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M.H.R School Of Nursing > Allergies > Flashcards

Allergies Flashcards

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1
Q

Immune System

A

Network of cells, tissues, organs that work together to defend body against attacks by foreign invaders.

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2
Q

Key to healthy immune system

A

Ability to distinguish btwn own cells & foreign cell

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3
Q

3 Functions of Immune System

A

Defense Homeostasis Surveillance

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4
Q

Allergy

A

-adverse reaction to foreign subst that doesn’t normally → reaction - antigen & antibody interaction

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5
Q

Atopy

A

genetic trait predisposing for localized anaphylaxis

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6
Q

Antigen

A

Foreign body –>formation of antibodies Most composed of protein All of body’s cells have antigens that identify cell as self or non-self.

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7
Q

Four Methods by which Antigen Enters the Body

A

1) Ingestion 2) Inhalation 3) Injection 4) Absorption

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8
Q

Ingestion

A

proteins – milk, wheat, egg whites

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9
Q

Inhalation

A

pollen, dust, old spores

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10
Q

Injections

A

PCN (penicillin)

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11
Q

Absorption

A

Across skin/ mucous membrane

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12
Q

Antibody

A
  • synthesized by B lymphocytes in response to antigen - proteins/ immunoglobulins
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13
Q

Two types of lymphocytes

A

o B lymphocytes o T lymphocytes (t for thymus)

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14
Q

B lymphocytes

A

in the bone marrow • Differentiate into plasma cells when activated • → antibodies

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15
Q

T lymphocytes (t for thymus)

A

cells moved from bone marrow to thymus • 70-80% of circulating lymp • immunity to viruses, tumor cells, & fungus • attack infected or cancerous cells.

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16
Q

Humoral Immunity

A

Antibody-mediated immunity Pathogen (bacteria) enters body–>encounter B lymph. specific for antigens, B cell activated –> differentiates into mature plasma cells→ secrete immunoglobulins.

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17
Q

Five types of immunoglobulins (antibodies):

A

IgG IgM IgA IgD IgE

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18
Q

IgG

A
  • crosses placenta–> newborn w/ passive immunity (3+ mo.)
  • -> secondary immune response
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19
Q

IgM

A
  • 1st type of antibody formed
  • Primary Immune Response- can kill bacteria
  • Large in size-confined to intravascular space
  • Blood Incompatibility Reaction
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20
Q

IgA

A
  • Protects against infection in _intestines & respiratory trac_t.
  • Lines mucous membranes & protects body surfaces.
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21
Q

IgD

A

o Present on lymphocyte surface. o Assists in: differeientiation of B lymph

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22
Q

IgE

A
  • –>symptoms of allergic reactions.
  • Hayfever, asthma, eczema.
  • ** Fixes to mast cells & basophils--> releases histamines**
  • defend against parasites.
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23
Q

Cell-Mediated Immunity

A
  • initiated via specific antigen recognition by T cells
  • –> Immunity against pathogens that live i/s cells – Virus, some bacteria, fungal infections, tumor immunity, tissue transplant, contact hypersensitivity
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24
Q

Sequence of Events in Immune Response

A

1) Antigen introduced into body. 2) Initial latent period (induction period) - no antibodies can be detected in serum. 3) Rapid rise in antibody production - peaks & then declines to maintenance level o both IgG & IgM antibodies present in primary response (IgM higher) 4) If antigen introduced again, antibody responds again much more rapidly & reaches higher titer. IgG - main antibody produced w/ repeated antigen stimulation

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25
Q

Hypersensitivity Reactions

A
  • abnormal/ allergic reaction to antigen-antibody formation
  • Classified by source of antigen, time sequence, mechanism (4Types)
  • immune response is over reactive against antigen
  • Autoimmune disease- body fails to recognize self-proteins
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26
Q

Five types of Hypersensitivity Reactions:

A

Type I: Anaphylactic Reactions (Immediate) Type II: Cytotoxic and Cytolytic Reactions Type III: Immune Complex Reactions Type IV: Delayed Hypersensitivity Reactions Type V: Stimulatory Reactions

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27
Q

Type I: Anaphylactic Reactions (Immediate)

A

Only in susceptible persons highly sensitized to specific allergens.

  • IgE antibodies produced in response to antigen.
  • S&S – Local/ systemic depending on mediator
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28
Q

Examples of Type I

A

allergic rhinitis (hayfever), asthma, atopic dermatitis, food/drug allergies, urticaria

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29
Q

Type I Hypersensitivity Reaction

A

Anaphylactic Reactions (Immediate)

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30
Q

Type II Hypersensitivity Reaction

A

Cytotoxic and Cytolytic Reactions

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31
Q

Type III

A

Immune Complex Reactions

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32
Q

Type IV

A

Delayed Hypersensitivity Reactions

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33
Q

Type V

A

Stimulatory Reactions

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34
Q

Early mediator of Hypersensitivity Reactions

A

Histamine→ causes: Smooth muscle contraction & Capillary dilation (increased vascular perm → increased fluid into tissue

