4. HYPERSENSITIVITY

Question 1

Steve Johnson’s Disorder is what type of disorder

Answer 1

Hypersensitivity Disorders

Question 2

Systemic Lupus Erythematosus is what type of disorder

Answer 2

Autoimmune Disorders

Question 3

state of altered reactivity in which the body reacts with an exaggerated immune response to what is perceived as a foreign substance

Answer 3

Hypersensitivy

Question 4

programmed to produce one specific antibody. On encountering a specific antigen, they stimulates production of plasma cells, the site of antibody production.

Answer 4

B cell, or B lymphocyte

Question 5

assists the B cells in producing antibodie

Answer 5

T cell, or T lymphocyte

Question 6

FUNCTION OF ANTIGENS

Two groups:

Answer 6

1. Complete protein antigens
2. Low-molecular-weight substances.

Question 6

secrete substances known as lymphokines that encourage cell growth, promote cell activation, direct the flow of cell activity, destroy target cells, and stimulate the macrophages.

Answer 6

T cell, or T lymphocyte

Question 7

FUNCTION OF ANTIGENS Two groups:

*such as animal dander, pollen, and horse serum, stimulate a
complete humoral response.

Answer 7

Complete protein antigens

Question 7

FUNCTION OF ANTIGENS Two groups:

such as medications, function as haptens, binding to tissue or serum proteins to produce a carrier complex that initiates an antibody response.

Answer 7

Low-molecular-weight substances.

Question 7

Types of Allergens

Answer 7

*Inhalants
*Ingestants
*Contactants
*Self Allergens

Question 8

Two types of chemical mediators:

Answer 8

*Primary
*Secondary

Question 9

type of chemical mediators:

are inactive precursors formed or released in response to primary mediators.

Answer 9

*Secondary

Question 9

type of chemical mediators:

preformed and found in mast cells or basophils

Answer 9

*Primary

Question 10

Classification of Hypersensitivity Reactions

Answer 10

• Type I - Immediate Hypersensitivity
• Type II - Cytotoxic/Cytolytic Hypersensitivity
• Type III - Immune Complex Disease
• Type IV - Delayed/Cell Mediated Hypersensitivity

Question 10

Factors that affect the degree of hypersensitivity reactions:

Answer 10

1. Responsiveness of host to allergen
2. Amount of allergen
3. Nature of allergen
4. Timing of exposure to allergen
5. Site of allergen-immune mediator reaction
6. Host’s threshold reactivity

Question 11

Classification of Hypersensitivity Reactions

• An exagerated immune response occurring in persons who have been previously sensitized to the specific antigen
• Inherited as a dominant trait

Sensitizing dose > Challenging dose > Allergic reaction

Answer 11

TYPE I: Immediate Hypersensitivity Reaction

Question 11

This measures the levels of allergy antibody, or IgE, produced whhen your blood is mixed with a series of allergens in a laboratory

Answer 11

Blood Test

Question 12

Classification of Hypersensitivity Reactions

Systemic life-threatening hypersensitivity reaction characterized by edema in many tissues and a fall in blood pressure secondary to vasodilation resulting from the intravascular presence of antigen introduced by injection, insect sting, or absorption across the epithelial surface of the skin or gastrointestinal mucosa.

Answer 12

Anaphylactic (Systemic) Reactions

Question 13

Classification of Hypersensitivity Reactions

It occurs when the antigen is confined to a particular site by virtue of exposure.
*i.e allergic rhinitis; food intolernce

Answer 13

Atopic (Local) Reactions

Question 14

• Characterized by symptoms of sneezing, itching and watery discharge from the eyes and nose
• Typical allergens may include pollens from grasses, weeds and trees; fungal spores; house dust mites; animal dander; feathers.

It is divided into 2 types:
* Perennial type-experience symptoms throughout the year
* Seasonal allergic rhinitis-plagued with intense symptoms in conjunction with periods of high allergen exposure

Answer 14

Allergic Rhinitis

Question 15

It stabilizes mast cells and prevents degranulation when administered before expected contact with an allergen

Answer 15

Intranasal cromolyn

Question 16

Type II: Cytotoxic/Cytolytic Hypersensitivity Reaction

Clinical Manifestations (Blood transfusion)

Answer 16

• Acute hemolytic
• Febrile, non-hemolytic
• Mild allergic
• Anaphylactic

Question 16

it involves frequent (usually weekly) injections of the offending antigens- stimulate production of high levels of IgG which acts as a blocking antibody by combining with the antigen before it can combine with the cell-bound IgE antibodies.

