Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 84 Allergic, Immune, and Autoimmune Disorders

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Allergy Immune response –Human immune system protects individuals against “foreign invaders” (antigens). Allergy –Hypersensitivity disorder of the immune system Autoimmune disorder –The body fails to recognize its own cells as “self” and begins to destroy them.

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Diagnostic Tests Laboratory tests –Complete blood count, white blood cell differential, and eosinophil count –Eosinophil smear of secretions –Measurement of blood levels of immune response factors such as IgE (immunoglobulin E) Skin tests –Epicutaneous method; wait 20 min ; erythema and induration;not 100%

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Allergy testing

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Positive ppd

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Skin Test by Intradermal Injection

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process Data collection Planning and implementation Evaluation

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Allergies Immunogens –Antigens that cause an immune response Allergens –Antigens that cause a tissue reaction Allergens can enter the body via –Inhalation, ingestion, injection, or direct contact

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? Disorders of the immune system contribute to systemic symptoms and problems.

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True Disorders of the immune system are believed to contribute to or cause many systemic symptoms and problems. For example, allergies are responsible for symptoms that range from rhinorrhea and skin rash to asthma or a total anaphylactic response.

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Allergies With a Skin Response Urticaria –Reddened areas (erythema), itching (pruritus), and burning around swollen patches on the skin. The swellings are called hives, wheals, or urticaria Eczema or atopic dermatitis –Tiny blisters that itch and ooze cover the skin Contact dermatitis –Contact with the skin

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Hives

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Allergic salute

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Allergies With a Respiratory Response Allergic asthma –Allergens can cause spasms of the smooth muscles of the bronchi. Edema of the nasopharyngeal passages causes breathing difficulties. Bronchial asthma –Recurring paroxysms of dyspnea and, often, expiratory wheezing Allergic rhinitis or hay fever –Inflammation of the nasal passages caused by an allergen

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Food Allergy Food allergy or food sensitivity –Immune system reacts to an otherwise harmless substance. Lactose intolerance Allergy to dairy products such as cow’s milk and beef may take the form of migraine headaches.

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? Latex allergies are noted in individuals who are hypersensitive to bananas.

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True Latex allergies are noted in individuals who are hypersensitive to bananas, avocados, kiwis, and chestnuts. Symptoms include local urticaria (e.g., a rash inside latex gloves) and itching of the hands or face. More severe symptoms, including anaphylaxis, can also occur.

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Drug Allergy Allergic versus adverse reactions –A true drug allergy results from the antigen– antibody response. –An adverse drug reaction is a noxious or unintended effect of a medication. Serum sickness or serum reaction –Administration of certain drugs may cause a serum reaction. The client’s body mounts a reaction and immunologic attack on the serum or medication administered.

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Allergy With Multisystem Response Some allergies produce symptoms in more than one body system. Initially, the client may experience localized itching and edema, but soon, systemic gastrointestinal or respiratory symptoms may appear.

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Treatments Avoidance of the substance Immunotherapy Medication therapy –Antihistamines –Bronchodilators –Corticosteroids –Anticholinergics

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? Clients must use antihistamines for perennial allergies.

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False Clients should not use antihistamines for perennial allergies because prolonged use is associated with undesirable effects. These medications may cause drowsiness. In clients who have asthma, antihistamines may dry up the secretions so much that clients cannot swallow or expectorate.

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Anaphylaxis –Severe hypersensitivity reaction to an antigen Any allergen can cause anaphylaxis. Nursing considerations –Administer medications –Breathing (open the airway) –Circulation

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Immune Disorders Infectious diseases Immunosuppression Overproduction of gamma globulins Severe immune response to an invading antigen (anaphylaxis) Rejection response

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Autoimmune Disorders The body begins to produce antibodies against its own healthy cells or inhibits normal cell function. Genetic predisposition and influence of certain antigens in rejection of a person’s own tissue Interaction with physical, chemical, and biological agents that trigger an abnormal immune response Abnormalities in immune cells that lead to an inappropriate immune response Autoimmunity is related to many disorders.

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Types of Autoimmune Disorders Organ-specific (affecting one organ) Systemic (affecting the entire body) Non–organ-specific (affecting one or more organs)

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Examples Rejection of a transplanted organ Systemic lupus erythematosus Rheumatoid arthritis

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Treatment Symptomatic Use of mild analgesics, corticosteroids, and radiation Difficult to treat successfully

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins End of Presentation