The 15 invited reviews discuss topics such as the role of stress in allergy and asthma, the concept of programming in utero and in childhood and adulthood, the significance of neurotrophins, and the involvement of the nervous system in the lung in asthma and lung inflammation. The interactions between mast cells and the nervous system are examined as well as the role of the gut microbiome in regulating the hypothalamic-pituitary-adrenal axis and the stress response. Further chapters are devoted to neural and behavioral changes associated with food allergy, the role of the neuroendocrine system in the skin, and the way in which itch is processed by the brain.
Unique in its field, this valuable volume is recommended reading not only for allergologists, psychologists specializing in allergy and somatic manifestations, respirologists and asthma researchers, but for anyone interested in psychoneuroimmunology. Read more Read less. Here's how restrictions apply. Chemical Immunology and Allergy, Vol. Karger; 1 edition June 22, Language: Be the first to review this item Amazon Best Sellers Rank: Start reading Allergy and the Nervous System on your Kindle in under a minute. Don't have a Kindle? Try the Kindle edition and experience these great reading features: Share your thoughts with other customers.
Write a customer review. Dermatologic Immunity Expert reviews of a wide range of skin diseases. Current Directions in Autoimmunity Vol.
Allergies and the Immune System | Johns Hopkins Medicine Health Library
The skin, being the largest organ of the body, is constantly attacked by a diverse array of pathogenic agents including bacteria, viruses and fungi; it also suffers from solar damage and wide fluctuations in temperature and humidity. In some individuals, the immune system, which normally offers protection against fatal external assaults, can malfunction and cause chronic inflammation in the absence of a known pathogen, resulting in a host of disorders categorized as autoimmune skin diseases.
This volume contains a series of 19 review articles on a wide range of autoimmune disease processes in the skin. Featuring disorders of humoral as well as cellular immunity, it covers allergic contact dermatitis, toxic epidermal necrolysis, psoriasis, atopic dermatitis, cutaneous lupus erythematosus, bullous pemphigoid, pemphigus foliaceus, lichen planus, vitiligo, scleroderma, alopecia areata and dermatomyositis.
For these diseases, the latest insights into their etiology and pathophysiology as well as therapeutic strategies are presented by experts in the fields of dermatology, genetics, immunology and pathology. In addition, overviews of the skin as an active immune organ and of the immune privilege of the skin are included. Comprehensive and up-to-date, this book is recommended for basic and clinical researchers, allergists , immunologists , dermatologists, internists and anyone interested in autoimmunity. From the Preface Knowing his second edition to have been overtaken by continuing discovery and innovation, de Groot has applied himself once again to updating this essential aid to the investigation of contact dermatitis.
Book Contents Chemicals - Abbreviations - Groups of chemicals and substances - Products - Photosensitivity - Immediate contact reactions - Patch test sensitization. Covering virtually every allergic condition, from the immunological and molecular basis of the allergic response to future trends in allergic disease prevention, the new international editorial team A. Kay, Jean Bousquet, Pat Holt and Allen Kaplan have completely revised and updated the text, from both a scientific and clinical perspective. References will continue to be added to the text until it goes to press making this the most up-to-date book available in the field.
Book contents VOL 1. Also new to this edition: Includes online access to the entire contents of the book, fully searchable. This book provides a practical and comprehensive review of all types and aspects of urticaria and angioedema important to the clinician. This clinical guide highlights current knowledge about pathophysiology and focuses on the clinically relevant aspects of diagnosis and treatment.
Allergies and the Immune System
It also includes a full range of standard operating procedures, as well as patient information leaflets in a copy-ready format, thus offering invaluable assistance in the daily practical management of urticaria patients. This book provides indispensable assistance to all physicians specializing in dermatology, allergy , internal medicine, pediatrics and general medicine.
Book Contents Historical Preface. Drug Hypersensitivity The first book to provide a truly comprehensive perspective. Immune-mediated reactions with exanthems, fever and internal organ involvement are a challenge to research: Approaching the phenomenon of drug hypersensitivity in a comprehensive manner, this book aims to be of immense value to allergologists, dermatologists and anyone prescribing medication, as well as to scientists in the pharmaceutical industry challenged by the economic effects of failures in drug development or drug removal from the market.
