Immunologic and Allergic Diseases

1. IMMUNOLOGIC AND
ALLERGIC DISEASES

2. IMMUNE SYSTEM
 Mission: to seek and kill
“invaders” or foreign bodies
(microorganisms, parasites,
cancer cells, etc.)
 Must be able to distinguish
between what is self and
non-self
 Any substance identified as
non-self, stimulate an
immune response in the body
INTRODUCTION

3.  Antigen – maybe contained within or on bacteria,
viruses, other microorganisms or cancer cells
- They may exist on their own
e.g. food molecules, pollen
 A normal immune response
Ag (antigen) – activates / mobilizes forces to defend
by attacking it.
 Mistake self for non-self – attack own tissues
(autoimmune disorder)

4.  Immune System is made up of lymphoid tissues in
the body which includes:
- bone marrow - parts of spleen – GIT
- Thymus - tonsils
- proteins and cells in the
blood are also part of the
immune system

5. TERMINOLOGIES:
 Antibody (immunoglobulin) – a protein produced by
B cells
– interacts with antigen
 Antigen – any substance that the immune system
recognizes and can stimulate an immune response
 B Cell (B Lymphocyte / Bursa Cells / Humoral
Immunity) – bone marrow derived or bursa
equivalent lymphocyte in a WBC that produces
antibodies specific to the Ag that stimulated their
production
UNDERSTANDING THE IMMUNE SYSTEM

6.  T Cell (T Lymphocyte / Thymus / Cellular
Immunity)
- thymus derived, WBC that is involved in specific
immunity and that maybe one of 3 types:
• Helper T-Cell
• Killer (Cytotoxic) T-Cell
• Regulatory T-Cell
 Basophil – WBC that releases histamine
- produces substances to attract other WBC to a
troubled spot

7.  Cytokines – proteins secreted by cells that act as the
immune systems messengers and that help regulate
an immune response
 Eosinophils – WBC that kills bacteria
- Kills other foreign cells too big to ingest
- Help immobilize and kill parasites
- Participates in allergic reactions
- Help destroy cancer cells

8.  Macrophage – large cell that develops from a
WBC called monocyte
- ingests bacteria and other foreign cells
 Neutrophil – WBC that ingests and kills
bacteria and other foreign cells
 Phagocyte – A cell that ingests / kills /
destroys invading microorganisms, other
cells and cell fragments

9. B CELL or HUMORAL IMMUNITY

10. T CELL or CELLULAR IMMUNITY

11. 1. The body generates an immune response
against itself (autoimmune disorder)
2. The body cannot generate appropriate
immune responses against invading
microorganisms (immunodeficiency
disorder)
3. An excessive immune response to often
harmless foreign antigens damages normal
tissues (an allergic reaction)
DISORDERS OF THE IMMUNE SYSTEM
OCCUR WHEN:

12. - immune system mistakenly attacks and
destroys healthy body tissue response is
a hypersensitivity reaction similar to the
response in allergic reaction.
ALLERGY – reaction to an outside substance
that it would normally ignore
AUTOIMMUNE DISORDER – reaction to
normal body tissue that it would normally
ignore
I. AUTOIMMUNE DISORDERS

13. CAUSE: UNKNOWN
THEORY: some microorganisms
(bacteria & virus) or drugs may trigger
some of these changes, especially in
people who have genes that make
them more likely to get autoimmune
disorders.

14. 1. An autoimmune disorder may
result in:
• destruction of one or more types
of body tissues
• abnormal growth of an organ
• changes in organ function
CHARACTERISTICS:

15. 2. An autoimmune disorder may affect one or more
organ or tissue types.
a. It can be organ specific:
• ENDOCRINE SYSTEM
thyroid gland – Hashimoto’s thyroiditis
– Grave’s disease
– Type I & II autoimmune
polyglandular syndrome
– Insulin dependent DM

16. • SKIN
- pemphigus vulgaris
- dermatitis herpetiformis
- epidermolysis bullosa
- autoimmune alopecia
- contact dermatitis

17. • HEMOTOLOGIC
- autoimmune hemolytic anemia
- autoimmune thrombocytopenic purpura
- autoimmune neutropenia
• NEURO-MUSCULAR SYSTEM
- myasthenia gravis
- multiple sclerosis
- Guillain – Barre’ Syndrome

