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Samenvatting Allergologie, Eigen Niet-eigen 2

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  • Course
  • Eigen En Niet Eigen 2
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  • Universiteit Antwerpen (UA)

Samenvatting van de cursustekst 'allergie een praktische gids', geschreven door oa professor Ebo. Dit voor het vak 'Self and non-Self 2' ofwel 'Eigen en niet-eigen 2' in Bachelor 3 van de opleiding Geneeskunde. Geschreven in 18-19.

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Document information

  • December 27, 2020
  • 126
  • 2018/2019
  • Summary

Subjects

  • self and nonself
  • eigen niet eigen 2
  • allergie
  • allergologie
  • bachelor 3
  • geneeskunde

Written for

  • Universiteit Antwerpen (UA)
  • Geneeskunde
  • Eigen En Niet Eigen 2
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1  review

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By: martijnlodewyckx • 3 year ago

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saraceuppens

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Sara Ceuppens



Allergie: een praktische gids
Inhoud
1. Inleiding........................................................................................................................................... 4
1.1. Het immuunsysteem ............................................................................................................... 4
1.2. De normale immuunrespons ................................................................................................... 6
1.3. De allergische reactie .............................................................................................................. 8
2. Inhalatieallergieën ......................................................................................................................... 14
2.1. Inleiding ................................................................................................................................. 14
2.2. Huisstofmijt ........................................................................................................................... 15
2.3. Huisdieren ............................................................................................................................. 16
2.4. Kakkerlakken ......................................................................................................................... 17
2.5. Schimmels.............................................................................................................................. 18
2.6. Pollen (stuifmeel) .................................................................................................................. 19
3. Primaire voedselallergie ................................................................................................................ 23
3.1. Definities................................................................................................................................ 23
3.2. Mechanismen ........................................................................................................................ 24
3.3. Kliniek .................................................................................................................................... 24
3.4. Voedselallergenen ................................................................................................................. 25
3.4.1. Koemelk ......................................................................................................................... 25
3.4.2. Eieren............................................................................................................................. 26
3.4.3. Vis .................................................................................................................................. 26
3.4.4. Schaal- en weekdieren .................................................................................................. 27
3.4.5. Vlees .............................................................................................................................. 28
3.4.6. Granen ........................................................................................................................... 29
3.4.7. Pinda’s, soja en andere groenten (peulvruchten) ......................................................... 30
3.4.8. Noten ............................................................................................................................. 32
3.4.9. Groenten en fruit........................................................................................................... 33
3.4.10. Specerijen, kruiden en andere smaakmakers ............................................................... 34
4. Secundaire voedselallergie ............................................................................................................ 35
4.1. Inleiding ................................................................................................................................. 35
4.2. Clusters van kruisreactiviteit – plantaardig ........................................................................... 37
4.3. Latex-fruit syndroom ............................................................................................................. 41
4.4. Cannabis (marihuana)-fruit/groente syndroom .................................................................... 42
4.5. Clusters van kruisreactiviteit – dierlijk .................................................................................. 42


1

,Sara Ceuppens


5. Allergie ten opzichte van hymenopteragif (wesp, bij, hommel) ................................................... 44
5.1. Inleiding ................................................................................................................................. 44
5.2. Ecologie van wespen en bijen ............................................................................................... 44
5.3. Epidemiologie ........................................................................................................................ 46
5.4. Kliniek .................................................................................................................................... 46
5.5. Natuurlijk verloop van gifallergie .......................................................................................... 48
5.6. Diagnose ................................................................................................................................ 49
5.7. Behandeling ........................................................................................................................... 51
5.8. Steken voorkomen ................................................................................................................ 53
6. IgE-gemedieerde natuurlijke rubber latexallergie ........................................................................ 54
6.1. Inleiding ................................................................................................................................. 54
6.2. Pathofysiologie ...................................................................................................................... 54
6.3. Kliniek .................................................................................................................................... 55
6.4. Kruisallergie: het latex-fruit syndroom ................................................................................. 56
6.5. Diagnose ................................................................................................................................ 56
6.6. Aanpak ................................................................................................................................... 58
7. Allergie voor genees- en genotsmiddelen..................................................................................... 59
7.1. Inleiding ................................................................................................................................. 59
7.2. Pathofysiologie van geneesmiddelenallergie en verwante bijwerkingen ............................. 60
7.3. Oorzaken van geneesmiddelenallergie en verwante bijwerkingen ...................................... 60
7.3.1. Antibiotica ..................................................................................................................... 60
7.3.2. ACE-i – inhibitoren van het Angiotensine Converting Enzyme en aanverwanten ........ 63
7.3.3. Chloorhexidine .............................................................................................................. 64
7.3.4. Curariserende spierontspanners, narcotica en anesthetica algemene narcose ........... 64
7.3.5. Non-Steroid Anti-Inflammatory Drugs (NSAIDs) en paracetamol ................................. 68
7.3.6. Radiologisch contrastvloeistoffen (jodiumhoudend en gadolinium) ............................ 70
7.3.7. Vaccins ........................................................................................................................... 73
7.4. Allergie voor genotsmiddelen ............................................................................................... 74
8. Diagnostiek van IgE-gemedieerde allergie .................................................................................... 79
8.1. Inleiding ................................................................................................................................. 79
8.2. Dosering van totaal en allergeenspecifiek serum IgE ........................................................... 79
8.3. Dosering componentspecifiek serum IgE (componentgeoriënteerde diagnostiek: CRD) ..... 81
8.4. Klinisch relevante specifieke IgE-antistoffen......................................................................... 84
8.5. Functionele in vitro tests ....................................................................................................... 86
8.6. Huidtests................................................................................................................................ 88
8.7. Provocatietests ...................................................................................................................... 89

