ALLERGOLOGY 2024-2025
ALLERGOLOGY 2024-2025...................................................................................................................... 1
Introductie.......................................................................................................................................................5
Het immuunsysteem...................................................................................................................................5
Innate immune system......................................................................................................................... 5
Adaptive immune system..................................................................................................................... 6
Het normale immuunantwoord............................................................................................................. 7
Immune pathologic reactions..................................................................................................................... 8
“Allergische” reacties............................................................................................................................9
Atopie....................................................................................................................................................... 12
Kliniek van allergic diseases & related conditions....................................................................................14
Urticaria.............................................................................................................................................. 14
Angio-oedeem (AE)............................................................................................................................15
GI-symptomen....................................................................................................................................16
Anafylaxie...........................................................................................................................................16
Progressie van symptomen................................................................................................................17
Gell & Coombs type I (IgE-gemedieerd).................................................................................................. 17
Gell & Coombs type II (cytotropic Ab (IgG))............................................................................................. 23
Gell & Coombs type III (immune complexes)........................................................................................... 24
Gell & Coombs type IV (cellulair)............................................................................................................. 25
Diagnostiek...................................................................................................................................................27
Testing voor type I reacties (allergische aandoeningen).......................................................................... 27
History & clinics........................................................................................................................................ 27
History................................................................................................................................................ 27
Clinics.................................................................................................................................................28
Paired tryptase................................................................................................................................... 28
Specifiek IgE = sIgE................................................................................................................................. 29
sIgE proteins...................................................................................................................................... 29
tIgE..................................................................................................................................................... 30
Kruisreactiviteit................................................................................................................................... 32
Omgaan met FP-resultaten................................................................................................................ 33
Component resolved allergy diagnosis (CRD)........................................................................................ 34
Skin tests..................................................................................................................................................36
Provocatietest...........................................................................................................................................37
In vitro / ex vivo: confirmatory diagnostics................................................................................................38
Nonsense testen = rommel (niet kennen)................................................................................................ 38
Testing voor type IV reacties.................................................................................................................... 39
Take-home message................................................................................................................................ 39
Overzicht.......................................................................................................................................................40
Inhalatieallergie............................................................................................................................................ 41
Wat is een inhalatie-allergie?................................................................................................................... 41
Etiologie..............................................................................................................................................41
Pathomechanisme..............................................................................................................................41
Symptomen........................................................................................................................................ 42
Diagnose............................................................................................................................................ 43
Behandeling....................................................................................................................................... 43
1
, Mijten........................................................................................................................................................46
Dieren.......................................................................................................................................................48
Kakkerlakken............................................................................................................................................49
Schimmels................................................................................................................................................49
Pollen....................................................................................................................................................... 50
Types overdracht / bestuiving.............................................................................................................51
Invloed van pollutie.............................................................................................................................51
Soorten pollen.................................................................................................................................... 51
Oefenvragen.............................................................................................................................................53
Inleiding primaire voedselallergieën - IgE-gemedieerd............................................................................56
Classificatie.............................................................................................................................................. 56
IgE-gemedieerde allergie......................................................................................................................... 56
Symptomen........................................................................................................................................ 56
Fatale voedselallergie........................................................................................................................ 57
Epidemiologie.....................................................................................................................................58
Primaire vs. secundaire voedselallergie.............................................................................................58
Voedselallergie - diagnostiek................................................................................................................... 60
1. Anamnese...................................................................................................................................... 60
2. Screening voor sensitisatie............................................................................................................ 61
3. Orale provocatietest....................................................................................................................... 62
Voedselallergie - behandeling.................................................................................................................. 63
Voedsel orale immunotherapie (OIT)................................................................................................. 63
Monoklonale antilichamen..................................................................................................................63
Voedselallergie - primaire preventie......................................................................................................... 63
Primaire voedselallergieën - IgE-gemedieerd........................................................................................... 64
Fruit & groenten........................................................................................................................................64
Non-specific Lipid Transfer Proteins (nsLTP)..................................................................................... 64
Pollen-food allergy syndrome.............................................................................................................64
Cannabis sativa allergy...................................................................................................................... 66
Fruit-latex syndrome...........................................................................................................................66
Tarwe & andere granen............................................................................................................................ 67
Peanuts.................................................................................................................................................... 67
Soja.......................................................................................................................................................... 68
Tree nuts & seeds.................................................................................................................................... 68
Vlees........................................................................................................................................................ 68
Vis............................................................................................................................................................ 69
Schaaldieren............................................................................................................................................ 70
