Exam 3: Chapter 37: Assessment and Management of Patietns with Allergic Disorders Flashcards
What is a Allergy?
Inappropriate often harmful response in the immune system to a usually harmless item
What is a Allergen?
Substance that causes manifestations of allergy. The substance that causes the allergy response
What is a Atopy?
Genetic component of what we are allergic to. This includes peanuts, nuts, mushrooms. The chemical mediator is released due to this exposure
What is an Allergic Reaction?
Manifestation of tissue injury due to interaction between antigen and antibody. This causes the inflammatory response. Body defenses recognize these as foreign and the body attempts to remove these objects from the body
What lymphocytes respond to the antigen, what is produced?
Antibodies
What is the key and what is the lock in the specificity example?
ANtigens are the keys, and they fit only certain antibodies
Immunoglobulins can be found where?
In the lymph nodes, tonsils, appendix, and Peyer patches of the intestinal tract or circulating in the blood and lymph
Antibodies that are formed by lymphocytes and plasma cells are known as what?
Immunoglobulins
IgE antibodies are involved with
allergic disorders.
If performed a blood test after allergic reaction, what should be present?
Eosinophils and Basophils
IgE producing cells are located in the
respiratory and intestinal mucosa
Two or more IgE molecules bind together to an allergic and trigger
mast cells or basophils to release chemical mediators, such as histamine. This produces a allergic skin reaction, astha, and hay fever
When IgE molecules bind, what chemical mediators do they release?
Histamine, Serotonin, Kinins, SRS-A (Slow Reactions Substances of Anaphylaxis) and Neutrophil Factor
Histamine released in a allergic reaction produces what type fo response?
Eyes/Nose Watering and the individual sneezing
B Cells are programmed to
produce one specific antibody.
When encountering a specific antigen
B Cells stimulate production of plasma cells
T Cells assist the
B cells
T Cells secrete
substances that direct te flow of cell activity, destroy target cells, and stimulate the macrophages. Macrophages present the antigens to the T Cell
Example of Complete Protein Antigens?
Animal dander, pollen, and horse serum, stimulate a complete humoral response
What plays a major role in IgE-mediated immediate hypersensitivity?
Mast cells. Allergen triggers B Cell to make IgE antibody. When allergen reappears, it binds to the IgE and triggers the mast cell to release its chemicals
In Allergic Response, where are Histamine 1 and 2 Located?
1 located in Bronchail and 2 located in the gastric area
Two types of chemical mediators?
Primary and SEcondary
Primary MEdiators are
preformed and found in mast cells of basophils
Secondary Mediators
inactive precursors that are formed or released in response to primary mediators
Examples of Primary Chemical Mediators
Histamine,
Eosinophils
Prostaglandins
Platelet-Activating Factors
Examples of Secondary Chemical Medidators
Bradykinin
Serotonin
Leukotrienes
Heparin
What does Histamine do (Found in Mast Cell)
Vasodilation
Smooth Muscle Contraction, Increased Vascular Permeability
Increased Mucus Secretions
What does Eosinophil Chemotactic Factors of Anaphylaxis (Performed in Mast Cell) do?
Attracts Eosinophils
What does Platelet-Activating Factor (requires synthesis by mast cells) do?
Smooth muscle contraction
Incites platelets to aggregate and release serotonin and histamine
What does Prostaglandins (requires synthesis by cells) do?
D + F Series = Bronchoconstriction
E SEries = Bronchodilation
D, E, and F Series = Vasodilation
What does Basophil (Performed in mast cell) do?
Freees bradykinin, which causees bronchcontrction, vasodilation, and nerve stimulation
What does Bradykinin do?
Smooth muscle contraction, increased vascular permeability, stimultes pain receptors
What does SErotonin do?
Smooth muscle cotnraction, increased vascular permeability
What does Heparin do?
Anticoagulant
What does Leukoktrienes do?
Smooth musclle contraction, increased vascular permeability
Histamine is released by ___ and is the ____
mast cells, and is the first chemical mediator to be releasd in immune and inflammatory responses
Hypersensitivity is
an excessive or aberrant immune response to any type of stimulus. REaction that follows re-exposure after an immune reseponse to any type of stimulus.
