Allergic Disorders

Front 1

1. Def. allergic reaction
2. 3 ways antibodies react with antigens
3. Hypersensitivity

Back 1

1. Manifestation of tissue injury resulting from interaction between an antigen and antibody.
2. By coating the antigen, neutralizing, or precipitating.
3. Exaggerated immune response to a foreign agent resulting in injury to the host

Front 2

1. Different types of antigens

Back 2

1. Microbes (bacteria, fungi, viruses, protozoas, and parasites
Non-microbial (protein antigens: animal dander, pollen, horse serum.

Front 3

1. Exposure to antigens can be through:
2. Immune function disorders result from:

Back 3

1. inhalation, ingestion, injection or skin contact.

2. EXCESSES OR DEFICIENCIES OF IMMUNOCOMPETENT CELLS, ALTERATIONS IN FUNCTION OF CELLS, INAPPROPRIATE OR EXAGGERATED RESPONSES TO ANTIGENS

Front 4

Major components of the immune system: (2)

Back 4

1. Bone marrow - production site of WBCs/lymphocytes
2. Lymphoid tissue (thymus, lymph nodes, spleen

Front 5

Lymph nodes/Spleen

Back 5

Remove material from lymph before it enters the blood. Center for proliferation. Spleen filters out old RBC's; white pulp in spleen contains B and T lymphocytes.

Front 6

Immunity (2)
3. 3 functions of immune sys.

Back 6

1. state of responsiveness to foreign substances (micro-organisms and tumor proteins)
2. collective coordinated response of cells and molecules of the immune system
3. defense
homeostasis
surveillance

Front 7

Innate Immunity

Back 7

Nonspecific response, in place before infection. Born with it. Doesn't have to recognize a substance to react to it.

Front 8

Major components of innate immune system

Back 8

Epithelial, chemical, phagocytic cells, natural killer cells, plasma proteing, and cytokines.

Front 9

1.Chemical component of innate immunity.
2. phagocytes
3. Macrophages
4. NK cells
5. cytokines

Back 9

1. saliva, gastric acid, enzymes in tears & saliva
2. neutrophils, monocytes, and macrophages
3. Complement proteins; made in the liver; couples with antigen
4. Natural killer cells; different from T and B lymphocytes; recognize invaders kill tumor cells and viruses.
5. regulate and coordinate activities of immune system.

Front 10

Adaptive (Acquired ) immunity(7)

Back 10

1. immunologic responses acquired after birth
2. Develops as a result of prior exposure
3. Able to recognize, react to, & distinguish among differernt microbes & molecules
4. Components - B&T lymphocytes
5. Active and Passive immunity
6. Humoral - mediated by molecules in the blood
7. Cell-mediated - mediated by specific T lymphocytes

Front 11

Adaptive (Acquired) Immunity:
1. Active
2. Passive
3. Humoral
4. Cell-mediated

Back 11

1. from immunizations
2. temporarily transmitted from another source. Ex: exposed to Hep A. give immunoglobulin.
3. Involves B lymphocytes; primarily against bacteria
4. Involves T lymphocytes; primarily viruses and intracellular organisms.

Front 12

Three responses to invasion by antigen

Back 12

1. Phagocytic immune response; WBC's ingest foreign parts; trigger inflammatory response
2. Humoral or antibody response: B lymphocytes transform into plasma cells and release the antibodies.
3. Cellular response: T lymphocytes convert into killer T cells and attack pathogen

Front 13

Stages of immune response (4)

Back 13

1. recognition
2. proliferation
3. response
4. effector

Front 14

Immunoglobulins (6)

Back 14

1. Antibodies formed b lymphocytes and plasma cells in response to an immunogenic stimulus. Antibodies=immunoglobulins. They are formed by B cells and plasma cells in response to a stimulus.

Front 15

Immunoglobulins (cont.)
2. group of__
3. found where

Back 15

2. Group of serum proteins - immunoglobulins
3. Found in lymph nodes, tonsils, appendix, intestinal tract, circulating blood or lymph

Front 16

Immunoglobulins (cont.)
4. Five classes
5. purpose of above

Back 16

4. G,A,M,D,E
5. each responds to a specific cell/molecule. They mobilize other components of the immune system to defend against invader.

Front 17

1. IgG

Back 17

1. 75% of total
Major role in bloodborne & tissue infections
Activates complement system and enhances phagocytocis.
Crosses placenta

Front 18

1. IgA

Back 18

1. 15% of total
Protects against resp., GI, & gu infections.
Passes to neonate in breast milk.

Front 19

1. IgM

Back 19

1. 10 % of total
1st immunoglobuilin produced in response to bacterial and viral infections
Activates complement system

Front 20

1. IgD
2. IgE

Back 20

1. 0.2% of total
Influences B-lymphocyte differentiation, role is unclear.
2. 0.004% of total
Allergic and hypersensitivity reactions.
Combats parasitic infections

Front 21

1. Atopy

Back 21

1. allergic reaction involving IgE antibodies and a genetic predisposition ot allergies

Front 22

Chemical Mediators

Back 22

1. Mast cells stimulated by antigens
2. chemical mediators released resulting in hyprsensitivity
3. two types: Primary & secondary

Front 23

Primary mediators

Back 23

1. IgE-mediated inflammation
2. Antibodies attach to mast cell and causes it to release preformed chemicals:
a. histamine
b. eosinophil chemotactic factor of anaphylaxis
c. platelet-activating factor (PAF)
d. Prostaglandins

Front 24

Effects of histamine
H1 and H2 blockers

Back 24

Itch, bronchospasm, contracts bronchial smooth muscle, dilates venules, increased gastric secretions.
H1 blocker is Benedryl
H2 blocker is Zantac/Pepcid

Front 25

1. Eosinophil Chemotactic Factor of Anaphylaxis
2. PAF
3. prostaglandins

Back 25

1. Primary mediator. Moves eosiniphils to the site.
2. Platelet activating factor; initiates platelet aggregation; smooth muscle contraction; stops spread of reaction.
3. fatty acids; increase smooth muscle contractions; vasodilation, cause pain and fever.

