NCM notes: Allergic reactions


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NCM notes: Allergic reactions

  1. 1. ALLERGIC REACTIONSHypersensitivity/allergic responses- an increased or excessive response to the presence of an antigen towhich the client has been previously exposedType1: Rapid hypersensitivity reactions - Reaction of IgE antibody on the mast cells with antigen, which results in the relase of mediators, especially histamine - Can be contacted in the following ways: o Inhaled- plant pollen, fungal spores, animal dander, house dust, grass, ragweed) o Infested- food, food additives, drugs o Injected- bee venom, drugs, biologic substances such as dyes and adrenocorticotropic hormone - Contracted- pollens, foods, environmental proteinsType 2: Cytotoxic- reaction of IgG with host cell membrane or antigen absorbed by host cell membrane - Examples: Autoimmune hemolytic anemia - Goodpasture’s syndrome - Hemolytic transfusion reactionType 3: Immune complex-mediated - Formation of immune complex of antigen and antibody, which results in complement release and inflammation - Examples: serum sickness, vasculitis, SLE, rheumatoid arthritisType 4: delayed hypersensitivity reactions - Reaction of sensitized T-cells with antigen and release of lymphokines, which activate macrophages and induce inflammation - Examples: poison ivy, graft rejection, positive TB skin tests, sarcoidosisType 5: stimulatory reactions - Reaction of autoantibodies with normal cell-surface receptors, which stimulates a continual overreaction of the target cell - Ex: Grave’s dse, B-cell GammopathiesALLERGIC DISORDERS
  2. 2. ANAPHYLAXIS- results from type1 in w/c release of chemical mediators from mast cells result in massivevasodilation, increased capillary permeability - Loss of consciousness, hives, swelling of tongues and throat tissues, inability to swallow, difficulty breathing, low BP - CxMx- uneasiness, apprehension, weakness, generalized itching, urticaria - Intvns: tourniquet, CPR, O2, epinephrine, antihistamine, bronchodilators, steroids, strict IV regulationsALLERGIC RHINITIS- inflammation of the nasal mucosa caused by an allergen - Dx: inc eosinophil in nasal smear o Skin testing confirms hypersensitivity to specific allergen o Radioallergosorbent test - Mgt: antihistamines, topical or oral decongestants, intranasal cromolyn sodium, corticosteroids intranasally or orally, immunotherapy - Supportive care: reassure patient that suffocation will not occur o Use bedside humidifier and inc fluid intake o Observe pt after immunotherapy injection for 30mins for reaction - Health maintenance- nasal inhalers, OTC decongestants to 2-3days onlyDERMATITISContact dermatitis- acute or chronic rash caused by either direct contact with an irritant substance or bycontact with an allergenATOPIC DERMATITIS- chronic rash that occurs with respi allergies and atopic skin dseDERMATITIS MEDICAMENTOSA- drug reactionsMgt: avoidance therapy, steroids - Avoid applying oil-based products to sweaty skin folds; favourably used - Corticosteroids never cure - Antihistamines - Compresses and baths - Colloidal oatmeal preparations, tar extracts, cornstarch or oils are often added to baths to relieve itchingURTICARIASERUM SICKNESS - Caused by a collection of immune complexes deposited in the skin, joints and kidney
  3. 3. - Less common now because vaccines are made with human protein - Causative agents: antilymphocyte globulin - Interventions: symptomatic tx, antihistamine, aspirin, prednisoneLATEX ALLERGY