNCRASY, HYPERSENSITIVITY ,PSYCHOGENIC

52. CLASSIC ANTIHISTAMINICS ETHANOLAMINES EXAMPLES : DIPHENHYDRAMINE , CARBINOXAMINE CLEMASTINE, DIMENHYDRINATE GENERAL COMMENTS: SEDATIVE EFFECT HIGH, MODERATE ANTICHOLINERGIC EFFECTS, RELATIVE LOW GIT EFFECTS

53. CLASSIC ANTIHISTAMINICS ALKYLAMINES : CHLORPHENIRAMINE , TRIPROLIDINE, BROMPHENIRAMINE, PHENIRAMINE GENERAL COMMENTS : LOW SEDATIVE , ANTICHOLINERGIC AND GI EFFECTS , BEST GROUP FOR DAYTIME USE

54. CLASSIC ANTIHISTAMINICS ETHYLENEDIAMINES: ANTAZOLINE TRIPELENNAMINE GENERAL COMMENTS :LOW SEDATIVE , ANTICHOLINERGIC EFFECTS , GI EFFECTS COMMON

55. CLASSIC ANTIHISTAMINICS PIPERAZINES : HYDROXYZINE , MECLIZINE , CHLORCYCLIZINE GENERAL COMMENTS : DROWSINESS IS FREQUENT ,DRY MOUTH A USUAL CHOLINERGIC EFFECT

56. CLASSIC ANTIHISTAMINICS PHENOTHAZINE : METHDILAZINE , PROMETHAZINE TRIMEPRAZINE GENERAL COMMENTS : MARKED SEDATIVE EFFECT ( USEFUL TREATMENT OF PRURITUS )

57. CLASSIC ANTIHISTAMINICS PIPERIDINES : CYPROHEPTADINE , BENZOCYCLOHEPTATHIPINE AZATADINE GENERAL COMMENTS : DROWSINESS IS COMMON USEFUL IN THE TREATMENT OF URTICARIA