Primaire voedselallergieën - kinderen....................................................................................................... 72
Introductie.................................................................................................................................................72
Primaire voedingsallergie......................................................................................................................... 73
Signs & symptoms..............................................................................................................................73
Diagnose............................................................................................................................................ 73
Behandeling....................................................................................................................................... 74
Koemelk allergie (CMA)........................................................................................................................... 74
Non-IgE gemedieerde voedingsallergieën......................................................................................... 75
Ei allergie..................................................................................................................................................76
Potato allergie.......................................................................................................................................... 76
Tarwe allergie........................................................................................................................................... 76
Peanut allergie......................................................................................................................................... 77
2
, Noten allergie........................................................................................................................................... 77
Preventie.................................................................................................................................................. 78
Learning Early About Peanut (LEAP-trial)..........................................................................................78
International guidelines...................................................................................................................... 78
Verdere research................................................................................................................................79
Drug hypersensitivity.................................................................................................................................. 81
Nomen est omen & post hoc is not propter hoc....................................................................................... 81
Adverse drug reactions............................................................................................................................ 81
Klinische classificatie..........................................................................................................................82
Mechanistische classificatie............................................................................................................... 83
Grote database: potentials & pitfalls........................................................................................................ 84
Diagnose.................................................................................................................................................. 84
Is stopping the drug always the best option?........................................................................................... 86
Betalactams..............................................................................................................................................88
Kruisreactiviteit................................................................................................................................... 88
Penicilline allergie...............................................................................................................................89
NSAIDs.....................................................................................................................................................89
Urticaria & angio-oedeem............................................................................................................................92
Definitie.................................................................................................................................................... 92
Classificatie van urticaria..........................................................................................................................93
Urticaria bij multisysteem aandoeningen................................................................................................. 94
Familiale hypertryptasemie................................................................................................................ 94
PLAID................................................................................................................................................. 94
Autoinflammatory syndromes.............................................................................................................94
Diagnose.................................................................................................................................................. 95
Urticaria vasculitis.............................................................................................................................. 96
Bradykinine.........................................................................................................................................97
IL-1..................................................................................................................................................... 99
Overzicht............................................................................................................................................ 99
CSU: verder onderzoek nodig?.............................................................................................................. 100
Provocatietesten...............................................................................................................................100
AI-BAT.............................................................................................................................................. 101
CSU: prognose.......................................................................................................................................101
Disease monitoring...........................................................................................................................102
Disease control.................................................................................................................................103
CSU: behandeling.................................................................................................................................. 104
Conclusie................................................................................................................................................105
Mastocytose............................................................................................................................................... 106
Presentatie............................................................................................................................................. 106
Cutane mastocytose.........................................................................................................................106
Systemische mastocytose................................................................................................................107
Diagnostiek.............................................................................................................................................107
Diagnostiek bij kinderen................................................................................................................... 108
Diagnostiek bij volwassenen............................................................................................................ 108
Clinical suspicion of SM....................................................................................................................110
Associatie met anafylaxie....................................................................................................................... 110
Overzicht.................................................................................................................................................111
Mast cell activation syndrome (MCAS).................................................................................................... 112
Inleiding.................................................................................................................................................. 112
3
, Tryptase assay....................................................................................................................................... 113
Paired tryptase................................................................................................................................. 113
Baseline tryptase.............................................................................................................................. 113
Overzicht................................................................................................................................................ 115
Hymenoptera.............................................................................................................................................. 116
Hymenoptera venom allergy (HVA)........................................................................................................ 116
Taxonomie.............................................................................................................................................. 116
Apidae (= bijen)................................................................................................................................ 117
Vespidae (= wespen)........................................................................................................................ 117
Formicidae (= mieren)...................................................................................................................... 118
Presentatie van HVA.............................................................................................................................. 118
Lokale reactie (LR)........................................................................................................................... 119
Grote lokale reactie (LLR)................................................................................................................ 119
Systemische reactie (SR)................................................................................................................. 119
Indolent systemic mastocytosis (ISM).............................................................................................. 120
Epidemiologie van hymenoptera steekreacties................................................................................120
Diagnostiek van HVA..............................................................................................................................121
Behandeling van HVA............................................................................................................................ 122
Take-home message.............................................................................................................................. 123
Casussen............................................................................................................................................... 123
4
