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40 Cards in this Set

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1. Def. allergic reaction
2. 3 ways antibodies react with antigens
3. Hypersensitivity
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
1. Different types of antigens
1. Microbes (bacteria, fungi, viruses, protozoas, and parasites
Non-microbial (protein antigens: animal dander, pollen, horse serum.
1. Exposure to antigens can be through:
2. Immune function disorders result from:
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
Major components of the immune system: (2)
1. Bone marrow - production site of WBCs/lymphocytes
2. Lymphoid tissue (thymus, lymph nodes, spleen
Lymph nodes/Spleen
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.
Immunity (2)
3. 3 functions of immune sys.
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
Innate Immunity
Nonspecific response, in place before infection. Born with it. Doesn't have to recognize a substance to react to it.
Major components of innate immune system
Epithelial, chemical, phagocytic cells, natural killer cells, plasma proteing, and cytokines.
1.Chemical component of innate immunity.
2. phagocytes
3. Macrophages
4. NK cells
5. cytokines
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.
Adaptive (Acquired ) immunity(7)
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
Adaptive (Acquired) Immunity:
1. Active
2. Passive
3. Humoral
4. Cell-mediated
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.
Three responses to invasion by antigen
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
Stages of immune response (4)
1. recognition
2. proliferation
3. response
4. effector
Immunoglobulins (6)
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.
Immunoglobulins (cont.)
2. group of__
3. found where
2. Group of serum proteins - immunoglobulins
3. Found in lymph nodes, tonsils, appendix, intestinal tract, circulating blood or lymph
Immunoglobulins (cont.)
4. Five classes
5. purpose of above
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.
1. IgG
1. 75% of total
Major role in bloodborne & tissue infections
Activates complement system and enhances phagocytocis.
Crosses placenta
1. IgA
1. 15% of total
Protects against resp., GI, & gu infections.
Passes to neonate in breast milk.
1. IgM
1. 10 % of total
1st immunoglobuilin produced in response to bacterial and viral infections
Activates complement system
1. IgD
2. IgE
1. 0.2% of total
Influences B-lymphocyte differentiation, role is unclear.
2. 0.004% of total
Allergic and hypersensitivity reactions.
Combats parasitic infections
1. Atopy
1. allergic reaction involving IgE antibodies and a genetic predisposition ot allergies
Chemical Mediators
1. Mast cells stimulated by antigens
2. chemical mediators released resulting in hyprsensitivity
3. two types: Primary & secondary
Primary mediators
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
Effects of histamine
H1 and H2 blockers
Itch, bronchospasm, contracts bronchial smooth muscle, dilates venules, increased gastric secretions.
H1 blocker is Benedryl
H2 blocker is Zantac/Pepcid
1. Eosinophil Chemotactic Factor of Anaphylaxis
2. PAF
3. prostaglandins
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.
Secondary mediators: leukotrienes
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
secondary mediators: 1.Bradykinin
2.Serotonin
1. causes increased vascular permeability and vasodilation; causes hypotension
2. released during platelet aggregation; vasodilator; smooth muscle constriction
Hypersensitivity (3)
1. Excessive or aberrant immune response
2. usually does not occur with the 1st exposure
3. reactions have been classified into 4 types
Type I Hypersensitivity (4)
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.
Type I hypersensitivity cont. (3.)
1. Local reaction "wheal & flare"
2. most severe form is anaphylaxis
3. atopic reactions
Anaphylaxis
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
Atopic Reactions
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)
Type II hypersensitivity
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
Type III Hypersensivity
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
Type IV hypersensitivity
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
Collaborative Care in allergic rxs.
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.
1. First priority in caring for allergy pt.
2. Common allergens
1. Reduce Exposure
2. foods (nuts, shellfish)
medications (antibiotics, anesthetic agents, NSAIDS), animal serums (tetanus), insect stings, latex
Pharmacologic Therapy for allergies
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)
Anaphylaxis treatment
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)
Latex Allergies
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.