Professional Documents
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MANAGEMENT OF ALLERGIC
DISEASES IN CHILDREN
Zakiudin Munasir
CURRICULUM VITAE
Nama
Tempat/ tanggal lahir
Pekerjaan/jabatan
Globally important
allergens
ALLERGIC INFLAMMATION
Intact allergen
T Cell
ALLERGIC INFLAMMATION
CELLULAR RESPONS
Th2
IL-4
IL-5
IL-10
IL-13
HUMORAL RESPONS
ALLERGIC INFLAMMATION
Th2
IL-5
IL-4
B-cell
Eosinophil
IL-3, IL-4
Mast-cell
SENSITATION
IgE
Plasma-cell
YY
IL-5
B cell
EOSIN
IL-4, 6
Histamine,
mediators, cytokines
ALLERGIC INFLAMMATION
Mast cell
Sneeze
Itch
Eosin
Histamine
Mucus
PGD2
Smooth
muscle
Tryptase
TNF
Congestion
ICAM-1
ALLERGIC INFLAMMATION
Oedema
Mucus
LT-A4
LT-B4
Chemotaxis
Chemotaxis
LT-C4
Sm muscle stim
LT-D4
BHR
LT-E4
Eosinophilia
ALLERGIC MARCH
ATOPY
GIT ALLERGIC DISEASES
ATOPIC DERMATITIS
ASTHMA
ALLERGIC RHINITIS
Step-wise management of
allergic diseases
Gloria 2000
Step 3
Step 2
Step I
Immunotherapy
Pharmacotherapy
Treatment
Antihistamine
Antihistamines
Block histamine receptor
Stabilise mast cell membrane
Reduce
Mediator release
ICAM-1 expression
Eosinophil recuitment
Antihistamine
Cetirizine
Potent and specific AH
Second generation H1 receptor
antagonist, active metabolite of
carboxylic acid of first generation
H1 antihistamine , hydroxyzine
Not metabolized through
cytochrome P450, excreted in large
amount in urine
Cetirizine
ATOPY
AN
TI
EARLY TREATMENT
BR
-IN
ON
FL
CH
AM
OD
MA
I LA
TI
TO
ON
R
ALLERGIC DISEASES
ALLERGIC MARCH
ATOPIC DERMATITIS
GEN
GRASS POLLEN
HOUSE DUST MITE
CAT DANDERS
BRONCHIAL ASTHMA
ALLERGIC RHINITIS
Corticosteroids
Mucus secretion
Vascular permeability/oedema
Mediator release
Cytokine production
Inflammatory infiltrate/activation
Langerhan cells in epithelium
Glucocorticoid inhibits
The production of the major RV receptor,
ICAM-1
Van de Stolpe et al. Am J Respir Cell Mol Biol 1995
Antiinflamatory
potency
Na+ - Retaining
potency
Duration of action
Equivalent dose,
mg
20
Cortisone
0.8
0.8
25
Fludrocortisone
10
125
++
Prednisone
0.8
Prednisolone
0.8
6-methylprednisolone
0.5
Triamnicolone
Betamethasone
25
0.75
Dexamethasone
25
0.75
Cortisol
(Schimmer BP, Parker KL. Adrenocorticotropic hormone, adrenocortical steroids and their
synthetic analogs, inhibitor of the synthesis and actions of adrenocortical hormones;
Goodman & Gilmans the pharmacological basis of theurapeutics, 2001)
Macrolide antibiotics
inhibit
1.
5.
Symptomatic drugs
Bronchodilator :
2 agonists
Phosphodiesterase inhibitors
Epinephrine
FULL AGONISTS
Isoproterenol
80%
PARTIAL AGONISTS
60%
Fenoterol (42%)
40%
Strong
Procaterol
Pormoterol (30-40%)
Weak
20%
Salbutamol (5%)
0%
Decongestant
Pseudoephedrine: stereoisomer of
ephedrine but less potent
Ketotifen
Generation II AH
Sodium cromoglycate
2 agonist + phosphodiesterase
inhibitor combination
LEUKOTRIEN RECEPTOR
ANTAGONIST
Montelukast
Zafirlukast
Immunotherapy
Reduced allergen-specific IgE
Blocking IgG antibodies
Altered Th1 / Th2 response
reduced IL-4/IL-5 secretion
reduced eosinophil recruitment