ALLERGOLOGY 2024-2025...................................................................................................................... 1
Introductie.......................................................................................................................................................5
Het immuunsysteem...................................................................................................................................5
Innate immune system......................................................................................................................... 5
Adaptive immune system..................................................................................................................... 6
Het normale immuunantwoord............................................................................................................. 7
Immune pathologic reactions..................................................................................................................... 8
“Allergische” reacties............................................................................................................................9
Atopie....................................................................................................................................................... 12
Kliniek van allergic diseases & related conditions....................................................................................14
Urticaria.............................................................................................................................................. 14
Angio-oedeem (AE)............................................................................................................................15
GI-symptomen....................................................................................................................................16
Anafylaxie...........................................................................................................................................16
Progressie van symptomen................................................................................................................17
Gell & Coombs type I (IgE-gemedieerd).................................................................................................. 17
Gell & Coombs type II (cytotropic Ab (IgG))............................................................................................. 23
Gell & Coombs type III (immune complexes)........................................................................................... 24
Gell & Coombs type IV (cellulair)............................................................................................................. 25
Diagnostiek...................................................................................................................................................27
Testing voor type I reacties (allergische aandoeningen).......................................................................... 27
History & clinics........................................................................................................................................ 27
History................................................................................................................................................ 27
Clinics.................................................................................................................................................28
Paired tryptase................................................................................................................................... 28
Specifiek IgE = sIgE................................................................................................................................. 29
sIgE proteins...................................................................................................................................... 29
tIgE..................................................................................................................................................... 30
Kruisreactiviteit................................................................................................................................... 32
Omgaan met FP-resultaten................................................................................................................ 33
Component resolved allergy diagnosis (CRD)........................................................................................ 34
Skin tests..................................................................................................................................................36
Provocatietest...........................................................................................................................................37
In vitro / ex vivo: confirmatory diagnostics................................................................................................38
Nonsense testen = rommel (niet kennen)................................................................................................ 38
Testing voor type IV reacties.................................................................................................................... 39
Take-home message................................................................................................................................ 39
Overzicht.......................................................................................................................................................40
Inhalatieallergie............................................................................................................................................ 41
Wat is een inhalatie-allergie?................................................................................................................... 41
Etiologie..............................................................................................................................................41
Pathomechanisme..............................................................................................................................41
Symptomen........................................................................................................................................ 42
Diagnose............................................................................................................................................ 43
Behandeling....................................................................................................................................... 43
1
, Mijten........................................................................................................................................................46
Dieren.......................................................................................................................................................48
Kakkerlakken............................................................................................................................................49
Schimmels................................................................................................................................................49
Pollen....................................................................................................................................................... 50
Types overdracht / bestuiving.............................................................................................................51
Invloed van pollutie.............................................................................................................................51
Soorten pollen.................................................................................................................................... 51
Oefenvragen.............................................................................................................................................53
Inleiding primaire voedselallergieën - IgE-gemedieerd............................................................................56
Classificatie.............................................................................................................................................. 56
IgE-gemedieerde allergie......................................................................................................................... 56
Symptomen........................................................................................................................................ 56
Fatale voedselallergie........................................................................................................................ 57
Epidemiologie.....................................................................................................................................58
Primaire vs. secundaire voedselallergie.............................................................................................58
Voedselallergie - diagnostiek................................................................................................................... 60
1. Anamnese...................................................................................................................................... 60
2. Screening voor sensitisatie............................................................................................................ 61
3. Orale provocatietest....................................................................................................................... 62
Voedselallergie - behandeling.................................................................................................................. 63
Voedsel orale immunotherapie (OIT)................................................................................................. 63
Monoklonale antilichamen..................................................................................................................63
Voedselallergie - primaire preventie......................................................................................................... 63
Primaire voedselallergieën - IgE-gemedieerd........................................................................................... 64
Fruit & groenten........................................................................................................................................64
Non-specific Lipid Transfer Proteins (nsLTP)..................................................................................... 64
Pollen-food allergy syndrome.............................................................................................................64
Cannabis sativa allergy...................................................................................................................... 66
Fruit-latex syndrome...........................................................................................................................66
Tarwe & andere granen............................................................................................................................ 67
Peanuts.................................................................................................................................................... 67
Soja.......................................................................................................................................................... 68
Tree nuts & seeds.................................................................................................................................... 68
Vlees........................................................................................................................................................ 68
Vis............................................................................................................................................................ 69
Schaaldieren............................................................................................................................................ 70
