E2 Hypersensitivity Flashcards by Raven Jackson

Altered immune response to an antigen

Hypersensitivity

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Hypersensitivity response to environmental or exogenous antigens

Allergy

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The protein part of the invading organism which is responsible for stimulating antibody production

Antigen / Allergen

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Produced and released by B lymphocytes;
Carried to the attacking organism and binds with the antigen

Antibody

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Proteins which work together to assist the action of antibodies

Complement

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Types of B-lymphocytes

Memory - helps the body recognize the organism if it returns
Plasma - makes antibodies; attracted to a specific antigen

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Types of T-cells

Memory - helps the body recognize the organism if it returns
Cytotoxic - release inflammatory substances that attack organisms
Suppressor - keep other t-cells in check, keep them from responding in the wrong way

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__________ are on pathogen cell surface.
____________ produced by __________ bind with the __________, resulting in the release of ___________ causing __________

Antigen
Antibodies
b-lymphocytes
antigen
chemical mediators
allergic response

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allergic reactions characterized by IgE antibody action and a genetic predisposition

examples:
atopic dermatitis (eczema)
allergic rhinitis
asthma

Atopy

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What are the 5 immunoglobulins/antibodies?

IgG, IgA, IgM, IgE, IgD

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Which antibody is..
the most abundant
found in all bodily fluids
protects against bacterial and viral infections
only ones to cross the placenta to protect baby

IgG

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Which antibody is…
found in mucous membranes, particularly the lining of respiratory passages, GI tract, as well as saliva and tears

IgA

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Which antibody is…
mainly found in blood and lymph
first to fight a new infection

IgM

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Which antibody is…
associated mainly with allergic reactions
found in the lungs, skin, and mucous membranes

IgE

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Which antibody is…
exists in small amounts in the blood
not really understood

IgD

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______ molecules bind to an allergen and trigger mast cells or basal cells

IgE

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Type I Hypersensitivity

Localized or Anaphylactic

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Type II Hypersensitivity

Cytotoxic / [B]lood

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Type III Hypersensitivity

Immune [C]omplex-Mediated

Type IV Hypersensitivity

Delayed

Which reaction is…
IgE mediated

Seen with:
Allergic rhinitis (hay fever)
Allergic asthma
Hives

Type I Local

Anaphylaxis is an …

acute systemic type 1 response that may result in shock and death

What occurs in anaphylactic reactions with the release of histamine and other mediators

Vasodilation [hypotension]
Increased capillary permeability [angioedema]
Smooth muscle contraction
Bronchial constriction [dyspnea, stridor/wheezing]
Light-headedness
Itching

Signs and Symptoms of Hypovolemic Shock

Tachycardia
Decreased LOC - confusion, restlessness, lethargic
Diaphoresis - vasodilation (cool and clammy)
Pallor

Low BP is a late sign

What is the priority during anaphylaxis?

Airway

Which reaction is... involves binding of IgG or IgM to a cell-bound antigen result of the body mistakenly identifying blood cell as foreign results in lysis of RBCs Seen in: Pernicious anemia Hemolytic disease Blood transfusion reactions Thrombocytopenia

Type II Cytotoxic (Blood) Reaction

Which reaction is... results from the formation and deposition of IgG or IgM antibody-antigen immune complexes in the circulatory system particularly susceptible to joints and kidneys Seen in: SLE RA Nephritis

Type III Immune Complex Reaction

Which reaction is ... a cell-mediated immune response triggered by T-cells occurs 1-3 days after exposure to an antigen involves tissue damage erythema and itching Seen in: Contact dermatitis Graft-versus-host disease Hashimoto's thyroiditis

Type IV Delayed Reaction

Diagnostic tests for allergic disorders

CBC with differential - eosinophils count elevated in allergic-type reactions Total serum IgE - most common antibody in IgE reactions Type & Crossmatch Indirect Coombs [BEFORE] Direct Coombs [AFTER] Immune Complex and Compliment Assays - help identify type 3/C reactions Skin tests (screen)

What screening questions should be asked prior to skin testing?

Are you on any immunosuppressants? Are you on any antihistamines?

Which skin test consists of... A drop of diluted allergenic extract placed on the skin Skin is pricked through the drop If hive or well after 10 mins = allergic

Skin Prick

Which skin test consists of... A small amount (enough to create a wheal) of diluted allergen extract injected into the forearm If no response occurred at 15-20 minutes = NEGATIVE Erythema and wheal > 5 mm = POSITIVE

Intradermal test

Which skin test consists of... A 1-in. patch impregnated with an allergen is applied to the skin for 48 hours. Absence of a response = NEGATIVE Mild (Erythema) / Severe (Erythema, papules, vesicles, ulcerations) = Positive

Patch test

Which test consists of... taken as a blood test used if you do not want to reintroduce the allergen to the patient tests for the amount of IgE antibodies in the blood More IgE antibodies = POSITIVE

RAST (Radioallergosorbent test)

Treatments of Allergies

Oxygen therapy Medication [epinephrine - anaphylactic reactions] Remove or withdraw allergen completely [stop infusion]

Treatment of Type II reaction includes...

Management of bleeding [give blood] or renal failure [treat kidneys, monitor renal function]

Treatment of Type III reactions includes...

Removal of the antigen and interruption of the inflammatory response

Anaphylaxis Treatment

⭐️ IV epinephrine - open airways, ⬆️ BP, ⬆️ HR IV fluids - give more volume, NS to prevent fluid shift Antihistamines - IV benadryl Corticosteroids - decrease inflammations Bronchodilators - albuterol

Epinephrine: dose, window, dose maximum?

(0.3-0.5mg) = 0.3 - 0.5 mL IM Repeats q 10 to 20 min Up to 3 doses

Side Effects of epinephrine

tachycardia, hypertension, headache, anxiety, apprehension, palpitations, diaphoresis, nausea, vomiting, weakness, and tremor [think: working too well]

Patients with _______________ reactions should be transported to the ___________ for __________ due to risk for ________-___________ after initial allergic reaction

anaphylactic hospital monitoring rebound reaction

How long should a patient be monitored for a rebound reaction?

4 to 10 hours

Symptoms of allergic rhinitis

Think: CHINDS Clear watery discharge Hoarseness & Headache Itching - nasal, throat, soft palates Nasal congestion Dry Cough Sneezing

Allergic Rhinitis Treatments

First Gen Antihistamine - Benadryl Second Gen - Zyrtec, Claritin, Allegra Nasal and ophthalmic adrenergic agents: Nasal Decongestants- phenylephrine, pseudoephedrine Ophthalmic agents for eye irritation Inhaled corticosteroids: Beclomethasone (Beconase) Fluticonase (Flonase) Leukotriene Modifiers Montelukast (singulair) Mast Cell Stabilizers Cromolyn Sodium (NasalCrom/ Intal)

What is immunotherapy? What Used for How How often Where

Allergy shots Used for desensitization Continuously exposing someone to a specific allergen to build up a tolerance Weekly or bi-weekly basis Most of the time given in doctor offices so they observe a reaction