Allergic reactions Types
Type I: Anaphylactic (Most Severe)
Type II: Cytoxic
Type III: Immune Complex
Type IV: Delayed Type
Type I is an
anaphylactic reaction that is characterized by vasodilation, increased capillary permeability, smooth muscle contraction, and eosinophilia
Type I: When vasodilating, the blood…
just pools there. It sits and you do not have the contraction to get it back to the heart as easily
Type I: Increased capillary permability means
that fluid is leaking out (Sodium and Albumin too)
Type I: If smooth muscle contractions, you cannot
breathe
Type I: Systemic Reactions involve
laryngeal stridor, angioedema (Swelling around throat and tongue), hypotension, and bronchial, BI, or Uterine Spasm
Type I: Location reactiosn characterized by
Hives. This could have been done by a bee sting.
Type I: Examples included
Extrinsic Asthma
Allergic Rhinitis
Systemic Anaphylaxis
Reactions to Insect Stings
Type II (Cytotoxic): Occurs when
the system mistakenly identifies a normal constituent of the body as foreign
Type II (Cytotoxic): Reaction MAY BE the result of
cross-reacting antibody, possibly leading to cell and tissues damage
Type II (Cytotoxic): This involves binding
either the IgG or IgM antibody to a cell-bound antigen, which may lead to eventual cell and tissue damage
Type II (Cytotoxic): Examples
Masthenia Gravis, Goodposture Syndrome Pernicious Anemia Hemolytic Disease of the Newborn TRansfusion Reaction Thrombocytopenia
Type II (Cytotoxic): What happens in Myasthenia GRavis
The body mistakenly generates antibodies against normal nerve ending greceptors
Type II (Cytotoxic): What happens in Goodpasure syndrome
Generates antibodies against lung and renal tissue, producing lung damage and kidney injury
Type III (Immune Complex): What is this?
Hypersensitivity involves immune complexes that are formed when antigens bind to antigens . This is marked by acute inflammation resulting from formation and deposition of immune complexes
Type III (Immune Complex): If this is deposited in tissues or vascular endothemium, what happens.
The increased amount of circulating complexes and the presence of vasoactive amines contribute to injury. As a result, there is increase in vascular permeability and tissue injury
Type III (Immune Complex): Who is easily susceptible to this?
Joints and Kidneys.
This is associated with systemic lupus, erythematosus, serum sickness, nephritis, and rheumatoid arthritis
Type III (Immune Complex): Some signs and symptoms?
Urticaria, Joint Pain, Fever, Rash, and Adenopathy (Swolllen Glands)
Type IV (Delayed Type): What is this?
A delayed or ceullar reactions that occurs 1-3 days after exposure to an antigen
Type IV (Delayed Type): Reaction
Results in tissue damage and involves activity by lymphokines, macrophages, and lysozymes
Type IV (Delayed Type): What type of reaction is common?
Erythea amd itching.
Type IV (Delayed Type): Examples?
Contact Dermatitis (Poison Ivy, Laundry Soap, and Latex)
Graft-Versus-Host Disease
Hashimotos Thyroiditis
Sarcoidosis
Common diagnostic tests?
Blood Tests, Smears of Body Secretions, Skin Tests, and Serum-Specific IgE Test
WBC count is usually normalexcept with
infection and inflammation.
WBC range that is considered abnormal?
A range greater than 5-10% is considered abnormal and may be found in patients with allergic disorders
An increase in Eosinophil indicates
an active allergic response
What are some specific diagnostic tests?
CBC: Eosinophil Count
Total Serum IgE
Skin Tests: Prick, Scratch, and Intradermal
High IgE levels indicate
that an allergic disease is present.
Positive (Wheal-And-Flare) reactions are clinically
significant when correlated with the history, physical findings, and results of other laboratory result
Methods of skin testing include
prick skin tests, scratch tests, and intradermal skin testing
Most suitable place to perform a intradermal skin test?
The back, because it permits the performance of many tests
What does a positive reaction mean on a skin test?