Primaire voedselallergieën - kinderen....................................................................................................... 72
Introductie.................................................................................................................................................72
Primaire voedingsallergie......................................................................................................................... 73
Signs & symptoms..............................................................................................................................73
Diagnose............................................................................................................................................ 73
Behandeling....................................................................................................................................... 74
Koemelk allergie (CMA)........................................................................................................................... 74
Non-IgE gemedieerde voedingsallergieën......................................................................................... 75
Ei allergie..................................................................................................................................................76
Potato allergie.......................................................................................................................................... 76
Tarwe allergie........................................................................................................................................... 76
Peanut allergie......................................................................................................................................... 77
2
, Noten allergie........................................................................................................................................... 77
Preventie.................................................................................................................................................. 78
Learning Early About Peanut (LEAP-trial)..........................................................................................78
International guidelines...................................................................................................................... 78
Verdere research................................................................................................................................79
Drug hypersensitivity.................................................................................................................................. 81
Nomen est omen & post hoc is not propter hoc....................................................................................... 81
Adverse drug reactions............................................................................................................................ 81
Klinische classificatie..........................................................................................................................82
Mechanistische classificatie............................................................................................................... 83
Grote database: potentials & pitfalls........................................................................................................ 84
Diagnose.................................................................................................................................................. 84
Is stopping the drug always the best option?........................................................................................... 86
Betalactams..............................................................................................................................................88
Kruisreactiviteit................................................................................................................................... 88
Penicilline allergie...............................................................................................................................89
NSAIDs.....................................................................................................................................................89
Urticaria & angio-oedeem............................................................................................................................92
Definitie.................................................................................................................................................... 92
Classificatie van urticaria..........................................................................................................................93
Urticaria bij multisysteem aandoeningen................................................................................................. 94
Familiale hypertryptasemie................................................................................................................ 94
PLAID................................................................................................................................................. 94
Autoinflammatory syndromes.............................................................................................................94
Diagnose.................................................................................................................................................. 95
Urticaria vasculitis.............................................................................................................................. 96
Bradykinine.........................................................................................................................................97
IL-1..................................................................................................................................................... 99
Overzicht............................................................................................................................................ 99
CSU: verder onderzoek nodig?.............................................................................................................. 100
Provocatietesten...............................................................................................................................100
AI-BAT.............................................................................................................................................. 101
CSU: prognose.......................................................................................................................................101
Disease monitoring...........................................................................................................................102
Disease control.................................................................................................................................103
CSU: behandeling.................................................................................................................................. 104
Conclusie................................................................................................................................................105
Mastocytose............................................................................................................................................... 106
Presentatie............................................................................................................................................. 106
Cutane mastocytose.........................................................................................................................106
Systemische mastocytose................................................................................................................107
Diagnostiek.............................................................................................................................................107
Diagnostiek bij kinderen................................................................................................................... 108
Diagnostiek bij volwassenen............................................................................................................ 108
Clinical suspicion of SM....................................................................................................................110
Associatie met anafylaxie....................................................................................................................... 110
Overzicht.................................................................................................................................................111
Mast cell activation syndrome (MCAS).................................................................................................... 112
Inleiding.................................................................................................................................................. 112
3
, Tryptase assay....................................................................................................................................... 113
Paired tryptase................................................................................................................................. 113
Baseline tryptase.............................................................................................................................. 113
Overzicht................................................................................................................................................ 115
Hymenoptera.............................................................................................................................................. 116
Hymenoptera venom allergy (HVA)........................................................................................................ 116
Taxonomie.............................................................................................................................................. 116
Apidae (= bijen)................................................................................................................................ 117
Vespidae (= wespen)........................................................................................................................ 117
Formicidae (= mieren)...................................................................................................................... 118
Presentatie van HVA.............................................................................................................................. 118
Lokale reactie (LR)........................................................................................................................... 119
Grote lokale reactie (LLR)................................................................................................................ 119
Systemische reactie (SR)................................................................................................................. 119
Indolent systemic mastocytosis (ISM).............................................................................................. 120
Epidemiologie van hymenoptera steekreacties................................................................................120
Diagnostiek van HVA..............................................................................................................................121
Behandeling van HVA............................................................................................................................ 122
Take-home message.............................................................................................................................. 123
Casussen............................................................................................................................................... 123
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