18. • HEPATOBILIARY SYSTEM
- autoimmune chronic active hepatitis
- primary biliary sclerosis
- sclerosing cholangitis
• GIT
- pernicious anemia
- inflammatory bowel disease

19. b) It can be organ nonspecific
• CONNECTIVE TISSUE DISEASES
- systemic lupus erythematosus
- rheumatoid arthritis
- scleroderma
- sjogren’s syndrome
- ankylosing spondylitis
- psoriasis

20. • VASCULITIC SYNDROMES
- hypersensitivity vasculitis
- Wegener’s Granulomatosis
- Takayasu’s Arteritis
- Kawasaki’s Disease
- Sarcoidosis
- Graft versus host disease

21.  symptoms of an autoimmune disease vary
based on the disease and location of the
abnormal immune response
 symptoms that often occur with autoimmune
diseases include
- fatigue
- fever
- body malaise
SYMPTOMS:

22. depends on the type of disease which will
generally include:
- ANA (antinuclear antibody tests)
- autoantibody test
- CBC
- C-Reactive Protein (CRP)
- erythrocyte sedimentation rate (ESR)
DIAGNOSIS:

23. GOALS:
• reduce the symptoms
• control the autoimmune process
• maintain the body’s ability to fight disease
1. SUPPLEMENTS
- hormonal replacement
- vitamins e.g. B12
- insulin injections
- thyroid supplements
TREATMENT:

24. 2. BLOOD TRANSFUSION
3. PHYSICAL THERAPY
4. MEDICINE
- to control or reduce immune system’s
response (immunosuppressive drugs)
- corticosteroids
- non-steroidal drugs - azathioprine
- cyclophosphamide
- sirolimus
- tacrolimus

25. - Depends on the disease
- Can be controlled by treatment
- Symptoms can come and go
- Flare-up when symptoms worsen
PROGNOSIS:

26. - Occurs when the body’s immune response is
reduced or absent
- Occurs when T or B lymphocytes do not
work as well as they should or when the body
does not produce enough antibodies.
- Can be congenital, spontaneously acquired or
iatrogenic
- Unusual susceptibility to infection and
frequently to autoimmune diseases and
lymphoreticular malignancies.
II. IMMUNODEFICIENCY DISORDER

27. - Ataxia telangiectasia
- Chediak-Higashi Syndrome
- Combined immunodeficiency disease
- Complement deficiencies
- Di George Syndrome
- Hypogammaglobulinemia
- Panhypogammaglobulinemia
- Selective deficiency of IgA
- Wiscott-Aldrich Syndrome
A. PRIMARY IMMUNODEFICIENCIES

28. - Acquired Immuno Deficiency Syndrome
(AIDS)
- Iatrogenic
- Idiopathic CD4 and T lymphocytopenia
B. ACQUIRED IMMUNODEFICIENCY

29. depend on the disorder
TELL-TALE SIGNS:
• chronic infection
• severe infection from bacteria or other
forms that do not usually cause severe
infection
• poor response to treatment
• delayed or incomplete recovery from illness
• certain types of cancers (Kaposi’s sarcoma
or non-Hodgkin’s lymphoma
• certain infections
SYMPTOMS:

30.  Complement levels in blood
 HIV Test
 Blood immunoglobulin levels
 CHON electrophoresis
 T lymphocyte count
 WBC Count
DIAGNOSIS:

31. GOAL – to prevent infections and treat any
disease and infections that do develop.
1. Avoid contact with persons who have
infections or contagious disorders
2. Avoid people who have been vaccinated
with live virus vaccine within the past 2
weeks
3. Aggressive Treatment – long term use of
Abtx. or antifungal
- Prophylactic Tx
TREATMENT:

32. 4. Interferon – tx viral infection and
some types of cancer
- immunostimulant drug
5. Bone Marrow Transplant
6. Passive Immunity
7. Immunoglobulin Infusions

33. 4 Types of Hypersensitivity Reactions:
TYPE I: immediate Ig-E mediated
which causes rapid degranulation of
mast cells
- IgE binds to the mast cells via a high
affinity Fc receptor.
- Early Phase: within minutes
- Late Phase: hours after initial response
e.g. allergic rhinitis, food allergy,
allergic or atopic asthma.
III. ALLERGIC DISEASES:

