Samenvatting allergology
Inhoudsopgave
Inleiding: deel 1 ............................................................................................................................ 4
Mechanismen van pathologische immuunreacties ............................................................................ 4
Atopie ............................................................................................................................................. 7
Inleiding deel 2 ............................................................................................................................ 11
IgE-gemedieerd (Gell-Coombs type I) .............................................................................................. 11
Cytotropische AL (IgG) (type II) ........................................................................................................ 15
Immuuncomplexen (type III) ........................................................................................................... 15
Diagnostiek: deel 1 ...................................................................................................................... 16
Voorgeschiedenis, kliniek, paired tryptase....................................................................................... 16
Groene blokje (sIgE, BAT, HRT, pMAT, T-cel) .................................................................................... 17
Diagnostiek: deel 2 ...................................................................................................................... 20
CRD (component resolved allergie) ................................................................................................. 20
Huidtesten (SPT, IDT) ..................................................................................................................... 20
Provocatie (blauw blokje) ............................................................................................................... 21
Nonsense testen............................................................................................................................ 21
Take home message ...................................................................................................................... 21
Inhalatieallergie .......................................................................................................................... 22
Introductie ..................................................................................................................................... 22
Mites ............................................................................................................................................. 26
Dieren ........................................................................................................................................... 28
Fungi ............................................................................................................................................. 29
Pollen............................................................................................................................................ 30
Primaire voedselallergie (kinderen) .............................................................................................. 34
Inleiding ........................................................................................................................................ 34
Tekens en symptomen ................................................................................................................... 34
Diagnose ....................................................................................................................................... 35
Behandeling .................................................................................................................................. 35
Primaire voedselallergie (bij kinderen) ............................................................................................. 35
1
, Koemelk allergie ............................................................................................................................ 36
Eiwitallergie ................................................................................................................................... 37
Aardappelallergie........................................................................................................................... 37
Tarwe allergie ................................................................................................................................ 38
Pinda-allergie ................................................................................................................................ 38
Notenallergie ................................................................................................................................. 38
Guidelines bij voedselallergie preventie .......................................................................................... 39
Voedselallergie preventie: in onderzoek .......................................................................................... 40
IgE-gemedieerde voedselallergie deel 1 ....................................................................................... 42
Classificatie van adverse food reactions ......................................................................................... 42
Symptomen van IgE-gemedieerde voedselallergie ........................................................................... 42
Fatale voedselallergie .................................................................................................................... 42
Prevalentie van IgE-gemedieerde voedselallergie ............................................................................ 42
Natuurlijk verloop .......................................................................................................................... 43
Caveats ......................................................................................................................................... 44
Diagnose van voedselallergie ......................................................................................................... 44
Sensitisatie .................................................................................................................................... 46
Voedselallergie: behandeling.......................................................................................................... 47
Take home messages ..................................................................................................................... 47
IgE-gemedieerde voedselallergie: allergenen ............................................................................... 49
Fruit en groenten ............................................................................................................................ 49
Tarwe en andere granen ................................................................................................................. 50
Pinda............................................................................................................................................. 51
Soja............................................................................................................................................... 51
Boom noten en zaden .................................................................................................................... 51
Vlees ............................................................................................................................................. 52
Vis................................................................................................................................................. 52
Schaaldieren ................................................................................................................................. 53
Drug hypersensitiviteit................................................................................................................. 54
Nomenclatuur ............................................................................................................................... 54
Grote databases ............................................................................................................................ 56
Diagnose ....................................................................................................................................... 56
Medicatie stoppen? ....................................................................................................................... 58
2
, Βetalactams .................................................................................................................................. 59
NSAIDs .......................................................................................................................................... 61
Urticaria ...................................................................................................................................... 62
Urticaria-angio-oedeem: definitie ................................................................................................... 62
Acuut vs chronisch......................................................................................................................... 63