This is evidenced by a urticarial wheal (round, reddened skin elevation), diffused redness or irregular projection at the end of the wheal.
Skin tests are used most frequently with
the diagnosis of allergic rhinitis
Negative test results are helpful in
ruling out food allergy
Positive skin tests correlate
highly with food alergy
Provocative testing involves the
direct administration of the suspected allergen to the sensitive tissue, such as teh conjunctiva, nasal, or bronchial mucosa, with observation of target organ response
Serum specific igE test formerly known as a
RAST
What are the two types of IgE-mediated allergic reactions
Atopic and Nonatopic disorders
Atophy is defined as
the genetic predisposition to mount an IgE response to inhaled or ingested innocuous proteins
Atopic diseases consist of
asthma, allergic rhinitis, and atopic dermatitis.
Nonatopic is more about
contact. Something that the person themselves makes, such as latex. They lack the genetic component and organ specificity of the atopic disorders
First thing to do in the case of allergic reaction?
Administer oxygen. Supplemental oxygen is important when they themselves are not receiving it.
After administering epinephrine, what should be given?
Intravenous fluids (normal saline solution), volume expanders, and vasopressor given to maintain blood pressure and normal hemodynamic status
In patients with bronchospasm or a history of bronchial asthma or chronic obstructive pulmonar disease, what should be given?
Aminophylline and corticosteroids may also be given to improve airway patency and function
Where should an epipen be administered?
Upper extremity or thigh
Some side effects after taking an epipen?
Fast heart rate and vasoconstriction
After getting an epipen, what should the person do?
They should immediately drive themselves to the hospital because of the risk of rebound. Should also wait 30 minutes after injection because people may have a delayed response
What do you give if you want to stop histamine production?
Antihistamine
What does administering corticosteroids do?
Decreases inflammatory response
What is Anaphylaxis?
A clincal response to an immediate immunologic reaction between a specific antigen and an antibody. Reaction results from a rapid release of igE mediated chemicals, which can induce a severe life-threatening reaction
What type is Anaphylaxis considered to be?
A Type I IgE allergic reaction to an antigen, a foreign substance that has entered the body
Anaphylaxis is caused by
the cross-links of allergen with allergen -specific IgE antibodies found on the surface membrane of mast cells and basophils, leading to cellular degranulation
What do you do first in Anaphylaxis?
ABC. Protect the Airway, Breathing, and Constriction
You should always tell your doctor about any sort of reaction you have because
the reaction may not be the same the next time you have an allergic reaction
Closely resembling anaphylaxis is
an anaphylactoid reaction
an anaphylactoid reaction caused by
the release of mast cell and basophil meditors trigger by non IgE mediated events
an anaphylactoid reaction may occur with
medications, food, exercise, or cytotoxxic antibody transfusions.
Local reactions usually involv
urticaria and angioedema at the site of antigen exposure
Systemic reactions occur within
30 minutes after exposure and involve cardiovascular, respiratory, GI, and integumentary organ systems
Some symptoms of Anaphylaxis?
Flushing Urticaria Angioedema Hypotension Bronchoconstriction
Common foods that cause anaphylaxis
Peanuts, Tree Nuts, Shellfish, Fish, Milk, Eggs, Soy, Wheat
Medications that cause Anaphylaxis
Antibiotics, especially penicillin and sulfa antibiotics
Other pharmacentucal / Biological Agents that cause Anaphylaxis
Animal Serums (Tetanus Antitoxin, Snake Venom Antitoxin) Antigens used in skin testing
Insect Stings that cause Anaphylaxis
Bees, Wasps, Hornets, Yellow Jackets, Ants
Latex: Common Causes of Anaphylaxis
Medical and Nomedical Productions Containing Latex
Mild systemic reactions consist of
peripheral tingling and a sensation of warmth, possibly accompanied by a sensation of fullness in the mouth adn throat. Nasal congestion, periorbital swealling, pruritus, sneezing, and tearing can also be expected
Moderate systemic reactions include
flushing, warmth, anxiety, and itchng in addition to any of the milder symptoms
More serious systemic reactions include
bronchospasm and edema of the airways or larynx with dyspnea, cough, adn wheezing
Severe systemic reactions have an
abrupt onset with same signs and symptoms as more serious systemic reactions. Symptoms progress to bronchspasm, laryngeal edema, severe dyspnea, cyanosis, and hypotension
The most common serious allergic reactions to insect stings are from what family?