Answer 16

Desensitization

Question 16

Food Intolerance

*In children: ???
*In adults: ???

Answer 16

• milk, eggs, peanuts, soy, fish and shellfish foods
• peanuts, shellfish, and fish

Question 17

* Blood test using immunoassay test to detect specific IgE Ab * To determine the substances a subject is allergic to.

Answer 17

*Radioallergosorbent test (RAST)

Question 17

# **Type III: Immune Complex Disease** Deposition of immunoglobulins, complement, and fibrinolytic products in blood vessels happens

Answer 17

Localized Immune Complex Reactions | **Arthus reaction**

Question 18

# **Type II: Cytotoxic/Cytolytic Hypersensitivity Reaction** Medical Management

Answer 18

* Avoidance therapy * Immunotherapy * Medications * Diet

Question 18

# **Type II: Cytotoxic/Cytolytic Hypersensitivity Reaction** Diagnostic Procedures

Answer 18

*Serologic testing *Urinalysis

Question 18

Characterized by the formation and deposition of antigen-antibody complexes in various tissues which results in complement activation and inflammation

Answer 18

Type III: Immune Complex Disease ## Footnote * Systemic Immune Complex Disorders: Serum Sickness * Localized Immune Complex Reactions: Arthus Reaction

Question 19

______ directly kill the antigen-presenting target cells that can lead to tissue injury by killing infected target cells even if the virus itself has no cytotoxic effects

Answer 19

Cytolytic T lymphocytes

Question 20

* Confined to the skin initiated by re-exposure to an allergen to which a person had previously become sensitized (e.g. cosmetics, hair dyes, metals, topical drugs) * The reaction does not become apparent for at least 12 hours and usually more than 24 hours after exposure and may last from days to weeks

Answer 20

Allergic Contact Dermatitis

Question 21

Associated with exposure to inhaled organic dusts or related occupational antigens that may lead to chronic lung disease with minimal reversibilit

Answer 21

Hypersensitivity Pneumonitis ## Footnote E.g. “**farmer’s lung**”- a condition resulting from exposure to moldy hay

Question 22

# **Steven Johnsons Syndrome** Risk Factors

Answer 22

*Viral infections *Immunocompromise *Previous history *Medications – allopurinol, carbamazepine *Family history

Question 23

# **Steven Johnsons Syndrome** Manifestations

Answer 23

* **Skin Pain** – most common * **Flu-like symptoms** – malaise, fever, headache, Joint pain * **Rash** – red to purple that spreads and form blisters * **Large blisters** - painful sores after bursting * **Facial swelling and swollen lip**

Question 23

# **Steven Johnsons Syndrome** Diagnosis

Answer 23

* **Physical Exam** * **Medical history** * **Biopsy** – to confirm the diagnosis

Question 24

# **Steven Johnsons Syndrome** Nursing Intervention

Answer 24

* Small frequent feeding * Give analgesics * Provide basic comfort measures * Assess coping mechanism * Educate about the disease

Question 24

# **Steven Johnsons Syndrome** Medical Management

Answer 24

* NSAIDS * Fluid replacement * Topical corticosteroids * Antibiotics * Eyedrops * Mouthwashes * Cool moist compresses held against the skin * Moisturizer

Question 25

# **Systemic Lupus Erythematosus** Risk Factors

Answer 25

* **Genetic** * **Hormonal** * **Environmental** – sunlight * **Medications** – hydralazine, isoniazi

Question 26

# **Systemic Lupus Erythematosus** Clinical Manifestations

Answer 26

* **Classical symptoms** – fever, weight loss, pleuritis * **Musculoskeletal** – arthritis (common), joint swelling, pain, tenderness * **Integumentary** – butterfly rash * **Cardiovascular** – pericarditis (common)

Question 27

# **Systemic Lupus Erythematosus** Diagnosis

Answer 27

* History * Physical Examination

Question 28

# **Systemic Lupus Erythematosus** GOAL

Answer 28

* Prevent progressive loss of organ function * Reducing likelihood of acute disease * Minimize disease-related disabilities * Prevention of complications

Question 29

# **Systemic Lupus Erythematosus** Pharmacologic Management

Answer 29

* NSAID * Corticosteroids – tab/IV * Antimalarial drugs * Immunosuppressive agents

Question 30

# **Systemic Lupus Erythematosus** Nursing Management

Answer 30

* Cover * Reduce stress * Monitor for infection * Refer to dietician