HYPERSENSITIVITY OR ALLERGY
Is an increased or excessive response to the presence of an antigen ( foreign protein or allergen) to which the client has been previously exposed. Initial responses:
Itching
Watery
eyes sneezing
Leads to life-threatening conditions such as:
Allegric
asthma Anaphylaxis Bronchoconstriction or Circulatory collapse
BASIC TYPES
TYPE 1 HYPERSENSITIVITY REACTION
Anaphylactic hypersensitivity ORGAN SPECIFIC The most severe form of hypersensitivity reaction The most severe immune-mediated reaction results from the increased production of the Ig E antibody class
Signs and symptoms:
ANAPHYLAXIS:
Uneasiness
Apprehension Weakness
Impending
doom
ALLERGIC RHINITIS: Runny nose watery eyes Itching fever
BRONCHIAL ASTHMA
Dyspnea
wheezing
ATOPIC ECZEMA/ DERMATITIS
Urticaria
angioedema
CLINICAL EXAMPLES
Hay fever Allergic asthma Anaphylaxis
TYPE II: CYTOTOXIC REACTIONS
ORGAN SPECIFIC May affect variety of organs and tisssues Reaction time is 10 to 14 mins. Primarily mediated by antibodies of Ig M and Ig G classes and phagocyte as well as T cells
Signs and symptoms
Fever
Nausea
CIRCULATORY OVERLOAD Dyspnea headache tachypnea Cough chest tightness
SEPSIS Fever
nausea
vomiting
diarrhea
Treatment
Autologous transfusion
CLINICAL EXAMPLES
Autoimmune hemolytic anemia Good Pastures Syndrome Myasthenia Gravis
TYPE III: IMMUNE MEDIATED HR
NON-ORGAN SPECIFIC May be general (serum sickness), may involve individual organs including skin (Systemic Lupus Erythematosus), kidneys (nephritis), lung (aspergillosis), blood vessels (polyarthritis), joints (arthralgia, athritis/ rheumatoid arthritis) Reaction may take 3-10 hours after exposure of the antigen Mediated by Ig G and Ig M
Signs and symptoms:
Urticaria
Joint
pain Fever Rash Adenopathy (swollen glands)
Treatment
-symptomatic treatment
Antihistamines-
for
itching Aspirin- for athralgia Prednisone- for severe symptoms
CLINICAL EXAMPLES
Serum sickness Vasculitis Systemic Lupus Erythematosus Rheumatoid arthritis
TYPE IV : T- CELL MEDIATED HR
ORGAN SPECIFIC Delayed Hypersensitivity reaction Mediated by T cells rather than antobodies Lesions are more papular
CLINICAL EXAMPLES
Poison ivy Graft rejection Positive TB skin tests Sarcoidosis
TYPE V: STIMULATORY REACTIONS
- B cell Mediated HR This type of reaction involves inappropriate type of hyperthyroidism, results from excessive output of thyroid hormones caused by abnormal stimulation of thyroid glands by circulating immunoglobulins.
CLINICAL EXAMPLES
Graves disease
Signs and symptoms
Exophthalmos Palpitations Abnormal increased pulse Pruritus perspiration
Treatment
Antithyroid agents Radioactive iodine surgery
Diagnostic Evaluation
Blood tests Smears of body secretions Skin tests Radioallergosorbent test (RAST) CBC differential Eosinophil count Total serum Ig E levels