Hymenoptera, which includes bees, ants, wasps, and yellow jackets
Epinephrine has what type of dilution?
1:1000
Allergic Rhinitis (Hay Fever, Seasonal Allergic Rhinitis) is the most
common form of respiratory allergy, which is mediated by an immediate (Type I) reaction. Affects about 12% of the population
Rhinitis is considered to be
the alergic form of the symtoms if they are caused by an allergen-specific Ig-mediated immunologic response
Allergic Rhinitis in Early Spring?
Tree Pollen (Oak, Elm, Poplar)
Allergic Rhinitis in Early Summer?
Grass Pollen
Allergic Rhinitis in Early Fall?
Weed Pollen
Four major signs and symptoms of allergic rhinitis included
copious amounts of serous nasal discharge, nasal congestion, sneezing, as well as nose and throat itching
Diagnosis of seasonal allergic rhinitis is based on
history, physical examination and diagnostic tesst results
Allergic Rhinitis: Diagnostic tests include
Nasal Smears, Peripheral Blood COunts, Total Serum IgE, Intradermal Testing, and Nasal PRovocation
Allergic Rhinitis: Results indicative of allergy as the cause of rhinitis include
increased igE and Eosinophil levels and positive reactions on allergen testing
Allergic Rhinitis: Therapy may include
Avoidance Therapy
Pharmacologic Therapy
Immunotherapy
Allergic Rhinitis: Diagnosis
Pain
Inneffective Airway
Ineffective Breathing Problems
DEficient Knowledge about Allergy
How do Antihistamines work?
H1 blockers bind selectively to H1 receptors, preventing the actions of histamines t these sites. Best if taken right away
What are Adrenergic Agents?
Vasoconstrictors of mucosal vessels and are used topically in nasal and ophthalmic forultions
What do Adrenergi Agents do?
They reduce the local blood flow fluid exudation, and mucosal edema.
What does NasalCrom do?
Stablizes the mast cell membrane, thus reducing the release of histamine and other mediators of the allergic response. It also inhibits macrophages, eosinophihls, monocytes, and platelets involved in the immune response
Goals of Immunotherapy include
reducing the level of circulating IgE, and reducing mediator cell sensitivity.
Immunotherapy has been most effective for
treatment of grass, tree pollen, cat dander, and house dust mite.
Allergic Rhinitis: Most common treatmetn is SIT (Subcutaneous Immunotherapy) , which consists of
the serial injection of one or more antigens that are selected in each particular case ont he basis of skin testing
Allergic Rhinitis: Diagnosis Examples
Ineffective breathing pattern related to allergic reaction
Deficient knowledge about allergy and recommended modifications in lifestyle and self-care practices
Ineffective coping with chronic of condition and need for environmental modification
Contact Dermatitis is
a type IV delayed hypersensitivity reaction, that can be acute or chronic caused by contact with an exogenous substance that elicits an alergic response
Four types of Contact Dermatitis
Allergic, Irritant, Phototoxic, and Photo Allergic
Contact Dermatitis: Symptoms include
Itching, burning, erythema, skin lesions, and edema , followed by skin thickening, hardening and scaling
Contact Dermatitis: Assessment should include
the date of onset, and any identifiable relationship to work environment and skin care products
Simple total definition of Contact Dermatitis
Type IV delayed reaction. Exposed to ingenious substances, or something on the outside. Can be irritants such as soap, detergent, and can be for short or long exposure. Can have rash or itching, skin lesions, swelling, edema
Atopic Dermatitis is a
Type I immediate hypersensitivity disorder characterized by inflammation and hyper reactivity of the skin
Atopic Dermatitis: Most patients have elevated
IgE levels and peripheral eosinophilia. Eosinophil count may be increased depending on concomitant respiratory allergies
Atopic Dermatitis: What are the most consistent feautres of this?
Pruritus and Hyperirritability of the skin and are related to large amounts of histamine in the skin
Atopic Dermatitis is often linked in a process called atopic march that often leads to
asthma, allergic rhinitis, or food allergy
Atopic Dermatitis: Itching can be decrease dby
wearing cotton fabrics; washing with mild detergent; humidifying dry heat in winter; maintaining normal room temperature; using antihistamines and avoiding animals, dust, sprays, and perfumes
Atopic Dermatitis: What should be use to inhibit T Cells and mast cells involved in atopic dermatitis
Immunosuppressive agents such as cyclosporine, tacrolimus, and pimecrolimus
Dermatitis Medicamentosa: This is a
type I hypersensitivity disorder, and is the term that is applied to skin rashes associated with certain medications
Urticaria: What is this?
Hives, and this is a Type I hypersensitive allergic reaction of the skin that is characterized by the sudden appearance of edemtous,. pink, or red wheals of variable sizes
Urticaria: Most commonly instigated by
infections, allergic reaction to food, insect stings, and medications
Urticaria: Management includes
Removing the food
Avoiding NSAIDs
Minimizing Aggravators
Short Course of Corticosteroids
Angioneurotic Edema: Involves
Deeper layer of the skin resulting in more diffuse swelling than the discrete lesions characteristicss of hives
Angioneurotic Edema: Region most often involved is
Lips, Eyelids, Cheeks, Hands, Feet, Genitalia, and Tongue
Hereditary Angioedema: Symptoms caused by
Edema to the skin, the respiratory tract, or the digestive tract
Cold Utricaria: What happens to someone with this?
They break ot in hives when exposed to cold. Urticaria may be prompted by exposure to cold weather.
Cold Utricaria: Symptoms include
Fever, Chills, Conjuctive, Infection, Sweating, Headache, and Arthralgia
Cold Utricaria: During the attack patient may develop
Leukocytosis, an increas e in the erthrocyte sedimentation rate, and raised C-Reactive protein levels
Cold Utricaria: Diagnosed by
physical testing. Ice cube provocation testing involves placing cube on skin for 1-5 minutes.
Food Allergy: Most common offenders include
Seafood, Peanuts, Tree Nuts, Berries, Eggs, Wheat, Milk, and Chocolate
Food Allergy: Clinical Symptoms are
Urticaria, Dermatitis, Wheezing, Cough, Laryngeal Edema, Angioedema and GI Symptoms
Food Allergy: Medication Therapy
This includes use of H1 blockers, antihistamines, adrenergic agents, corticosteroids, ad cromolyn sodium
Latex Allergy: Has been implicated in
rhinitis, conjunctivits, contact dermatitis, urticaria, asthma, and anaphylaxis
Latex Allergy: Those at risk include
8-17% of health care workers, Patients with atopic allergies or multiple surgerie People working in latex factories females 67% patients with Spina Bifida
Latex Allergy: Allergic reaction to
natural rubber proteins
Latex Allergy: Irritant Contact DErmatitis, a Nonummunologic response, may be caused by
mechanical skin irritation or alkaline pH associated with latex gloves
Latex Allergy: Common symptoms of irritant dermatitis include
erythema and pruritus. Can be eliminated by changing the brand of gloves
Latex Allergy: The use of hand lotion before donning latex gloves can
worsen the symptoms, because lotions may leach latex proteins from the gloves
Latex Allergy: Delayed hypersensitivty to latex (Type IV reaction), is localized
to the area of exposure and is characterized by symptoms of contact dermatitis
Latex Allergy: Immediate ypersensitivity (Type I) is mediated by
the IgE mast cell system.
Latex Allergy: Symptoms of Immediate Hypersensitivy include
rhinitis, conjunctivitis, asthma, anaphylaxis
Latex Allergy: Clinical Manifestations of Immediate Hypersensitivity include
having a raipid onset and can include urticaria, wheezing ,dyspnea, laryngeal edma, bronchospasm, tachycardia, angioedema, hypotension, and cardiac arrest
