Chapter 5 Immune System MDT Flashcards
Immunologically mediated hypersensitivity reaction to a foreign antigen manifested by tissue inflammation and organ dysfunction
Allergy
The expression of allergic disease depends on:
Prior immunologic responsiveness
Antigen exposure
Genetically influenced host factors
Immediate allergic reaction
Within 60 minutes of exposure
Delayed allergic reaction
Many hours to days/weeks after exposure
The most serious and potentially life-threatening manifestation of mast cell and basophil mediator release
Anaphylaxis
Anaphylaxis is defined by:
Allergen exposure followed by the acute onset of illness involving:
Skin or mucosal tissue and either respiratory compromise or hypotension
(Systolic less than 90; or 30% less than baseline)
Anaphylaxis is defined by:
LIKELY allergen followed by the acute onset of TWO or more of the following conditions:
Skin or mucosal tissue involvement, respiratory compromise, hypotension, and persistent GI symptoms
Anaphylaxis is defined by:
KNOWN allergen exposure followed by:
Hypotension
Most acute systemic food allergy is caused by:
Proteins in milk
Egg
Wheat
Soy
Fish
Shellfish
Peanuts
Tree nuts
The most common causes of food anaphylaxis in adults
Shellfish, peanuts, and tree nuts
Diagnosis of food allergy relies on a combination of:
History
Skin tests
Specific IgE tests
Allergic reaction:
Symptoms and signs typically occur within __ minutes of initial exposure buy may appear several hours later
30 minutes
Symptoms/Physical Exam Findings:
- Skin manifestations, urticaria, flushing, rashes, pruritus
- Respiratory distress; wheezing, stridor, bronchospasm, airway angioedema
- GI symptoms; cramping, emesis, diarrhea (Food allergy)
- Hypotension; light headedness, dizziness, syncope
Allergic Reaction
Cornerstone of therapy for anaphylaxis
IM Epinephrine
Delayed repeat anaphylaxis can be up to __ hours after initial treatment
4 hours
Patients with new or unexplained onset of anaphylaxis should be evaluated by:
An allergist
Formation of an allergen mediated rash
Urticaria
Wheals or hives
Itching
Acute/self-limited (1-2 weeks)
Urticaria
Chronic urticaria
Episodes lasting longer than 6 weeks
Urticaria immunologic mechanism is mediated by:
IgE
Symptoms/Physical findings:
- Lesions are itchy, red swellings of a few mm to a few cm
- Individual lesions last less than 24 hours, often only 2-4 hours
Urticaria
In cholinergic urticaria, triggered by a rise in core body temperature, wheals are:
2-3 mm with large surrounding red flare
Papular urticaria resulting from insect bites persists for:
Days
Allergic plant dermatitis, streaked urticarial lesions may be seen in:
24-48 hours
Treatment for:
Urticaria
Antihistamines
Acute urticaria usually only lasts:
Few days to weeks
Complications from urticaria:
Cellulitis from intense itching
Anaphylaxis
Asthma
Swelling of vascular tissue involving deeper subcutaneous tissue with swelling of the lips, eyelids, palms, soles, and genitalia
Angioedema
Triggers of angioedema
NSAIDS
ACE inhibitors
Estrogens
ASA
CCBs
Amiodarone
Treatment for angioedema
Monitor for airway compromise and intubate
Treatment for:
Angioedema that develops anaphylaxis
Epinephrine
Antihistamines
Steroids
Inflammatory autoimmune disorder characterized by autoantibodies to nuclear antigens.
Effects multiple organ systems
Systemic Lupus Erythematosus
Lupus occurs mainly in:
Young women (85%)
Classic presentation of lupus
Malar rash (butterfly)
Lupus:
Joint symptoms in __% of patients
90%
Systemic features:
Fever, anorexia, malaise, weight loss.
Butterfly rash
Alopecia
Mucous membrane lesions
Lupus
Ocular manifestations of lupus:
Conjunctivitis
Photophobia
Transient or permanent monocular blindness
Blurring vision
Respiratory manifestations of lupus:
Pleurisy
Pleural effusion
Bronchopneumonia
Pneumonitis
Cardiac manifestations of Lupus
Pericardium is affected
Heart failure from myocarditis and HTN
Cardiac arrythmias
Neurological complications from Lupus
Psychosis
Cognitive impairment
Seizures
Peripheral and cranial neuropathies
Transverse Myelitis
Strokes
Antibody tests are nearly 100% sensitive for SLE but not specific
Antinuclear antibody tests
Labs:
Lupus
Antinuclear antibody test
Sedimentation rate and CRP (Inflammation)
Anemia and thrombocytopenia (CBC)
LFTs, BUN/Creatinine (Liver/Kidney involvement)
Treatment for SLE patients:
Education and emotional support
Caution against sun exposure (skin lesions respond to corticosteroids)
NSAIDs (Joint symptoms)
Systemic treatment for SLE is only prescribed by:
Rheumatologists
Initial care/follow up:
SLE
Check for antibodies with Antinuclear antibody test (ANA) and if positive refer to Rheumatologist
Long Term Complications:
SLE
Joint destruction and multisystem dysfunction
