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72 Cards in this Set
- Front
- Back
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What is our first line of defense against microbial invaders?
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epithelial cells that coat the skin and make up the lining of the respiratoty, GI, and GU tract
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How do antibodies react with antigens?
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1. coat the antigen's surface
2. neutralize antigens if they are toxins 3. precipitate the antigens out of the solution if they are dissolved *prepare antigens so that phagocyctic cells of the blood and tissue can dispose them |
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What is an allergic or hypersensitivity disorder?
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inappropriate or exaggerated responses to specific antigen initiated by IgE antibodies
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Define atony?
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allergic reactions that are characterized by action of the IgE antibodies and genetic predisposition to allergic reaction
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What happens during an allergic reaction?
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lymphocytes respond to an antigen and antibodies are produced aggresively to a substance that is normally harmless. Chemical mediators are then produced ranging from mild to deadly
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What are immunoglobulins?
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antibodies (serum proteins)formed by lymphocytes and plasma cells in response to immunogenic stimulus
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What the 5 immunoglobulins and where are they found?
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IgE, IgD, IgG, IgM, IgA
found in the lymph nodes, tonsils, appendix, peyers patches of intestinal tract and blood and lymph |
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How do the Ig's differ?
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each reacts with a specific effector cell and molecule to protect the body
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What do IgG, IgM, IgA specifically do?
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protective functions, neutralize toxins, viruses, precipitation, aggulation, and lysis of bacteria and other foreign material
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What does IgE specifically do?
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involved in allergic disorders and parasitic infections
located in resp and intestinal tract |
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How do the IgE work?
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two more more IgE molecules bind to an allergen and trigger mast cells/basophils, which release chemical mediators (histamines, serotinin, kinins, anaphylaxis, neutrophil factor)
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What do chemical mediators produce?
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alleric reactions such as skin reactions, asthmas, hay fever
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How do antibodies combine with antigens?
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lock and key, only certain antigens fit certain antibodies, must have affinity
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What is an epitope?
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an immunologically active site on an antigen
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Why is it important that antibodies are bivalent?
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they have two combining sites, so antibody becomes crosslinked between two antigens causing them to clump (aggluatination) and cleared from the bloodstream easier
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What is the role of the B cells
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they are programmed to produce one specific antibody, to destroy and remove that antigen
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What is the role of the T cells?
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secrete lymphokines that encourage cell growth, promote cell activation, destroy targets cells and stimulate macrophages
They assist in digestion and removal of antigen |
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Where are mast cells located and what do they do?
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located in skin and mucous membranes
when stimulated by antigens release chemical mediators |
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where are the IgE located?
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occupy certain receptors on mast cells and bind antigens
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Summarize allergen response
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allergen triggers B cell to make IgE antibody, IgE antibody attaches to mast cell, when antigen reappears it binds to IgE and triggers mast cell to release chemical mediators
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Describe histamine: where are they released from, how fast do they have an effect, their s/s
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released from mast cells granules within 15 mins of exposure, causes localized edema, pruritis, bronchio spasm, dilation of small vessels and constriction of large vessels, incr GI secretions
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What is the difference betwen histamine 1 and 2?
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1 are found in bronchiolar and vascular smooth muscle (benadryl)
2 are found in GI (zantac) |
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Describe eosinophil chemotactic factor of anaphylaxis
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performed in mast cells and effect movement of eosinophils at site of allergen, released from disrupted mast cells
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Describe platelet-activating factor
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responsible for platelet aggregation and leukocyte infiltration, causes bronchoconstriction and inc vascular permeability
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Describe prostaglandins
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produce smooth muscle contraction, vasodilation, incr capillary permeability, fever and pain
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What are primary mediators?
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found in mast cells or basophils, first effect on blood vessesl, smooth muscles, glandular secretions, second effect on cellular infiltration
histamine, eosinophil chemotactic factor, platelet-activiating factor, prostagladins |
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What are secondary mediators?
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inactive precursors that are formed or released in response to primary mediators
leukotrienes, bradykinin, serotonin |
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What do leukotrienes do?
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initiate inflammatory response, cause smooth muscle contraction, bronchial contraction, mucus secretion, wheal-and-flare rx of skin
BRONCHOSPASM- asthma |
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What does bradykinin do?
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incr vascular permeability, vasodilation, hypotension, smooth muscle contraction (bronchi), nerve cell fibers causing pain
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What does serotonin do?
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vasoconstrictor and contraction of bronchial smooth muscle
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What is hypersensitivity?
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excessive or aberrant immune response, usually following re-exposure, initated by buildup of antibodies
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Describe Type I hypersensitivity?
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ANAPHYLACTIC-occurs within minutes of exposure, mediated by IgE, causes release of vasoactive amines and other mediators
-vasodilation, inc capillary permeability, smooth muscle contraction, eosinophilia, laryngeal stridor, angioedema, hypotension, bronchial, GI, uterine spasm, hives, asthma, ALLERGIC RHINITIS, |
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Describe Type II hypersensitivity
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, thrombocytopenia
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Describe Type III hypersensitivity
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Immune complex, injury from vasoactive amines deposited, acute inflammation often in joints and kidneys, SLE, nephritis, RA
s/s-urticaria, joint pain, fever, rash, adenopathy, bacterial endocarditis |
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Describe Type IV hypersensitivity
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delayed-type/cellular hypersensitivity (24-72 hours), tissue damage from lymphokines, macrophages, lysozymes
s/s-CONTACT DERMATITIS, PPD, hashimotos, itching, erythema, raised lesions |
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Assessment/tests of allergic disease
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health history, OLDCART, WBC eosinphil level (15-40%), smear blood samples of eosinophils, Total serum immunoglobulin E levels,skin tests, provocative test (direct adm), radioimmunoassay that measures specific IgE
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What are atopic disorders?
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hereditary predisposition and local rx to IgE antibodies
allergic rhinitis, asthma, dermatitis/eczema |
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What are nonatopic diseases?
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lack the genetic component and organ specificity
latex allergy, contact dermatitis |
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Describe anaphylaxis
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antigen binds with IgE on mast cells and peripheral blood basophils, chemical mediators are released causing vascular permeability changes (dec BP), flushing, urticaria, angioedema, hypotension, bronchconstriction, mucosal edmea and inflamm, right away
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What are common causes of anaphylaxis
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foods, meds (antibiotics,IV anesthetics, asprin, NSAIDS, opiods), insects, latex, radiocontrast agents
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What are mild clinical manifestations of anaphylaxis
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peripheral tingling, warmth sensation, fullness in mouth and throat, nasal congestion, periorbital swelling, pruritis, sneezing, tearing within the first 2 hours of exposure
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What are moderate clinical manifestations of anaphylaxis
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flushing, warmth, anxiety, itching, bronchospasm, edema of airway, dyspnea, cough, wheezing
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What are severe clinical manifestations of anaphylaxis
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abrubt onset, bronchospasm, laryngeal edema, severe dyspnea, cyanosis, HYPOTENSION, dysphagia,abdominal cramping, V/D, SZ, cardiac arrest, coma
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How can one prevent anaphylaxis
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strict avoidance of allergen, screening, wearing identification, immunotherapy, desensitization
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What is the medical management for anaphylaxis?
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oxygen, epinephrine (1:1000 dilute), antihistamine, corticosteroids, IV fluids, vasopressor, glucagon,
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Describe allergic rhinitis
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(hay fever, seasonal allergic rhinitis), most common form of respiratory allergy mediated by Type I hypersensitivity, IgE response, 10-25% of population
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Describe what happens with allergic rhinitis
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exposure of antigen builds antibodies, re-exposure histamine is released causing tissue edema from vasodilation and inc capillary permeability
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What are the s/s of allergic rhinitis?
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sneezing, nasal congestion, clear, watery nasal discharge and itching, itching of throat, dry cough, headache, pain over sinuses, epistaxis (nose bleed0, fatigue, loss of sleep, poor concentration
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How is allergic rhinitis diagnosed?
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history, physical exam, relationship between seasons/stress, nasal smear, peripheral blood count, total serum IgE, epicutaneous and intradermal testing, RAST, food elimination/challenge, nasal provocation tests
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How is allergic rhinitis treated?
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avoidance, pharmacotherapy, immunotherapy
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How do antihistamines work?