34. TYPE II: Antibody mediated
- Ab binds to cells and causes
damage or impairment of
functions
e.g. transfusion reactions,
hemolytic anemias, graft
rejection, myasthenia gravis,
good pastures syndrome

35. TYPE III: immune complex
mediated
- Occurs when IgG or IgM binds
with Ag and the complexes are
deposited in tissues
e.g. serum sickness,
glomerulonephritis, arthritis
TYPE IV: T-Cell mediated
(delayed hypersensitivity)
- First exposure: T-cell is
sensitized subsequent exposure:
allergen is recognized and
detected, thereby these cells are
lysed by T Cells.
e.g. contact dermatitis,
granulomatous diseases

36. ALLERGY – exaggerated
immunologic response to an
otherwise innocuous agent, which
causes harm to the host
ALLERGEN – inciting agent

37. PATHOPHYSIOLOGY:
• IgE binds to surface of mast cells and
basophils
• Cross linking of IgE by Ag causes cellular
activation
• release of mediators – histamines
– prostaglandins
– leukotrienes
– SRS-A (slow-
reacting substance of
anaphylaxis
TYPE I HYPERSENSITIVITY
(Immediate Type)

38. - Anaphylaxis
- Serum Sickness
- Generalized Drug Reactions
- Food Allergy
- Insect Venom
- Mastocytosis
ALLERGIC DISEASES
GENERALIZED

39. - Allergic rhinitis
- Asthma
- Hypersensitivity
pneumonitis
- Urticaria
- Angioedema
- Eczema
- Atopic dermatitis
AIRWAYS SKIN

40. - Allergic conjunctivitis
- Atopic keratoconjunctivitis
- Giant papillary conjunctivitis
- Contact allergy
OCULAR ALLERGY

41. DEFINITION: the life threatening
anaphylactic response of a sensitized
human appears within minutes after
administration of specific Ag and is
manifested by respiratory distress, often
followed by vascular collapse or by
shock without antecedent respiratory
difficulty.
A. ANAPHYLAXIS

42. Hallmark of anaphylactic reaction: onset of
S/S within seconds to minutes after
introduction of the Ag
S/S: laryngeal edema – lump in throat,
hoarseness or stridor
bronchial obstruction – tightness in the chest
or wheezing
cutaneous wheals – erythematous, raised,
serpiginous borders and blanched centers;
pruritic
PATHOPHYSIOLOGYAND
MANIFESTATION

43. - Early recognition
- Mild symptoms (pruritis and urticaria)
– 0.2 ml to 0.5 ml of 1:1000
epinephrine SQ
- Hypotension – volume expanders
– vasopressor agents
(dopamine)
- O2
TREATMENT:

44. URTICARIA – involves the superficial
portion of the dermis
-well-circumscribed wheals
ANGIOEDEMA – well demarcated localized
edema involving the deeper areas / layers of
the skin, including the subQ tissues
ACUTE – recurrent episodes of less
than 6 weeks
CHRONIC – attacks persisting
beyond 6 weeks
B. URTICARIA and ANGIOEDEMA

45. - Urticarial eruptions are pruritic, appear in
crops of 24 – 72o duration
- Most common sites: extremities, external
genitalia, face
- History
- Skin testing
- Laboratory exam: complement levels,
ESR
PATHOPHYSIOLOGYAND
MANIFESTATION
DIAGNOSIS

46. - Avoidance of offending agents
- H1 and H2 antihistamines
• ranitidine 150 mg p.o. BID
• diphenhydramine 25-50 mg p.o. QID
• hydroxyzine 25-50 mg p.o QID
-
TREATMENT

47. - Inflammatory condition of the
nose characterized by sneezing,
rhinorrhea and obstruction of
nasal passages
PATHOPHYSIOLOGY:
impingement of allergens on nasal mucosa Ig-E
dependent triggering of mast cells release of
mediators hyperemia, swelling, fluid
transudation
C. ALLERGIC RHINITIS

48. - Accurate history
- physical examination: boggy nasal mucosa
- nasal smear – large # of eosinophils
- Antihistamines
- Oral Sympathomimetics: pseudoephedrine 30-
60mg p.o. QID
- topical nasal steroids: beclomethasone 2 sprays
in each nostril BID – TID
- topical nasal cromolyn sodium 1-2 sprays in
each nostril QID.
DIAGNOSIS:
TREATMENT: