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pathology perspectives BY RUTH WERNER SNEEZING? WHEEZING? ITCHING? BLAME ATOPY Atopy translates to "out of the way, unusual." In medical circles, this term is applied to the observation that a group of common hypersensitivity reactions occurs within the same family, or—unluckily—sometimes all in the same person. The trio is comprised of eczema (also called atopic dermatitis), hay fever (also called allergic sinusitis), and asthma. Eczema, hay fever, and asthma all involve type I hypersensitivity reactions. Type I reactions entail a nonthreatening trigger (usually an allergen like cat dander or oak pollen) that leads to the production of a class of antibodies called IgE. These molecules then cause mast cells and eosinophils (a type of white blood cell associated with allergic reactions) to secrete inflammatory chemicals, leading to swelling, capillary dilation, excess mucus production, itching, and other symptoms. Type I reactions typically occur within a few minutes of exposure to a trigger, but can be delayed for up to 12 hours. Recent research has uncovered an explanation for why these three conditions often appear together or in family groups: all of them involve a specific genetic pattern that creates a strong predisposition toward inflammatory type I hypersensitivity reactions. While genetics are only part of these multifactorial conditions, this understanding may open the door to new treatment options to help reduce the incidence and severity of atopic symptoms. ECZEMA Eczema is the result of systemic allergies that are manifested through inflammation, itching, and pathologic changes to the skin. Babies and toddlers experience eczema more than adolescents and adults, but for some people, it is a lifelong condition. Eczema has several subtypes, but the most common form is called atopic dermatitis. In addition to a genetic predisposition, contributing factors to eczema include two main issues: a deficiency in certain fatty acids that compromises the lipid layer of the stratum corneum, leading to a high risk of damaged skin; and immune dysregulation that promotes inflammation with capillary dilation, redness, and itching. Although it seems clear that eczema is connected to allergic triggers, flares can also be caused by local irritations, such as rough textures, detergents, harsh chemicals, extreme temperatures, and excessive sweating. Skin affected by eczema is typically red, flaky, and dry. These changes appear mostly in skin creases, such as knees, elbows, ankles, and hands. The skin may eventually thicken and feel rough: this is called lichenification. The itching associated with eczema can become a self-fulfilling prophecy: in a phenomenon called the itch- scratch cycle, constant irritation can lead to significant skin damage. Because of this, people with eczema are susceptible to secondary skin infections with viruses or bacteria. HAY FEVER Sinuses are hollow areas located lateral to, above, and behind the nose. They provide resonance for the voice, and they lighten the weight of the head considerably. When mast cells in the mucous membranes respond to allergens as if they were life-threatening organisms, inflammation then causes itchiness; production of huge amounts connect with your colleagues on massageprofessionals.com 97