Spontaan (CSU) vs inducible (CIndU) .............................................................................................. 63
Urticaria bij multisystemische aandoeningen .................................................................................. 64
Urticaria en/of angio-oedeem, histamine, bradykinine, IL-1 .............................................................. 65
CSU: diagnostiek ........................................................................................................................... 66
CSU: natuurlijk verloop en prognostische factoren .......................................................................... 67
CSU behandeling ........................................................................................................................... 68
Conclusies .................................................................................................................................... 69
Mastocytose en MCA (mastcel activatiesyndroom) ....................................................................... 70
Huidlaesies ................................................................................................................................... 70
Cutane mastocytose ...................................................................................................................... 71
Systemische mastocytose.............................................................................................................. 71
MCAS (mast cell activation syndroom) ............................................................................................ 74
Hymenoptera gifallergie .............................................................................................................. 76
Epidemiologisch overzicht .............................................................................................................. 76
Taxonomie ..................................................................................................................................... 76
Klinische evaluatie bij HVA ............................................................................................................. 78
Epidemiologie van hymenoptera steek reacties ............................................................................... 79
Natuurlijk verloop .......................................................................................................................... 79
Indolent systemische mastocytose ................................................................................................. 80
Toxische reacties ........................................................................................................................... 80
Voorgeschiedenis .......................................................................................................................... 80
Diagnostiek ................................................................................................................................... 80
Behandeling .................................................................................................................................. 81
Take home messages ..................................................................................................................... 82
3
, Inleiding: deel 1
Mechanismen van pathologische immuunreacties
Immuunsysteem: functie
- Verdediging
o Tegen pathogenen, harmful agentia, tumoren, noxen
- Discriminatie
o Eigen – niet-eigen (tolerantie)
o Bij niet-eigen: gevaarlijk (gevaarsignalen) – niet-gevaarlijk
- Innate immuunrespons – adaptieve immuunrespons (lymfocyten)
o Humoraal – cellulaire component
- Goed gecontroleerd (om excessieve activatie te voorkomen)
Immuun pathologische reacties
- Allergie
o Abnormale immuunrespons
o Niet-eigen antigen (allergeen)
o Bv. pollen, dander, huisstofmijt (HDM), voedsel, gif, medicatie
- Ortho-ergisch (= normaal, maar ongewild)
o Normale immuunrespons
o Niet-eigen antigen
o Bv. transplant rejection
- Auto-immuun
o Abnormale immuunrespons
o Eigen antigen (auto-antigen)
o Bv. RA, SLE, DM, Graves
Hypersensitiviteit ≠ allergie
- Allergie involves activatie van adaptieve immuunsysteem (met activatie van specifieke
T- en B-cellen)
o ó hypersensitiviteit: meestal enkel innate immuunsysteem
- Andere mechanismen:
o Effectorcel activatie via andere receptoren
o Interferentie met enzymen: COX, ACEi
“Allergische” reacties: Gell & Coombs classificatie
B-cel (humoraal, antilichamen) T-cel (cellulair, geen antilichamen)
Direct (<1u) – semi-laat (1-6u) Laat (>6u – maanden)
Type I: IgE-gemedieerd
Type II: cytofiele antilichamen (IgG, IgM)
Type III: circulerende immuuncomplexen
4
Inhoudsopgave
Inleiding: deel 1 ............................................................................................................................ 4
Mechanismen van pathologische immuunreacties ............................................................................ 4
Atopie ............................................................................................................................................. 7
Inleiding deel 2 ............................................................................................................................ 11
IgE-gemedieerd (Gell-Coombs type I) .............................................................................................. 11
Cytotropische AL (IgG) (type II) ........................................................................................................ 15
Immuuncomplexen (type III) ........................................................................................................... 15
Diagnostiek: deel 1 ...................................................................................................................... 16
Voorgeschiedenis, kliniek, paired tryptase....................................................................................... 16
Groene blokje (sIgE, BAT, HRT, pMAT, T-cel) .................................................................................... 17
Diagnostiek: deel 2 ...................................................................................................................... 20
CRD (component resolved allergie) ................................................................................................. 20
Huidtesten (SPT, IDT) ..................................................................................................................... 20
Provocatie (blauw blokje) ............................................................................................................... 21
Nonsense testen............................................................................................................................ 21
Take home message ...................................................................................................................... 21
Inhalatieallergie .......................................................................................................................... 22
Introductie ..................................................................................................................................... 22
Mites ............................................................................................................................................. 26
Dieren ........................................................................................................................................... 28
Fungi ............................................................................................................................................. 29
Pollen............................................................................................................................................ 30
Primaire voedselallergie (kinderen) .............................................................................................. 34
Inleiding ........................................................................................................................................ 34
Tekens en symptomen ................................................................................................................... 34
Diagnose ....................................................................................................................................... 35
Behandeling .................................................................................................................................. 35
Primaire voedselallergie (bij kinderen) ............................................................................................. 35
1
, Koemelk allergie ............................................................................................................................ 36
Eiwitallergie ................................................................................................................................... 37
Aardappelallergie........................................................................................................................... 37
Tarwe allergie ................................................................................................................................ 38
Pinda-allergie ................................................................................................................................ 38