2

,Sara Ceuppens


8.8. Dosering van serum tryptase ................................................................................................ 90
9. Urticaria & angio-oedeem ............................................................................................................. 91
9.1. Inleiding ................................................................................................................................. 91
9.2. Kliniek .................................................................................................................................... 92
9.3. Mechanisme .......................................................................................................................... 92
9.4. Oorzaken van urticaria en angio-oedeem ............................................................................. 94
9.5. Differentiaaldiagnose van urticaria en angio-oedeem.......................................................... 99
9.6. Behandeling van urticaria en angio-oedeem ........................................................................ 99
9.7. Het geïsoleerd angio-oedeem ............................................................................................. 100
9.8. Mastocytose (mestcelziekte)............................................................................................... 105
10. Behandelingen ......................................................................................................................... 110
10.1. Inleiding en algemene principes...................................................................................... 110
10.2. Preventie ......................................................................................................................... 110
10.3. Symptomatische behandeling ......................................................................................... 110
10.4. Vaak gebruikte geneesmiddelen van symptoombestrijding ........................................... 113
10.4.1. H1-antihistaminica ....................................................................................................... 113
10.4.2. H2-antihistaminica ....................................................................................................... 116
10.4.3. Leukotriënenreceptor-antagonisten ........................................................................... 116
10.4.4. Tranexaminezuur ......................................................................................................... 117
10.4.5. Nasale steroïden .......................................................................................................... 117
10.4.6. Inhalatie β-mimetica ................................................................................................... 118
10.4.7. Orale & parenterale glucocorticosteroïden ................................................................ 118
10.4.8. Inhalatiesteroïden ....................................................................................................... 118
10.4.9. Omalizumab................................................................................................................. 119
10.5. Immunotherapie.............................................................................................................. 120
10.6. Zelf-inspuitbare adrenaline ............................................................................................. 121
11. Informatiebrochures ............................................................................................................... 122
11.1. Huisstofmijt ..................................................................................................................... 122
11.2. Pollenallergie (stuifmeel)................................................................................................. 123
11.3. Schimmel in huis .............................................................................................................. 123
12. Niet-immunologische overgevoeligheid (in voeding) ............................................................. 124
12.1. Inleiding ........................................................................................................................... 124
12.2. Kleurstoffen ..................................................................................................................... 124
12.3. Andere opwekkers in voeding ......................................................................................... 125
12.4. Behandeling ..................................................................................................................... 126



3

, Sara Ceuppens


1. Inleiding
Doel/te kennen.

Basiskennis opbouw & functie immuunsysteem.
Pathofysiologische mechanismen allergie.
Essentiële begrippen en definities.

1.1. Het immuunsysteem

Primair doel: verdedigen van lichaam tegen gevaren:

• Ziekteverwekkers
bacterieel, viraal, parasitair
• Schadelijke stoffen
toxines
• Tumoren

Bestaat uit aangeboren en verworven ‘deel’, elk met eigen verdedigingsmechanismen die onderling
samenwerken. Telkens cellulair en humoraal compartiment.
Essentieel onderscheid: lichaamsvreemd vs lichaamseigen.
→ antigenen vs autoantigenen.

1.1.1. Het aangeboren immuunsysteem (innate)

Altijd en overal klaar → zsm Ag opruimen.
Belangrijkste effectormechanismen:

• Rechtstreekse vernietiging
• Fagocytose
fagocyten: monocyten, macrofagen, granulocyten

Zorgen voor:

• IC doding
• Vrijzetten van
o Bacteriostatische eiwitten
bacterieremmend
o Bactericide eiwitten
bacteriedodend
o Complement

Niet specifiek dus reageert bij elke nieuwe blootstelling aan Ag identiek: via PRR’s (Pattern
Recognition Receptors) die PAMP’s (Pathogen Associated Molecular Pattern) op vele pathogenen
herkennen. Reactie verloopt bij volgende blootstelling wel efficiënter omdat het verworven IS komt
helpen.




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