35
Q

Substances Released During Hypersensitivity

A
  • Histamine
  • Serotonin
  • Prostaglandins
  • Kinins
36
Q

Serotonin

A
  • increased vascular permeability
  • stimulates smooth muscle contraction.
37
Q

Prostaglandins

A
  • vasodilation
  • constrict smooth muscle
38
Q

Kinins

A

stimulate nerve endings to cause throbbing & pain

39
Q

“Wheal & flare”

A
  • Type 1
  • Localized - cutaneous (skin) reaction
  • Pale wheal containing edematous fluid surrounded by red flare from hyperemia.
  • minutes to hrs.
  • Usually not dangerous
40
Q

Type 1 Systemic

A
  • _Anaphylaxis/anaphylactic shock _
  • Occurs in mins-life threatening due to bronchial constriction airway obstruction & vascular collapse.
  • Death can occur
41
Q

Initial S/S of **Anaphylaxis/ Anaphylactic shock **

A
  • edema
  • itching at site of exposure
  • Shock follows → rapid, weak pulse, low blood pressure etc.
  • Death can occur
42
Q

Atopic Reactions

A

Inherited tendency to become sensitive to environmental allergens

43
Q

Angioedema

A
  • atopic reaction (Type 1)
  • Localized cutaneous (involving deeper layers)
  • Begins in face –> airway (Respiratory Complications) & so on
  • –> diffuse Swelling
  • Common reaction to AcE inhibitors
  • Interventions must be quick b/c –> too swollen to incubate
44
Q

Type II: Cytotoxic and Cytolytic Reactions

A
  1. Body makes auto-antibodies directed against self cells
  2. Self cells are destroyed (phagocytosis or lysis)
  3. Cellular tissue destroyed.
45
Q

Target cells frequently destroyed in Type II reactions:

A
  • erythrocytes
  • platelets
  • leukocytes.
46
Q

Examples of Type II: Cytotoxic and Cytolytic Reactions

A
  • ABO incompatibility transfusion reaction
  • Rh incompatibility transfusion rx,
  • Leukopenia’s
  • Thrombocytopenias,
  • Hemolytic anemia
47
Q

Type III: Immune Complex Reactions

A
  • Antigens + antibodies –> complexes that deposit in tissue-
  • –>acute inflammation, damage to tissue, &/ or blood vessels
48
Q

Common Deposit Sites for Antigen/ Antibody Complexes

(Type 3)

A
  • kidneys
  • skin
  • joints
  • BV
  • lungs
49
Q

Severe type III reactions include:

A

autoimmune disorders

  • lupus
  • rheumatoid arthritis
  • acute glomerulonephritis
50
Q

Type IV: Delayed Hypersensitivity Reactions

A

Cell Mediated Immune Response

  • Tissue damage w/o presence of antibody
  • T lymphocytes & macrophages destroy the antigen.
  • 24-48 hrs before reaction occurs
  • _Contact dermatitis, transplant rejection_s, reactions to some bacterial,
    fungal, viral infections, or some drug reactions.
51
Q

Type V: Stimulatory Reactions

A

Excessive stimulation of a normal receptor by an autoantibody = continuous “on” state.

  • Ex: Graves Disease – continuously stimulated thyroid cells→ thyroid hormone → sever hyperthyroidism
  • Tx = remove the tissue.
52
Q

EENT

A

(Eyes, ears, nose, throat)

  • red eyes
  • itchy eyes/nose
  • sniffling
  • dcreased hearing
53
Q

RAST

A

radioallergosorbent test

  • Specific test for IgE antibodies to specific allergens (in vitro test).
  • Expensive, Less sensitive & longer than skin tests.
  • Effective for individuals with severe anaphylactic reactions
  • Detect food & drug allergies.
54
Q

CBC+WBC differential

A

lymphocyte and eosinophil counts

55
Q

Sputum, nasal, bronchial secretions

A

can be tested for eosinophils.

56
Q

Purpose of Skin Testing

A
  • detect presence of atopic reactions to IgE in skin
  • isolate antigen (allergen) to which person sensitive.
57
Q

2 types of skin tests

A
  1. Scratch or prick.
  2. Intracutaneous
58
Q

Scratch or prick

(Skin Test)

A
  1. Area washed w/ alcohol
  2. Drop of allergen applied to skin
  3. area scratched (lancet)/pricked (needle)-sterile.
  4. Applied in rows w/ corresponding control sites op. test rows.
59
Q

Intracutaneous

A
  • Inject sm amt of sol. of allergen below epidermis-in row (Forearm)
  • Allergic reaction more severe with this method
  • Only used for persons who did not react to cutaneous methods.
60
Q

Precautions for Skin Testing

A
  • Highly sensitive>at risk for anaphylactic reaction to skin tests.
  • Never leave alone during skin testing
61
Q

severe reaction to skin/scratch test –>

A

extract/ remove & anti-inflam. topical cream applied.