Notenallergie ................................................................................................................................. 38
Guidelines bij voedselallergie preventie .......................................................................................... 39
Voedselallergie preventie: in onderzoek .......................................................................................... 40
IgE-gemedieerde voedselallergie deel 1 ....................................................................................... 42
Classificatie van adverse food reactions ......................................................................................... 42
Symptomen van IgE-gemedieerde voedselallergie ........................................................................... 42
Fatale voedselallergie .................................................................................................................... 42
Prevalentie van IgE-gemedieerde voedselallergie ............................................................................ 42
Natuurlijk verloop .......................................................................................................................... 43
Caveats ......................................................................................................................................... 44
Diagnose van voedselallergie ......................................................................................................... 44
Sensitisatie .................................................................................................................................... 46
Voedselallergie: behandeling.......................................................................................................... 47
Take home messages ..................................................................................................................... 47
IgE-gemedieerde voedselallergie: allergenen ............................................................................... 49
Fruit en groenten ............................................................................................................................ 49
Tarwe en andere granen ................................................................................................................. 50
Pinda............................................................................................................................................. 51
Soja............................................................................................................................................... 51
Boom noten en zaden .................................................................................................................... 51
Vlees ............................................................................................................................................. 52
Vis................................................................................................................................................. 52
Schaaldieren ................................................................................................................................. 53
Drug hypersensitiviteit................................................................................................................. 54
Nomenclatuur ............................................................................................................................... 54
Grote databases ............................................................................................................................ 56
Diagnose ....................................................................................................................................... 56
Medicatie stoppen? ....................................................................................................................... 58
2
, Βetalactams .................................................................................................................................. 59
NSAIDs .......................................................................................................................................... 61
Urticaria ...................................................................................................................................... 62
Urticaria-angio-oedeem: definitie ................................................................................................... 62
Acuut vs chronisch......................................................................................................................... 63
Spontaan (CSU) vs inducible (CIndU) .............................................................................................. 63
Urticaria bij multisystemische aandoeningen .................................................................................. 64
Urticaria en/of angio-oedeem, histamine, bradykinine, IL-1 .............................................................. 65
CSU: diagnostiek ........................................................................................................................... 66
CSU: natuurlijk verloop en prognostische factoren .......................................................................... 67
CSU behandeling ........................................................................................................................... 68
Conclusies .................................................................................................................................... 69
Mastocytose en MCA (mastcel activatiesyndroom) ....................................................................... 70
Huidlaesies ................................................................................................................................... 70
Cutane mastocytose ...................................................................................................................... 71
Systemische mastocytose.............................................................................................................. 71
MCAS (mast cell activation syndroom) ............................................................................................ 74
Hymenoptera gifallergie .............................................................................................................. 76
Epidemiologisch overzicht .............................................................................................................. 76
Taxonomie ..................................................................................................................................... 76
Klinische evaluatie bij HVA ............................................................................................................. 78
Epidemiologie van hymenoptera steek reacties ............................................................................... 79
Natuurlijk verloop .......................................................................................................................... 79
Indolent systemische mastocytose ................................................................................................. 80
Toxische reacties ........................................................................................................................... 80
Voorgeschiedenis .......................................................................................................................... 80
Diagnostiek ................................................................................................................................... 80
Behandeling .................................................................................................................................. 81
Take home messages ..................................................................................................................... 82
3
, Inleiding: deel 1
Mechanismen van pathologische immuunreacties
Immuunsysteem: functie
- Verdediging
o Tegen pathogenen, harmful agentia, tumoren, noxen
- Discriminatie
o Eigen – niet-eigen (tolerantie)
o Bij niet-eigen: gevaarlijk (gevaarsignalen) – niet-gevaarlijk
- Innate immuunrespons – adaptieve immuunrespons (lymfocyten)
o Humoraal – cellulaire component
- Goed gecontroleerd (om excessieve activatie te voorkomen)
Immuun pathologische reacties
- Allergie
o Abnormale immuunrespons
o Niet-eigen antigen (allergeen)
o Bv. pollen, dander, huisstofmijt (HDM), voedsel, gif, medicatie
- Ortho-ergisch (= normaal, maar ongewild)
o Normale immuunrespons
o Niet-eigen antigen
o Bv. transplant rejection
- Auto-immuun
o Abnormale immuunrespons
o Eigen antigen (auto-antigen)
o Bv. RA, SLE, DM, Graves
Hypersensitiviteit ≠ allergie
- Allergie involves activatie van adaptieve immuunsysteem (met activatie van specifieke
T- en B-cellen)
o ó hypersensitiviteit: meestal enkel innate immuunsysteem
- Andere mechanismen:
o Effectorcel activatie via andere receptoren
o Interferentie met enzymen: COX, ACEi
“Allergische” reacties: Gell & Coombs classificatie
B-cel (humoraal, antilichamen) T-cel (cellulair, geen antilichamen)
Direct (<1u) – semi-laat (1-6u) Laat (>6u – maanden)
Type I: IgE-gemedieerd
Type II: cytofiele antilichamen (IgG, IgM)
Type III: circulerende immuuncomplexen
4
