1. Chapter 84: Allergic, Immune, and Autoimmune Disorders

2. Allergy Immune response
Human immune system protects individuals against “foreign invaders” (antigens)
Antigen is a foreign substance that triggers the production of antibodies (immunoglobulins)
Antibodies
Immunoglobulins
Protein molecules produced by specialized WBC’s, goal is to recognize and bind to identified antigens, will help destroy the antigen
Hypersensitivity disorder of the immune system
Autoimmune disorder
The body fails to recognize its own cells as “self” and begins to destroy them

3. 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-small scratch on the skin
Erythema (redness is positive skin test)
Induration-degree of edema measured in mm indicates the severity of the reaction
Injected intradermally
Keep ice pack readily available*

4. Skin Test by Intradermal Injection
With the needle held nearly flat against the skin and the bevel up, the needle is inserted approximately one eight of an inch under the epidermis

5. Physical Signs and Symptoms of Allergies
Skin observations-color, rash
Respiratory observations-nasal edema, stridor, hoarseness
Ear observations-tympanic membrane bulging or retracting
Gastrointestinal tract observations-n/v/d
Cardiovascular observations-SYNCOPE, tachycardia
Nervous system observations-anxiety, confusion

6. Nursing Process Data Collection
Perform a head to toe assessment to establish baseline
Question sx such as SOB
Assess for fatigue
Frequent infections
Joint pain

7. Allergies Immunogens Antigens that cause an immune response Allergens
Antigens that cause a tissue reaction
Allergens can enter the body via
Inhalation, ingestion, injection (more dramatic reaction!), or direct contact

8. Allergies With a Skin Response
Urticaria (hives)
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
s/s tiny blisters that itch and ooze

9. 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
Exercise induced asthma
Physical activity can promote this event
Allergic rhinitis or hay fever
Inflammation of the nasal passages caused by an allergen

10. Asthma S/S Visible dyspnea Chest tightness Increased pulse and RR
Diminished breath sounds

11. Food Allergy Food allergy or food sensitivity
Immune system reacts to an otherwise harmless substance
Common allergens: peanuts, seeds, food additivies
S/S: swelling of the lips and throat, sneezing, urticaria, migraine headaches
Latex allergies are noted in individuals who have a sensitivity to bananas (avoid latex condoms)
Lactose intolerance
Allergy to dairy products such as cow’s milk and beef may take the form of migraine headaches

12. 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 (rabies antiserum) may cause a serum reaction. The client’s body mounts a reaction and immunologic attack on the serum or medication administered
Symptoms include: itching and inflammation, skin rash, ENLARGED lymph nodes

13. 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.

14. Treatments Avoidance of the substance Immunotherapy (desensitization)
Giving minute doses of allergens subcutaneously
Medication therapy
Antihistamines
may dry up secretions so much that client has difficulty swallowing
Box 84-1
Sedating drugs
Nonsedating
fexofenadine
cetirizine

15. Treatments Bronchodilators Corticosteroids Anticholinergics
Leukotrienes are chemical mediators that are more potent than histamine in causing brochospasm
Leukotriene antagonist or modifiers are the classification of medications that are effective in treating these inflammatory respiratory complications and commonly used for clients with asthma

16. Anaphylaxis Anaphylaxis Severe hypersensitivity reaction to an antigen
Use inhalers before sports!!
Any allergen can cause anaphylaxis
S/S include laryngoedema, shock, death (can result from laryngospasm and laryngeal edema leading to blockage of the airways and suffocation)
In practice 84-1 additional S/S
Edema and itching at the site of injection
Rash
Severe dyspnea
Pupillary dilation

17. Anaphylaxis Nursing considerations
Administer medications-ANTIHISTAMINES, epinephrine 1:1000 concentrations
1. corticosteroids
Breathing (open the airway)
2. ET tube
3. O2 or suction
Circulation
Ice pack can slow absorption
4. IV fluids
*remove causative agent

18. Immune Disorders Infectious diseases Immunosuppression
Overproduction of gamma globulins
Malignant blood diseases (leukemia)
Severe immune response to an invading antigen (anaphylaxis)
Rejection response
Suppress the organ rejection includes lifetime use of immunosuppressive drugs

19. Autoimmune Disorders
The body begins to produce antibodies against its own healthy cells or inhibits normal cell function
Body attacks itself!
*multiple disorders occur in the same clients
Genetic predisposition and influence of certain antigens in rejection of a person’s own tissue
Interaction with physical, chemical, and biologic agents that trigger an abnormal immune response
Abnormalities in immune cells that lead to an inappropriate immune response
*often many parts of the body are affected

20. Autoimmune disease treatment
1. Specific symptoms are treated as they occur (flare ups)
Use of mild analgesics to provide pain relief and to reduce inflammation
2. corticosteroids to treat more severe or chronic inflammation
3. radiation to suppress the body’s abnormal antigen- antibody responses
*Medications include DMARD’s
Shown to produce symptomatic relieve
Ex. Is methotrexate

21. Types of Autoimmune Disorders
Addisons
Celiac disease
Graves
Diabetes type I
Hashimoto
Multiple sclerosis
Myasthenia gravis

22. Types of Autoimmune Disorders
**Rheumatoid Arthritis
chronic and systemic disease
s/s: painful, stiff, swollen joints lasting longer than an hour
Schedule activities after bath
Consume omega 3’s (suppress inflammation)
Tx: hot/cold, methotrexate at lowest dose possible
NONPHARMACOLOGICAL
1. splint to rest joints
2. clothing with velcro to aid in dressing
3. apply moist heat to joints

23. Types of Autoimmune Disorders
Scleroderma-disease causing abnormal growth of connective tissue in the skin and blood vessels
s/s:thickening of skin, weight loss, diarrhea, fingers and toes that turn white, red or blue in response to heat or cold, thickening of skin
Nsg Dx: Impaired skin integrity

24. Systemic Lupus Erythematosis (SLE)
Disease that damages skin, joints, kidneys, heart that is exacerbated by pregnancy an infection
Sx: foamy urine, proteinuria associated with kidney damage, fever, weight loss
Labs: +ANA titer, pancytopenia
Tx: hydroxychloroquine (prevents inflammation)
Nsg. Considerations
1. avoid sun 2. monitor fevers 3. taper steroids when sx. Under control
TEACHING: 1. avoid sun 2. exercise minimally 3. avoid OTC meds 4. take rest periods as needed