CareOf

Hypersensitivity&

Autoimmunity

MEDICAL SURGICAL NURSING

SHARON KING, RN

Hypersensitivity 5 types:

Type I – V

Type I: Immediate IgE◦ Hay fever, allergy, asthma, anaphylaxis, allergic rhinitis

Type II: Cytotoxic IgG◦ autoimmune hemolytic anemia, MG, Goodpasture’s syndrome

Type III: Immune Complex Mediateddeposit in wall of blood vessel◦ Vasculitis, SLE, RA, serum sickness

Type IV: Delayed Sensitized T-cells◦ Poison ivy, graft rejection, positive TB, sarcoidosis, contact dermatitis

Type V: Stimulated Autoantibodies w/nl cell-surface receptors◦ Grave’s disease, B-cell gammopathies

Type I: Allergic Rhinitis

Type I: Allergic RhinitisAllergic

Perennial

Non-allergic

Type I: Allergic RhinitisAirborne allergens

Histamine activated (primary phase)

Leukotriene & prostaglandins (mediator of inflammation sec. phase)

Genetic tendencies

Type I: Allergic RhinitisRhinorrhea

Itchy, watery eyes

Drainage (posterior nasal drip)

Type I: Allergic RhinitisLabs:

◦ CBC & differential

Allergy Testing:

ROAT

Oral Food challenge

Skin (scratch or intradermal)◦ Systemic glucocorticoids d/c up2 4 wks. B4

◦ Antihistamines d/c up2 4 wks. B4

◦ Nasal sprays are permitted

Type I: Allergic RhinitisAvoidance

Drug therapy

CAM

Type I: Allergic RhinitisDecongestants

Benadryl, desloratadine, cetirizine, fexofenadine

Corticosteroids

Mast cell stabilizer: cromolyn sodium

Leukotriene modifiers: zileuton (Zyflo), zafirlukast (Accolade)

TI: Allergic RhinitisCAM: aromatherapy

Desensitization Therapy: “allergy shots”

Type I: Anaphylaxis

Type I: AnaphylaxisLife-threatening reaction

Occurs w/in 2nd’s after exposure

Type I: AnaphylaxisSevere abd. Cramping

N/V/D

Apprehension

Weakness

Impending doom

Anxious

Itching, urticarial

Dyspnea, stridor

Cyanosis, hypoxia

LOC, hypotonia, absent DTR

Erythema (angioedema): eyes, lips or tongue

Crackles, wheezing

hypotensive

Type I: AnaphylaxisRapid Response Team

ABC

Ensure emergency equipment ready

O2

If IV drug, Stop IT!

Stay w/client

Epinephrine (IM or IV)

HOB elevated

Neb: Albuterol Q2-4 hrs.

Raise feet and legs

Reassure client

Type I: AnaphylaxisEpinephrine

Isoproterenol

Ephedrine sulfate

Benadryl: 2nd line drug

Corticosteroids: 2nd line drug

Vasopressors: Support drugs◦ Norepinephrine

◦ Dopamine

Type I: Latex Allergy

Type I: Latex AllergyProtein in natural latex rubber

Avoidance Therapy

Intervention is based on level or reaction

High exposure incidents:◦ Patients

◦ Health care workers

◦ Use of latex condoms

Type II: Cytotoxic Reaction

Type II: Cytotoxic ReactionAutoantibodies directed against self cell

TX:

D/C offending drug

D/C offending blood product

Plasmapheresis

Treat symptomatic

Complications: hemolytic crisis, renal failure

Type III: Immune Complex Reactions

Type III: Immune Complex ReactionsExcess antigens cause complexes to form in blood

Complexes lodge in small blood vessel walls

Triggers inflammation & tissue damage

Type III: Immune Complex ReactionsSerum sickness:

Self-limiting◦ Fever◦ Arthralgia◦ Rash◦ Lymphadenopathy◦ Malaise

Keep emergency equipment & drug 4 anaphylactic reaction

Treatment is symptomatic

Antihistamines: 4 itching

Aspirin: arthralgia

Prednisone: if symptoms severe

Type IV: Delayed

Type IV: DelayedCollections of lymphocytes & macrophages

Causes edema, induration, ischemia & tissue damage @ site

Reaction is self-limiting 5-7 days

Positive PPD

Contact Dermatitis, poison ivy, insect stings,

Tissue transplant rejection

Sarcoidosis

Patch Testing: test chemicals in place 48 hrs

Avoidance Therapy & Treat symptomatically

Monitor sites distal 2 reaction: circulation

Benadryl

Corticosteroids

Type V: Stimulatory

Type V: Stimulatory Excessive stimulation of nl cell surface receptor

Continuous “turned on” state

Grave’s Disease

1 organ reactions: involve removing stimulated tissue

4 widespread reactions: tx reducing production of autoantibodies

Thank You