Besides epidemiological aspects, it addresses the immunological mechanisms underlying these complicated reactions which go far beyond the IgE-mediated drug allergies also considered in the book. Furthermore, the book covers clinical manifestations and new diagnostic methods, and introduces some recently established animal models. Well-accepted and also completely new concepts are presented and discussed in detail. Elucidating the mechanisms of drug hypersensitivity will not only help to identify patients at risk but will also provide novel insights into the pathophysiology of numerous immune-mediated diseases.
The chapters entailed refer to:. Paediatric ENT The first comprehensive textbook covering the whole of paediatric upper respiratory tract disorders. Published by Springer, Recent years have seen proliferating sub-specialization and a rapid expansion of the range of therapies available to pediatric ENT specialists. This concise, up-to-date textbook offers comprehensive coverage of all the practical and theoretical aspects necessary for those taking exams or wishing to up-date their knowledge.
The book is divided into sections covering rhinology, otology and head and neck problems.
The uniformly structured chapters cover all relevant topics comprehensively and succinctly. This useful and reader-friendly textbook will not only be inspirational to young specialists with an interest in pediatric ENT, but also to those who are due to take their final exams as well as for established specialists in the field. Among the issues analysed in the contents are: This volume provides an overview of exacerbation models of asthma and chronic obstructive pulmonary disease COPD. Within this wide field the book focuses on experimental systems that mimic pathobiological processes likely to be critical in exacerbations of these conditions.
To generate insight into the mechanisms of exacerbation of pulmonary disease and to promote the discovery of future treatments, both animal models and human experimental models are described. Models of Exacerbations in Asthma and COPD can be of great interest to pulmonologists, allergologists, specialists in internal medicine and critical care, as well as to microbiologists, infectiologists and pharmacologists studying the response to respiratory infections. Allergic rhinitis is considered to be the most common, but also the most under-diagnosed and mistreated of all allergic diseases. The vast majority of individuals with symptoms of rhinitis are managed in the primary care setting, while only severe cases are treated by specialists in allergy , lung medicine, pediatrics, otorhinolaryngology and dermatology.
Rhinitis belongs to a group of highly illustrated, concise handbooks and includes the very latest information on allergic and other forms of rhinitis , acute and chronic rhinosinusitis, nasal polyposis, plus comorbidities such as asthma, adenoid hypertrophy and otitis media with effusion. This short and compact text focuses on the early and accurate diagnosis, optimized treatment and apposite referrals of those with difficult disease. Allergy and allergens, Pathogenesis, Classification of allergic rhinitis , Seasonal allergic rhinitis , Non-allergy rhinitis , Diagnosing rhinitis , Therapeutic principles, Rhinosinusitis and nasal polyps, Comorbidities and complications of allergic rhinitis , Future tends and Useful resources.
The Atlas of Investigation and Management offers an in depth analysis of all aspects of the disease. Come and learn all you need to know as a specialist from this unique publication. This Atlas, is recommended to specialist doctors that want to be informed on the latest developments of the disease, providing vital visual information on the diagnosis, symptoms and prevention of asthma. Your account is inactive. Please contact member eaaci. EAACI recently updated its privacy policy and would like to highlight some key bits of information with you.
You disagreed with the new privacy policy — disclaimer and your feedback will be reviewed as soon as possible. Comprehensive in its coverage, the book includes the first clear descriptions of allergic diseases ; the major advances in treatments, such as the discovery of antihistamines, cortisone, biological therapies and immunotherapy; the great immunological advances, such as the discovery of immunoglobulin E IgE and leukotrienes; the possible factors behind the increase in allergy , such as the house dust mite, changes in hygiene and diet; and the growing understanding of the social, psychological and quality-of-life consequences of allergy.
That human beings respond to chronic exposure to environmental challenges by adapting, acclimating, acclimatizing, or even becoming addicted is widely recognized for a variety of substances. Most would agree that the use of narcotics, alcohol, nicotine, and even caffeine can be addicting. For example, the first cigarette ever smoked might be associated with eye and throat irritation, but over time, with more cigarettes, most individuals adapt, and primarily the pleasurable effects of nicotine on the brain are experienced. After months or years, more cigarettes or alcohol or caffeine or drugs may be required for the same amount of lift.
The individuals may exhibit addictive behavior, seeking cigarettes more frequently. Subsequently, quitting cigarettes or alcohol, caffeine, or drugs may lead to withdrawal symptoms including irritability, drowsiness, fatigue, moodiness, and headache. The reformed smoker may become extremely intolerant of the smoke of others, even in tiny amounts. Suddenly recalled are the irritation and unpleasant feelings associated with the first cigarette ever smoked. Over time the individual had "adapted" to those effects.
Adaptation, which on the surface would seem good for the organism, may in fact be a two-edged sword. Developing tolerance for the noxious properties of the exposure may allow the individual to remain in the exposure more comfortably while other harmful consequences of the exposure continue. Thus the heavy smoker who is "adapted" to tobacco smoke is at increased risk for developing emphysema, lung cancer or vascular disease. While often occurring at much lower levels of exposure than the above examples, food and chemical adaptation and addiction have been observed by some physicians in their patients.
Thus, frequent exposure to a substance results in adaptation irritation and other warning signals may disappear.
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Continued exposure may lead to addiction. Reduction or cessation of exposure generally results in withdrawal symptoms. What may confuse patients and practitioners is that the symptoms for which the individual is most likely to seek a physician's help are those that occur during withdrawal when the person is no longer exposed or is less exposed to the offending agent.
Thus headaches may occur when the individual smokes fewer cigarettes than usual or drinks less caffeine. Indeed, these unpleasant withdrawal symptoms may be forestalled by smoking another cigarette or taking another drink of coffee, thus perpetuating addiction. Patients may report that smoking a cigarette or drinking a cup of coffee in the morning after 8 or so hours without relieves their headache a withdrawal symptom and they feel better, not suspecting that the cigarette or coffee might also be the cause of their headache. Occupational health presents many examples in which acclimatization, inurement, or tolerance to a substance is known to develop, for example, exposure to ozone, nitroglycerin, and solvents.
Note that the incitants mentioned thus far are all quite different from one another: The point is that the human body appears able to adapt to an endless array of substances. By isolating MCS patients from their usual environments and then re-exposing them to various foods and chemicals one by one, physicians have observed that many common substances patients eat, drink or inhale seem to provoke symptoms. A biphasic response to some of these substances Figure 2 has been reported. Initially the individual might experience a stimulatory effect adapted response; tolerance develops lasting varying periods of time depending upon the incitant.
However, this "up" phase was generally followed by a withdrawal phase maladapted response; loss of tolerance. Upon beginning to experience unpleasant withdrawal symptoms, the individual would seek, consciously or unconsciously, more of the same substance. These ups and downs follow a sort of sinusoidal biphasic pattern, as depicted in Figure 2. On the graph, beginning at zero, the patient is free of symptoms and at baseline health status. Following a one-time or occasional exposure to a provoking substance, stimulatory effects result; after a period of time minutes to hours to days, depending upon the nature of the incitant , the stimulatory effects subside and give way to withdrawal symptoms.
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The frequency of these up and down reactions depends upon the frequency of exposures, and the amplitude of the stimulatory and withdrawal portions of the reaction depend upon the substance and the individual's susceptibility degree of adaptation or addiction to it. The particularly sensitive person exhibits larger amplitudes than the normals. The key to understanding multiple chemical sensitivity may lie in recognizing these ups and downs that appear to occur after exposure to many different substances.
The amplitude of a reaction varies from person to person and incitant to incitant, but the pattern is reported to be quite constant. Symptom progression of a single reaction to an incitant.
During the early phases of exposure to a particular substance, stimulatory symptoms predominate "up," "hyper," ''jittery". As exposure to the offending agent continues, adaptation occurs and fewer more After long-term exposure to a given incitant for instance, alcohol , especially in certain sensitive individuals, the degree and duration of stimulation may become less and less while the withdrawal or depressed phase becomes deeper and more prolonged. At face value, this sinusoidal reaction to a substance might seem a somewhat artificial construct, but Randolph asserts it is not.
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Chemical sensitivities may be difficult to assess while a patient remains at home or even in most hospitals because these places generally contain background low levels of natural gas, disinfectants, perfumes, cleaners, tobacco smoke, paints, varnishes, adhesives, and other substances. The patient's symptoms may be masked by the presence of these contaminants. Under normal living circumstances, the stimulatory and withdrawal levels for foods and chemicals overlap each other Figure 3 so that in real life-outside an environmental unit-at any given moment what the organism may be feeling is a summation of all effects, whether stimulatory or depressive, of all substances recently inhaled, contacted, or ingested.
Figure 3 illustrates that attempts to identify the effects of single substances would be frustrated by the overlapping responses. Only by placing the individual in an environment devoid of chemical and food incitants would one be able to determine whether the illness is alleviated. Assuming the patient improves which occurs in the majority of cases, according to ecologists , the next step would be to reexpose the person to individual substances in order to avoid overlapping responses, and then to observe the result.
If all possible food and chemical contributors are not removed, an effect may be missed. Hence, in order to rule out environmental illness definitively, an environmental unit would be required. Conceivably environmental illness could be ruled in on an outpatient basis, but not ruled out. Overlapping of responses to food and chemical incitants in an individual with multiple exposures and multiple chemical sensitivities. In real life, stimulatory and withdrawal reactions are observed but often not understood. For example, an asthmatic might feel well after spending a week on a Carribean island, breathing relatively uncontaminated air and eating a diet devoid of usual foods, only to have a severe, life-threatening asthmatic response to exhaust from the engine of a boat taking the individual home.
Once back home in a metropolis, the asthmatic readapts, acclimatizes to auto exhaust, combustion products and other air pollutants in the area, and experiences only chronic wheezing. Thus, following deadaptation removal from incitants , the individual exhibits a more acute and convincing reaction upon reexposure. This appears to be what occurs in an environmental unit during testing. So acute and convincing are some of these reactions that patients themselves erroneously at least in the eyes of some surmise they must have an "allergy" to a particular substance.
However, if the patient is not deadapted unmasked when tested, a reaction may not occur, convincing the physician that the "allergy" was all in the patient's mind. Occupational health has several widely recognized examples of adaptation that are analogous Ashford and Miller They, too, fit a biphasic pattern. Industrial hygienists and occupation health physicians know that one of the most valuable clues to work-related illness is a history of intense symptoms following return to work after a vacation or weekend leading to withdrawal and deadaptation.
Ozone, an air pollutant of special concern to residents of Los Angeles and other cities, has been the focus of considerable research relevant to adaptation. Intrigued by how little respiratory illness and death occurred relative to the high levels of ozone in very polluted cities and suspecting adaptation might play a protective role, Hackney and associates Hackney et al. Although reactivity varied greatly from individual to individual, Californians were only minimally reactive to levels that for the Canadians caused coughing, substernal discomfort and airway irritation, pulmonary function test decrements, and increased red blood cell fragility.
In another experiment, six volunteers with respiratory hyperreactivity were placed in an environmental chamber with ozone at 0. Five of six had decreased pulmonary function during days 1 to 3, but gradually improved almost to baseline by day 4, suggesting adaptation had occurred. The authors note that not all adverse effects of ozone may be prevented by adaptation; for example, increased red blood cell fragility may persist. Therefore, adaptation or masking of some symptoms may occur while other physiological alterations continue.
Individuals' abilities to adapt to ozone appear to depend upon their initial sensitivity to it. More sensitive persons adapt more slowly and cannot maintain the adaptation as long; they usually remain adapted less than 7 days following cessation of exposure Horvath, While nitroglycerin and ozone adaptation and deadaptation may differ in certain respects from the adaptation and deadaptation described in MCS patients, solvents are among the chemicals most frequently implicated by chemically sensitive patients who attribute the onset of their illness to a particular exposure Terr, ; Cone et al.
Vapors from various solvents are the most prevalent of indoor air contaminants Molhave, The volatile organic compounds VOCs associated with sick building syndrome are in large part solvent vapors. The sensory irritation, headache, drowsiness, and other symptoms noted by occupants of tight buildings are consistent with known effects of solvent vapors, albeit at much higher concentrations.
Those who have painted or used solvents to any major extent are well aware of the olfactory fatigue nasal adaptation that occurs and may have experienced the stimulatory and depressive properties of solvents. Alcoholic beverages contain the solvent ethanol, which has related and familiar stimulatory and withdrawal effects. Studies of xylene, one of the most prevalent solvents in indoor air, demonstrate that its effects are attenuated as exposure continues, presumably due to adaptation Riihimaki and Savolainen, Riihimaki aid Savolainen exposed healthy male volunteers to constant or ppm and varying or ppm hourly peak concentrations of xylene, adjusting baseline concentrations in the latter case so that a mean concentration of or ppm was maintained.
Exposures occurred over a six-hour period with a one-hour break at noon for five days, followed by a two-day weekend and one to three more days of active exposure to xylene. A variety of psychophysiologic parameters were measured, inducting reaction time, body balance, manual dexterity, and nystagmus. Of particular interest, Riihimaki and Savolainen observed that most of the adverse effects of xylene upon their normal subjects "tended to disappear after a few succeeding days of exposure.
With regard to patients with chemical sensitivities who also develop dietary intolerances, Bell notes that "foods are not only sources of nutrients, but also complex mixtures of organic chemicals. For instance, it is the unique pattern of chemical constituents that make a tomato a tomato rather than an apple" Bell, , pp. Interestingly, limonene and pinene which are present in oranges also are constituents of room air deodorizers which provoke symptoms in some chemically sensitive patients. Like airborne pollutants, foods contain a wide range of chemical constituents and are in intimate contact with the organism for long periods of time.
The surface area of the gastrointestinal tract is enormous, and the chemical load, in terms of both quantity and diversity of exposure, is huge. We have mentioned a amber of exposures that are recognized as involving adaptation. What is clear is that individuals with or without multiple chemical sensitivities undergo adaptation to a wide variety of substances in their environment.
What is not dear is the specific role adaptation plays in the dramatic responses patients with food and chemical sensitivities have to low-level exposures that do not overtly affect others. These concepts are familiar to occupational health practitioners and industrial hygienists because they observe such effects firsthand among workers exposed to chemicals. Randolph states that most physicians see patients long after adaptation has occurred and at the time when end organ damage is setting in: Through comprehensive environmental control that is, an environmental unit , one may be able to overcome the masking effect of adaptation and back up or reverse the exposure to allow monitoring of toxicity in progress.
The environmental unit may represent a kind of dynamic toxicology ; traditional medical approaches provide only a snapshot of what is happening to the patient. People are often exposed to dozens of different incitants simultaneously such as volatile organic compounds in a tight home or building and literally hundreds of different incitants over the course of a single day, so that health effects of these exposures may overlap, making it difficult to discern cause-and-effect relationships. With continuous or frequent exposure to the same substance or chemically-related substances such as xanthines in coffee, tea, chocolate and colas , individuals adapt or, in other words, develop tolerance to those exposures.
Acute symptoms gradually may give way to chronic symptoms that bear no apparent relationship to any particular exposure. Exposures may never stop long enough for the patient to reach baseline. Exposures that are initially pleasant or stimulating such as alcohol, solvents, or nicotine generally also have withdrawal effects such as headache, depression or irritability, associated with them. Such withdrawal symptoms may occur hours to a few days after cessation of, or reduction in, exposure, greatly confounding attempts by patients and physicians to relate symptoms to a particular incitant.