What are they typically used for? What are their side effects? |
selectively bind to H1 receptors, preventing the action of histamines
used for allergic rhinitis side effects-nervousness, tremors, dizziness, dry mouth, palpitations, anorexia, nausea, vomiting |
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How to adrenergic agents work?
What are their side effects? |
activate alpha-adrenergic receptor sites on smooth muscle of mucosal vessels reducing local blood flow, fluid exudation and mucosal edema
usually topical, can not be used long term--rebound effect side effects-HYN, dysrhythmias, palpitations, CNS stimulation, irritability, tremor, tachyphylaxis |
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When are corticosteroids used? what are their side effects?
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severe cases, metered spray, topical, oral, parenteral
suppress hosts immune system, must not stop suddenly, weight gain, fluid retention, gastric irriation, glucose intolerance, adrenal suppression |
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Describe immunotherapy
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injection of allergen extracts, gradually increasing quantities to reduce IgE circulating, increasing blocking antibody IgG and reducing mediator cell sensitivity
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What are some nursing considerations for immunotherapy
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should only be done in office with epinephrine is available, patient should wait 30 mins before allowed to leave
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What type of hypersensivity is contact dermatitis?
What causes it? |
Type IV- delayed
direct skin contact with chemicals or allergens |
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Describe the 4 types of contact dermatitus
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1. allergic-contact to skin (avoidance, corticosteroids, compress, antihistamines
2. irritant-contact that causes damage (removal, hydrophilic cream, antibodics) 3. phototoxic- allergic reaction that requires sun 4. photoallergic- allergic reaction tha requires light |
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S/S of contact dermatitus
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itching, burning, erythema, skin lesions, edema, weeping, crusting, dry and peeling skin, hemorrhagic bullae
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Describe atopic dermatitus
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type I immediate hypersensitivity, elevated IgE and peripheral eosinophilia, pruritus, hyperirritability, excess dryness, lesions, redness
may lead to asthma and allergic rhinitis |
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How is atopic dermatitus managed?
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antihistamines, avoidance, skin moisturizing, topical corticosteroids, antibodies, immunosuppressive agents, decrease itching
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What is dermatitis medicamentosa?
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type I, skin rash associated with medications
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What is urticaria?
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hives, type I, effects skin, mucous membranes, larynx, GI tract
if last >6 weeks chronic |
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What is angioneurotic edema?
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live hives yet effects deeper layers of skin that has diffuse swelling
effects lips, eyelids, cheeks, hands, feet, genitalia, tongue, bronchi, GI Swelling usually appears in one place at a time |
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What is hereditary angioedema?
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edema of skin, resp tract, digestive tract
precipated by trauma but genetic can last 1-4 days, can cause resp obstruction epinephrine, antihistamines, corticosteroids |
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What type of hypersensitivity are food allergies?
What are the s/s of food allergies? |
IgE mediated type I
urticaria, dermatitis, wheezing, coughing, laryngeal edema, angioedema, itching, swelling, abd pain, N/V/D |
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What are common food allergy foods?
What causes the most severe reactions? |
seafood, legumes, seeds, tree nuts, berries, egg whites, buckwheat, milk, chocolate
PEANUT and TREE NUTS |
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What is the medical management of food allergies?
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avoidance, H1 blockers, antihistamines, adrenergic agents, corticosteroids, cromolyn sodium, early recognition of reaction
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What is serum sickness?
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Type III, IgE & IgG, use to be found in animal sources of vaccinations
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What are the s/s of serum sickness and how is it treated?
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inflammtion, lymphadenopathy, fever, urticarial, purpuric, tender and swollen joints, cardiac involvement, Guillain-Barre
antihistamines, corticosteroids, ventilator support |
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What routes of exposure can occur to latex allergies?
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cutaneous, mucosal, parenteral, aerosol
-condoms, catheters, airways, nipples, IV lines, medical devices |
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What are the two types of latex allergy?
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Type IV- delayed hypersensitivity, most common
TypeI immediate hypersensitivity |
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What are s/s of Type IV and Type II?
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Type IV- pruritus, edema, erythema, crusting of skin
Type I- rhinitis, conjuctivitis, asthma, anaphylaxis, urticaria, wheezing, dyspnea, laryngeal edema, bronchospasm, tachycardia, angioedema, hypotension, cardiac arrest |
