Transcription of โรคจมูกอักเสบจากภ ูมิแพ (Allergic Rhinitis)
1 ( allergic rhinitis ) 1 ( allergic rhinitis ) .. ( allergic rhinitis ) IgE mediated type I hypersensitivity reaction , 1 1. Seasonal allergic rhinitis (outdoor allergens) , 2.
2 Perennial allergic rhinitis , , (WHO) 2 2 1. Intermittent 4 1 4 2. Persistent 4 1 4 objective parameters WHO 2 1. Mild 2. Moderate severe mild moderate severe 1 - Sleep disturbance, - Impairment of daily activities, leisure and / or sport, - Impairment of school or work, - Troublesome symptoms ( allergic rhinitis ) 2 10 25 3-6 (6 7 ) (13 14 ) 7.
3 2538 38 .. 2518 8 ( 23) 2 .. 2538 8-139 2210 .. 2533-2535 13 .. 2540-2542 22 (multifactorial disease) 3 1.
4 Predisposing factor (heredity) (atopic disease) immune response gene (IR - gene) gene 11 2. Primary or specific factors (antigen, allergen) (aeroallergen) (inhalant) (house dust), (house-dust mite), (pollen), , , , 3. Secondary or precipitating factors , (direct irritants) , , , physical factors , , psychic factor , , deviated nasal septum, septal spur ( allergic rhinitis ) 3 allergic inflammation 1.
5 Allergic inflammation (phase 1) IgE (phase 2) early-phase response mast cell activation mediators cellular infiltration late-phase response hyperresponsiveness antigenic non-antigenic stimuli sensitization phase clinical phase ( 1) (genetic predisposition for atopic disease) IgE sensitization antigen-presenting cells macrophages dendritic cells antigen T-helper cells (TH.)
6 CD 4+) B cell Interleukin (IL)-4 IL-13 TH-2 lymphocytes B cells IgE allergen specific IgE high affinity receptors mast cells basophils low affinity receptors monocytes, eosinophils platelet12-15 antigen cross-linking IgE degranulation mast cells inflammatory mediators histamine, leukotriene C4 (LTC4), prostaglandin D2 (PGD2)16 early-phase response (EPR) mediators end organs , , Phase 1:Sensitization phasePhase 2:Clinical phaseAntigenAntigen- presenting cellProcessedantigenT-helper cellsB cellPlasma cellIg EAntigenMast cellMediator releaseNasal end organ (blood vessels, nerves, glands)Sneezing, rhinorrhea, congestion, itching Induction of adhesion molecules Cellular infiltrationLate-phasereactionHyper-resp onsivenessPrimingIg EIL-4, IL-13 from TH-2 Early-phase responseLate-phase responseEosinophilsBasophilsMonocytesLym phocytes ( allergic rhinitis ) 4 , , 3 10 late-phase response (LPR)
7 50 17 LPR influx eosinophils, basophils, mononuclear cells T cells nasal secretions eosinophils TH-lymphocytes submucosa cytokine profiles nasal secretions nasal mucosa18 eosinophils mediators, neurotoxins peroxidases LPR basophils histamine LPR19 influx basophils allergic inflammation cytokines inflammatory response IL-4 mast cells20, IL-3, IL-4, IL-5 GM-CSF TH-2 lymphocytes IL-6 epithelial cells21 neuronal reflex allergic response mediators T-lymphocyte22 influx LPR expression adhesion molecules cell vascular endothelial cells cytokines leukocytes leukocyte activation, expression adhesion molecules vascular endothelial cells, (rolling)
8 Leukocytes , migration leukocytes endothelium migration nasal epithelium nasal secretions Adhesion molecules endothelial cells intercellular adhesion molecule-1 (ICAM-1), E-selectin vascular cell adhesion molecule-1 (VCAM-1) ligands eosinophils lymphocyte function associated antigen-1 (LFA-1) macrophage antigen-1(MAC-1) ICAM-1, very late antigen-4 (VLA-4) VCAM-1 sialyl-Lewis X E-selectin adhesion molecules co-receptors migration epithelial cells allergic inflammation nasal mucosa natural barrier mediators IL-1, IL-1 , IL-6, IL-8, GM-CSF, TNF- , MCP-1, RANTES23 expression adhesion molecules nasal epithelium allergic inflammation seasonal antigen24 antigen challenge25 mild expression ICAM-1 nasal conjunctival epithelium inflammatory cells inflammatory reaction (minimal persistent inflammation)
9 26 expression ICAM-1 inflammatory reaction allergic inflammation EPR LPR priming effect hyperresponsiveness inflammatory cellular infiltration, mediators end organ inflammatory cells ( allergic rhinitis ) 5 nasal mucosa permeability target inflammatory mediators end organ histamine, , methacholine22, 27.
10 28 allergic inflammation sensitization phase IgE clinical phase EPR degranulation mast cell LPR inflammatory cells cytokines cytokines mediators expression adhesion molecules chemoattractants , , , (hyponasality), (anosmia) , (postnasal drip) eustachian tube , (sense of lump in the throat) postnasal drip
