Type 1 Hypersensitivity
Description- anaphylactic, immediate-type sensitivity
Mechanism- Ag binding directly to IgE on mast/basophil causing degranulation of mast/basophil leads to the release of histamine, prostaglandins, and leukotrienes. *Response is IgE dependent
Examples-
Type 2 Hypersensitivity
Type 3 Hypersensitivity
Type 4 hypersensitivity
Allergic rxns manifest on a wide spectrum, true or false?
True
What is the function of histamine?
potent vasodilator, increases capillary permeability, stimulates smooth muscle contraction
Type 1 IgE mediators of allergic rxns include…
2 subgroups of IgE mediated Allergy
- anaphylaxis
Atopy
triggers:
pollon, mold, animal dander, dust mites
Anaphylaxis
-atopy + respiratory issues
(MASSIVE atopy to millionth degree)*
-systemic response, bronchioconstriction, vasodilation (volume decreases, cardiogenic shock), bronchospasm, GI and uterine muscle contraction, urticaria, angioedema, allergy that affects airway
Trigges:
drugs like penicillin, latex, insect venom, certain foods
What is urticaria?
How would this present?
Time for development and cessation
hives- may be few mm to cm in diameter
-immune mediated skin eruption of well circumscribed, blanching wheals on an erythematous base
often have central pallor, may be raised or flat
-can develop in minutes to hours, may only last 12-24hrs
what is Angioedema?
How would this present?
*drugs that may cause this?
Time for development and cessation
-rapid swelling of the dermis, sub Q tissue, mucosa, and submucosal
Urticaria and Angioedema caused by?
mast cell release of inflamm mediators (primarily histamine)
Physical Urticarias
dermatographism- gentle stroking of skin
pressure urticaria- pressure to skin
cold- eruptions following application of cold
cholinergic urticaria- triggered by exercise or hot shower
aquagenic urticaria- hives after contact with water
solar urticaria- hives develop after UV light exposure
Urticaria and ANgioe edema management
-prescribe epipen for anyone w/ sever bout of angioedema or anaphylaxis
Differences between Anaphylaxis and Anaphylactoid
anaphylaxis- allergic IgE mediated rxn
anaphylactoid- not IgE mediated rxn
*Presentation and management are identical
What is a late stage anaphylactic response and how would you treat it?
Anaphylactic pt manifestation
pruiritus (itching), flushing, sense of impending doom, urticaria (hives), angioedema, respiratory tract involvment (50%)
anaphylactic shock (30%)- caradiovascular collapse resulting from hypovolemia (d/t increased vascular permeability and up to 50% blood volume loss), myocardial depression
Anaphylactic Management
depends upon severity
*dont forget to prescribe epipen!
Common drug culprits of Type 1 IgE mediated hypersensitivity
How long will it take to mainfest symptoms in a patient that takes a drug they are allergic to?
depends on whether or not they have been sensitized.
Drug Allergy Rxn Pattern
Type 1 Hypersensitivity
What is generally the treatment of choice for Type 1 hypersensitivity rxns?
ANTI-HISTAMINES
Type II Hypersensitivity Mechanism
Antibody-dependent cytotoxicity
Mechanism- either IgG or IgM is made against normal self antigens (immune tolerance failure) or a foreign antigen resembling some molecule on the surface of host cells enters the body and IgG or IgM are made against that antigen
the binding of these antibodies to the surface of host cells leads to: