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Altered reactivity in humans and animals to allergens (substances foreign to the body that cause allergy) induced by exposure through injection, inhalation, ingestion, or skin contact. The most common clinical manifestations of allergy are hay fever, asthma, hives, atopic (endogenous) eczema, and eczematous skin lesions caused by direct contact with allergens such as poison ivy or certain chemicals.

A large variety of substances may cause allergies: pollens, animal proteins, molds, foods, insect venoms, foreign serum proteins, industrial chemicals, and drugs. Most natural allergens are proteins or polysaccharides of moderate molecular size (molecular weights of 10,000 to 200,000). Chemicals or drugs of lower molecular weight (haptens) have first to bind to the body's own proteins (carriers) in order to become fully effective allergens.

For the development of the hypersensitivity state underlying clinical allergies, repeated contact with the allergen is required. Duration of the sensitization period is usually dependent upon the sensitizing strength of the allergen and the intensity of exposure. Some allergens (for example, saliva, urine, and hair proteins of domestic animals) are more sensitizing than others. In most instances, repeated contact with minute amounts of allergen is required; several annual seasonal exposures to grass pollens or ragweed pollen usually occur before an overt manifestation of hay fever. On the other hand, allergy to cow milk proteins in infants can develop within a few weeks. When previous contacts with allergens have not been apparent (for example, antibiotics in food), an allergy may become clinically manifest even upon the first conscious encounter with the offending substance.

Besides the intrinsic sensitizing properties of allergens, individual predisposition of the allergic person to become sensitized also plays an important role. Clinical manifestations, such as hay fever, allergic asthma, and atopic (endogenous) dermatitis, occur more frequently in some families. In other clinical forms of allergy, genetic predisposition, though possibly present as well, is not as evident.

Exposure to sensitizing allergens may induce several types of immune response, and the diversity of immunological mechanisms involved is responsible for the various clinical forms of allergic reactions which are encountered in practice. Three principal types of immune responses are encountered: the production of IgE antibodies, IgG or IgM antibodies, and sensitized lymphocytes.

Diagnosis of allergic diseases encompasses several facets. Since many clinical manifestations of allergy are mimicked by nonallergic mechanisms, it is usually necessary to use additional diagnostic procedures to ascertain whether the person has developed an immune response toward the incriminated allergen. Such procedures primarily consist of skin tests, in which a small amount of allergen is applied on or injected into the skin. If the individual is sensitized, a local immediate reaction ensues, taking the form of a wheal (for IgE-mediated reactions), or swelling and redness occurs after several hours (for delayed hypersensitivity reactions). The blood may also be analyzed for IgE and IgG antibodies by serological assays, and sensitized lymphocytes are investigated by culturing them with the allergen.

Since the discovery of the responsible allergens markedly influences therapy and facilitates prediction of the allergy's outcome, it is important to achieve as precise a diagnosis as possible. Most tests indicate whether the individual is sensitized to a given allergen, but not whether the allergen is in fact still causing the disease. Since in most cases the hypersensitive state persists for many years, it may well happen that sensitization is detected for an allergen to which the individual is no longer exposed and which therefore no longer causes symptoms. In such cases, exposition tests, consisting of close observation of the individual after deliberate exposure to the putative allergen, may yield useful information.

The most efficient treatment, following identification of the offending allergen, remains elimination of allergen from the person's  environment and avoidance of further exposure. This form of treatment is essential for allergies caused by most household and workplace allergens.

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From McGraw-Hill Concise Encyclopedia of Environmental Science. The Content is a copyrighted work of McGraw-Hill and McGraw-Hill reserves all rights in and to the Content. The Work is © 2008 by The McGraw-Hill Companies, Inc.
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