Types of Hypersensitivities
- Atopic (Type I)
- Mediator: Immunoglobulin E
- result from action of antigen-antibody reactions that sensitize mast cells to release histamine
- e.g. asthma, allergic rhinitis, anaphylaxis
- Cytotoxic (Type II)
- Mediator: Immunoglobulin G and Immunoglobulin M
- result when the system mistakenly identifies a normal constituent of the body as something foreign
- e.g. hemolytic anemia, myasthenia gravis, transfusion reaction, rheumatic fever
- Immune Complex (Type III)
- Mediator: Immunoglobulin G
- manifests with acute inflammation resulting from formation and deposition of immune complexes when antigens bind to antibodies
- e.g. systemic lupus erythematosus (SLE), nephritis
- Delayed (Type IV)
- Mediator: T Cells
- occurs 24-72 hours after exposure to an allergen
- e.g. Graft vs. Host Disease (Chronic Transplant Rejection), multiple sclerosis
- Stimulatory Reaction (Type V)
- Mediator: Immunoglobulin G
- abnormal stimulation of a cell surface receptor by an autoantibody
Allergic Asthma
- inhaled allergens - histamine release from mast cells produces laryngeal edema causing bronchospasm
- Signs and Symptoms
- wheezing
- increased sputum production
- dyspnea
- restless and anxious
- Diagnostic Test Results
- elevated IgE
- elevated eosinophils
- Treatment of Choice
- short acting β2 agonist – albuterol (bronchodilator)
- long acting β2 agonist – salbutamol (bronchodilator)
- leukotriene receptor antagonist – montelukast, zafirlukast (lessens inflammation and bronchoconstriction brought about by leukotrienes)
- anti-inflammatories – NSAIDs
- mast cell stabilizers – cromolyn (prevents release of histamine)
- corticosteroids – fluticasone, prednisone (reduces inflammation)
- Nursing Management
- elevate head of bed - to help drain secretions and improve ventilation
- deep breathing - to increase air intake
- increase fluid intake - to loosen secretions
- administer O2
- avoid allergic triggers
Allergic Rhinitis / Hay Fever
- Signs and Symptoms
- rhinorrhea (runny nose)
- decreased nasal sinus transillumination
- sneezing
- nasal itching
- dry cough
- headache
- fatigue
- Diagnostic Test Results
- elevated IgE
- elevated eosinophils
- Treatment of Choice
- desensitization therapy (controlled exposure to allergens)
- 1st year – weekly
- 2nd year – every other week
- 3rd year – every 3-4 weeks
- Treatment of Choice
- antihistamines
- corticosteroids
- decongestants
- anticholinergics
Anaphylaxis
- may result into anaphylactic shock from systemic vasodilation and then death
- Signs and Symptoms
- systemic vasodilation
- tingling of extremities
- laryngospasm & bronchospasm
- hypotension
- dyspnea
- Drug of Choice
- EPINEPHRINE - increased BP and improves airway
- Nursing Management
- maintain patent airway
- O2 continuous
- absolute NPO
- semi-Fowler’s
- monitor V/S, I/O
Systemic Lupus Erythematosus (SLE)
- Types
- Discoid – affects skin only
- Systemic – affects skin, joints, and organs
- Signs and Symptoms
- butterfly rash (pathgnomonic sign)
- lupus arthritis
- myalgia
- lupus nephritis
- chest pain from pericarditis
- Diagnostic Test Results
- increased antinucleate antibody
- increased rheumatoid factor
- increased serum complement
- pancytopenia
- increased ESR (erythrocyte sedimentation rate)
- Treatment of Choice
- corticosteroids
- antimalarials
- Nursing Management
- use mild soap
- pat dry skin
- moisturizers
- use sun block
- mouth care
- support groups
Transplant Rejection
- Organ Donors
- homologous – from another person
- autologous – from self
- cadaveric – from dead persons
- Tissue Grafts
- autograft – from self
- isograft – from twin
- allograft – from another person
- xenograft – from another species
- Nursing Management
- proper screening and matching (HLA testing)
Serum Sickness
- inflammatory reaction after administration of antisera
- Causes
- penicillin
- antithymocyte globulin
- antilymphocyte globulin
- Signs and Symptoms
- fever
- arthralgia
- body malaise
- lymphadenopathy
- nephritis
- polyarthritis
- Treatment of Choice
- antihistamines
- corticosteroids
- aspirin
- Nursing Management
- adequate nutrition
- enhance mobility
Graft vs. Host Disease
- Infiltrated T lymphocytes are reactivated to attack the host after transplantation
- Treatment of Choice
- cyclosporine
- azathioprine
- prednisone
- interleukin-2 antagonist
- antithymocyte globulin
