Allergy: An Atlas of Investigation and Management (2006)

189 Pages·2005·2.18 MB·English

by  S.H. Arshad

An Atlas of Investigation and Management
ALLERGY

ALLERGY
S Hasan Arshad
North Staffordshire University Hospital
Stoke-on-Trent, Staffordshire, UK
Stephen T Holgate
Southampton General Hospital
Southampton, UK
N Franklin Adkinson, Jr
John Hopkins Asthma and Allergy Centre
Baltimore, MD, USA
K Suresh Babu
Southampton General Hospital
Southampton, UK
CLINICAL PUBLISHING
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© Atlas Medical Publishing Ltd 2005
First published 2005
This edition published in the Taylor & Francis e-Library, 2006.
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A catalogue record for this book is available from the British Library
ISBN 0-203-49280-3 Master e-book ISBN
ISBN 0-203-62586-2 (Adobe e-Reader Format)
ISBN 1 904392 24 5 (Print Edition)
The publisher makes no representation, express or implied, that the dosages in this book are
correct. Readers must therefore always check the product information and clinical
procedures with the most up-to-date published product information and data sheets
provided by the manufacturers and the most recent codes of conduct and safety regulations.
The authors and the publisher do not accept any liability for any errors in the text or for the
misuse or misapplication of material in this work.
Contents

Preface vi
Acknowledgements vii
Abbreviations viiI

1 Introduction 1
2 Assessment 30
3 Asthma 50
4 Allergic rhinitis 79
5 Atopic dermatitis 95
6 Contact dermatitis 107
7 Urticaria and angioedema 115
8 Food allergy 125
9 Insect allergy 138
10 Drug allergy 152
11 Anaphylaxis 162

Index 170
Preface
The last 30 years have witnessed an unprecedented increase in the prevalence of all
allergic disease that includes asthma, allergic rhinoconjunctivitis, drug and food allergy,
anaphylaxis, occupational allergy, and allergic skin disease manifesting as atopic eczema
and urticaria. While there is much debate about why this ‘epidemic’ has occurred, the
highest prevalence and greatest change in demography appears to be linked to aspects of
the Western lifestyle that not only includes altered exposure to micro-organisms, which is
frequently cited as the cause for the changing trends, but also changes in housing, drug
use, and diet, as well as indoor and outdoor air pollutants. It is most likely that more than
one factor is involved in driving the trends.
Irrespective of the underlying cause(s), allergic disease has now assumed public health
proportions affecting all age groups and often manifesting as multiple organ disease.
Indeed, complex allergy often presents a diagnostic and therapeutic challenge. Since
allergy has such protean manifestations it often falls not only within the domain of organ-
based specialists, but also general practitioners, immunologists, and those specializing in
allergy. All such professionals will find this Atlas an aid to the diagnosis and
management of allergy.
With the aid of clear diagrams and ample clinical and pathological illustrations, this
Atlas describes the mechanisms, epidemiology, diagnosis, and treatment of all of the
common allergies. Great care has been taken to draw out the most salient features of each
of the disorders and to present them in a way that will enhance learning and recall
memory.
While there are many books on allergy, both small and large, this Atlas fills a unique
niche in providing an accessible source of up-to-date information. This book is of special
value to medical students and those in post-graduate training, as well as to practitioners
who wish for an easy-to-use, illustrated reference source.
We are extremely grateful to our patients who co-operated in this effort and it is their
interest that has made this unique book possible. We hope you find its content valuable.
We are always pleased to receive comments, especially if you have any useful
suggestions for future revisions.
SH Arshad
ST Holgate
NF Adkinson, Jr
KS Babu
Acknowledgements
The authors would like to express their gratitude to patients attending the David Hide
Asthma and Allergy Centre for agreeing to have their photographs published in this
Atlas. The authors are also indebted to Mrs Sharon Matthews and the nursing staff of the
Centre for their invaluable help in the collection of many of the photographs.
Abbreviations
ACD allergic contact dematitis
AD atopic dermatitis
ADR adverse drug reaction
AHR airway hyper-responsiveness
AIDS aquired immunodeficiency syndrome
ALL acute lymphoblastic leukaemia
APC antigen-presenting cell
ARDS adult respiratory distress syndrome
ARIA Allergic Rhinitis and its Impact on Asthma (Study)
BALF bronchoalveolar lavage fluid
BHR bronchial hyper-responsiveness
BPT bronchial provocation test
CD contact dermatitis
CLA cutaneous lymphocyte-associated antigen
CLL chronic lymphocytic leukaemia
CS corticosteroids
DBPCFC double blind, placebo controlled food challenge
DH dermatitis herpetiformis
DNA deoxyribonucleic acid
DPI dry powder inhaler
ECP eosinophil cationic protein
ECRHS European Community Respiratory Health Survey
EDN eosinophil-derived neurotoxin
ELISA enzyme linked immunosorbent assay
EPO eosinophil peroxidase
FEV forced expiratory volume in 1 second
1
FGF fibroblast growth factor
FVC forced vital capacity
GALT gut associated lymphoid tissue
GI gastrointestinal
GM-CSF granulocytic monocyte colony stimulating factor
HDM house dust mite
HIV human immunodeficiency virus
HLA human leucocyte antigen
H/O history of
HPA hypothalamopituitary axis
ICAM intercellular adhesion molecule
ID intradermal (test)
Ig immunoglobulin
IL interleukin
i.m. intramuscular
IMN infectious mononucleosis
INF interferon
ISAAC International Study of Asthma and Allergies in Childhood
i.v. intravenous
LABA long-acting beta agonist
LT leukotriene
MBP major basic protein
MCP monocyte chemotactic protein
MCT mast cell tryptase
MCTC mast cell tryptase, chymase
MDI metered-dose inhaler
MHC major histocompatibility complex
MIP 1α macrophage inflammatory protein 1 alpha
NARES non-allergic rhinitis with eosinophilic syndrome
NK natural killer (-cell)
NO nitric oxide
(i)NOS (inducible) nitric oxide synthase
NSAID non-steroidal anti-inflammatory drug
OCP oral contraceptive pill
PAF platelet activating factor
PAR perennial allergic rhinitis
PC provocation concentration (20% decrease in FEV1)
20
PD provocation dose (20% decrease in FEV1)
20
PDE phosphodiesterase
PEF peak expiratory flow
PEFR peak expiratory flow rate
PG prostaglandin