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ALLERGIC REACTIONS



Hypersensitivity/allergic responses- an increased or excessive response to the presence of an antigen to
which the client has been previously exposed



Type1: 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 proteins

Type 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 reaction

Type 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 arthritis

Type 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, sarcoidosis

Type 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 Gammopathies

ALLERGIC DISORDERS
ANAPHYLAXIS- results from type1 in w/c release of chemical mediators from mast cells result in massive
vasodilation, 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
        regulations

ALLERGIC 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 only

DERMATITIS

Contact dermatitis- acute or chronic rash caused by either direct contact with an irritant substance or by
contact with an allergen

ATOPIC DERMATITIS- chronic rash that occurs with respi allergies and atopic skin dse

DERMATITIS MEDICAMENTOSA- drug reactions



Mgt: 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 itching

URTICARIA

SERUM SICKNESS

    -   Caused by a collection of immune complexes deposited in the skin, joints and kidney
-   Less common now because vaccines are made with human protein
   -   Causative agents: antilymphocyte globulin
   -   Interventions: symptomatic tx, antihistamine, aspirin, prednisone

LATEX ALLERGY

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NCM notes: Allergic reactions

  • 1. ALLERGIC REACTIONS Hypersensitivity/allergic responses- an increased or excessive response to the presence of an antigen to which the client has been previously exposed Type1: 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 proteins Type 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 reaction Type 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 arthritis Type 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, sarcoidosis Type 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 Gammopathies ALLERGIC DISORDERS
  • 2. ANAPHYLAXIS- results from type1 in w/c release of chemical mediators from mast cells result in massive vasodilation, 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 regulations ALLERGIC 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 only DERMATITIS Contact dermatitis- acute or chronic rash caused by either direct contact with an irritant substance or by contact with an allergen ATOPIC DERMATITIS- chronic rash that occurs with respi allergies and atopic skin dse DERMATITIS MEDICAMENTOSA- drug reactions Mgt: 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 itching URTICARIA SERUM SICKNESS - Caused by a collection of immune complexes deposited in the skin, joints and kidney
  • 3. - Less common now because vaccines are made with human protein - Causative agents: antilymphocyte globulin - Interventions: symptomatic tx, antihistamine, aspirin, prednisone LATEX ALLERGY