62
Q

severe reaction to intracutaneous test –>

A
  • tourniquet applied to arm
  • subcutaneous injection of epinephrine may be needed.
63
Q

_**Epinepherine = # 1 drug_
Best meds for tx of allergic rhinitis & urticarial (hives).

A

Antihistamines

64
Q

Antihistamines

A
  • Less effective for severe allergic reactions.
  • Given orally, IV, topical, inhaled or nasal spray.
  • Action = competes w/ histamines for H receptor site & blocking effect of histamines
  • Best if taken when symptoms appear.
65
Q

Antihistamines

(Side Effects)

A
  • *- Side effects:** drowsiness, sedation, disturbed coordination (use caution when driving/ operating heavy machinery)
  • Benadryl, Zyrtec, Chlor-trimeton.
  • New generation of meds - Claritin, Zyrtec, Allegra, Clarinex = decrease side effects.
66
Q

Major sympathomimetic med

A

epi (adrenalin)

67
Q

Sympathomimetic/Decongestant Meds

Epi

A
  • Drug of choice for anaphylactic reaction.
  • Hormone produced by adrenal medulla–> A & B-adrenergic receptors
  • →Vasoconstriction of peripheral blood vessels = decreases edema
  • Stimulation of B Receptors relaxes bronchial smooth muscle spasms
  • Last only a few minutes
68
Q

Corticosteroids

A
  • Nasal corticosteroids (vancenase, rhinocort, flonase)
  • *- Relieve symptoms of allergic rhinitis**
  • Oral corticosteroids: brief course for severe reactions – bad side effects
69
Q

Antipruritics

A
  • Topically applied.
  • Most effective when skin intact
  • Provide relief from itching.
  • OTC- calamine or Benadryl liquidyne
70
Q

Mast-Cell Stabilizing Drugs

A
  • Inhibit release of histamines, leukotrienes (chemical mediators of inflam) & other agents from mast cells
  • Inhalant nebulizer, nasal spray, po
  • Examples: Cromolyn spray (intal, nasalcrom) – decrease side effects.
  • Use before exposure to allergen-(cats, pollen season)
71
Q

Immunotherapy

A
  • For anaphylactic reactions → desensitization
  • Given injections weekly for up to 5 years – Allergy shots
  • injections may –> reaction. Use arm - monitor 20 mins.
  • May need maintenance for severe reactions to insects
  • Attempt to _stimulate IgG levels to mediate IgE to mast cells–>_reduces reactions & tissue damage.
72
Q

Anaphylaxis (type 1 systemic)

A
  • sudden hypersensitive rx w/ exposure to allergen
  • Can occur after injection of drugs (abx), blood products, insect stings.
  • Mild symptoms: puritus & urticaria
  • Severe symptoms: bronchial constriction, airway obstruction, vascular collapse, (shock)
73
Q

5 principles in therapeutic management of anaphylaxis:

(speed in)

A
  • recognition of anaphylactic reaction
  • maintenance of patent airway
  • prevention of spread of allergen by using tourniquet (i.e.snake bites).
  • med administration.
  • treatment for shock.
74
Q

Serum Sickness

A
  • Type III reaction (systemic)
  • deposits of antigen-antibody complexes in blood vessel walls of skin, joints, in renal glomeruli
  • Develops slowly (10 -14 days)
  • Self limiting – will resolve on own
  • **don’t need to be previously sensitized to react **
75
Q

Triggers for serum sickness

A
  • PCN, other abx
  • Animal serum based drugs
76
Q

Serum Sickness

Signs and Symptoms:

A
  • urticaris
  • angioedema,
  • fever
  • muscle soreness
  • malaise
  • lymphadenopathy
  • joint pain
  • polyarthritis
  • nephritis
77
Q

Latex Containing Products

A
78
Q

Items Containig Latex

A
  • Torniquets
  • BP cuffs
  • IV tubing
  • Syringes
  • Electode pads
  • O2 masks/tubing
  • Colostomy pouches
79
Q

Two types of latex allergies:

A
  1. Type IV allergic contact dermatitis
  2. Type I allergic reaction
80
Q

latex allergies: Type IV allergic contact dermatitis

A
  • Caused by chemicals used in manufacturing process of latex gloves.
  • Delayed reaction – 6-48 hrs
  • Symptoms = dryness, prutitus, fissuring, cracking of skin, followed by rednesss, swelling, crusting at 24-48 hours
81
Q

latex allergies: Type I allergic reaction

A
  • Response to natural rubber latex proteins & occurs w/in mins of contact with proteins.
  • Symptoms: Skin rednesss, Urticarial, Rhinitis, Conjunctivitis, Asthma, Full blown anaphylactic shock
82
Q

Risk factors for latex sensitivity:

A
  • Long term multiple exposures to latex products (health care staff, pts with many OR visits)
  • Hx Hayfever or Asthmas
83
Q

Food Allergies For Latex

A
  • Avocados
  • Guava
  • Kiwi
  • Bananas
  • Water chestneuts
  • Hazelnuts

M.H.R School Of Nursing (32 decks)

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