Front 26

Secondary mediators: leukotrienes

Back 26

Leukotrienes: Initiate inflammatory response; slow-reacting substance of anaphylaxis; cause smooth muscle contraction, bronchial constriction, mucous secretion in airways; 100-1,000 times more potent than histamine

Front 27

secondary mediators: 1.Bradykinin
2.Serotonin

Back 27

1. causes increased vascular permeability and vasodilation; causes hypotension
2. released during platelet aggregation; vasodilator; smooth muscle constriction

Front 28

Hypersensitivity (3)

Back 28

1. Excessive or aberrant immune response
2. usually does not occur with the 1st exposure
3. reactions have been classified into 4 types

Front 29

Type I Hypersensitivity (4)

Back 29

1. requires previous exposure to the specific antigen
2. mediated by IgE antibodies
3. clinical symptoms are determined by amt. of the allergen, amt. of mediator released, sensitivity of target organ, and route of allergen entry
4. reactions can be systemic or local
Primary chemical mediators are responsible.

Front 30

Type I hypersensitivity cont. (3.)

Back 30

1. Local reaction "wheal & flare"
2. most severe form is anaphylaxis
3. atopic reactions

Front 31

Anaphylaxis

Back 31

1. immediate systemic reaction
2. characterized by edema in tissues, mainly larynx, and hypotension
3. shock (related to vasodilation) can occur rapidly, death will occur if emergency treatment is not initiated
4. diarrhea r/t effect on GI tract

Front 32

Atopic Reactions

Back 32

1. inherited tendencysensitive to environmental allergens
2. allergic rhinitis (hay fever-yr around), asthma, atopic dermatitis, (eczema), utricaria(hives) and angiodema (swelling of lips, eyes, tongue, genitalia)

Front 33

Type II hypersensitivity

Back 33

1. Cytotoxic and Cytolytic reactions (body mistakes normal for foreign. Ex: hemolytic transfusion rxs; myasthena gravis; Rh hemolytic reaction);
2. Formation of antibodies (IgG, IgM) against cell surface antigens- binding of antibody ot cell-bound antigen
3. results in destruction of cell to which antigen is bound

Front 34

Type III Hypersensivity

Back 34

1. Immune-complex reactions
2. Immune complexes are formed when antigens bind to antibodies
3. complexes are cleared from circulation by phagocytic action and deposited in tissue
4. lead to inflammaiton & destruction of involved tissue
5. examples: Autoimmune disorders
a. SLE
b. Rheuatoid arthritis
c. acute glomerulonephritis

Front 35

Type IV hypersensitivity

Back 35

1. delayed hypersensitvity reactions
2. also termed Cell-mediated immune response
3. occors 24-72 hours after exposure
4. tissue damage occurs from cytokines attracting macrophages into area.
5. examples: contact dermatitis (new detergent), microbial reaction (TB, PPD reaction), transplant rejection, latex allergy
SYMPTOMS: itching, erythem, raised tissue

Front 36

Collaborative Care in allergic rxs.

Back 36

1. Assessment:
1. comprehensive hx.
b. obtain information about the clinical manifestations and course of allergic reaction
c. subjective and objective data on physical exam
d. lab studies (CBCw/WBC diff); absolute lymphocyte count and eosiniphil count; T & B cell quantification; Serum IgE levels
Skin testing for specific sensitivity in atopic isease
RAST: radioallergosorbent test- serum test that measures allergen-specific IgE; safer than skin test r/t dec risk of systemic rx.

Front 37

1. First priority in caring for allergy pt.
2. Common allergens

Back 37

1. Reduce Exposure
2. foods (nuts, shellfish)
medications (antibiotics, anesthetic agents, NSAIDS), animal serums (tetanus), insect stings, latex

Front 38

Pharmacologic Therapy for allergies

Back 38

1. antihistamines
a. H1-receptor antagonists bind selectively to receptors preventing action of histamine
b. sedating and non=sedating.Claritin non sed.
2. Addrenergic agents
a. used topically or orally; cause vasoconstriction of mucosal vessels
3. corticosteroids
a. intranasal used in sever cases when other methods not effective
b. oral used when conventional therapy ineffective (prednisone)

Front 39

Anaphylaxis treatment

Back 39

1. speed in recognition
2. maintain patent airway
3. prevent spread of allergen (legs down)
4. administration of drugs
5. high-flow oxygen
6. treatment of shock
anticipate intubation
Priority in triage
IV benedryl or pepcid
vasopressors (dopamine) IV to increase b.p. (makes vessels smaller)/
Epinephrine: 1:1000 subQ
.2-.5mL for mild symptoms
or 1:10,000 IV
.5mLQ10min.
recumbent position r/ hypotension; feet up; keep warm; use volume expandres run wide open (isotonic solution like salein, lactated ringer, 18 gauge in antecubital)

Front 40

Latex Allergies

Back 40

1. widespread increase due to universal precautions
2. proteins in the natural rubber latex or chemical reaction in manufacturing cause allergic reaction
3. 1-3% of general pop.; 10-17% of HCW
4. reaction can range from minor to life-threatening
5. best treatment is avoidance of latex products.