Assessment and Management of Patient's With Allergic Reactions

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ASSESSMENT AND MANAGEMENT OF PATIENT’S WITH ALLERGIC REACTIONS
ASSESSMENT AND
MANAGEMENT OF
PATIENT’S WITH
ALLERGIC
REACTIONS
ALLERGIC REACTIONS
- an inappropriate, often harmful response of the immune system to
normally harmless substances
- hypersensitive reaction to an allergen initiated by immunological
mechanisms that is usually mediated by IgE antibodies
Atopy – allergic reactions characterized by IgE antibody action and a genetic
predisposition
Allergen – the substance that causes the allergic reaction / response
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PATHOPHYSIOLOGY OF AN ALLERGIC REACTION
ANTIGEN (Foreign Substance)
Lymphocytes will respond to the Antigen
IMMUNE SYSTEM
Chemical Mediators
Allergic Reaction
HARMLESS SUBSTANCES IN THE ENVIRONMENT

(ANTIGEN)
POLLEN ANIMAL DANDER DUST MITE

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INSECT STINGS MOLDS FOOD
FOOD includes:
peanuts egg soy
shellfish shrimps milk
wheat crabs jelly
LATEX MEDICATIONS FRAGRANCE
IMMUNOGLOBULINS AND ALLERGIC RESPONSE

- antibodies (IgE, IgD, IgG, IgM, and IgA) react with specific effector cells
and molecules, and function to protect the body
- IgE antibodies are involved in allergic disorders
- IgE molecules bind to an allergen and trigger mast cells or basophils
- These cells then release chemical mediators such as histamine, serotonin,
kinins, and neutrophil factor
- These chemical substances cause the reactions seen in allergic response
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- Allergen triggers the B cell to make IgE antibody, which attaches to the
mast cell; when that allergen reappears, it binds to the IgE and triggers the
mast cell to release its chemicals
PRIMARY CHEMICAL MEDIATORS

1. HISTAMINE
o an organic nitrogenous compound involved in local immune responses,
as well as regulating physiological function in the gut and acting as a
neurotransmitter for the brain, spinal cord, and uterus. Histamine is
involved in the inflammatory response and has a central role as a
mediator of itching.
Effects:
o Localized edema (wheals)
o Contraction of bronchial smooth muscles (wheezing) and
bronchospasm
o Dilation of small venules
o Constriction of large vessels
o Increased secretion of gastric and mucosal cells (diarrhea)
A. Histamine 1 Receptors – found on bronchiolar and vascular smooth
muscles
B. Histamine 2 Receptors – found in gastric parietal cells
H2 Receptor Blockers:
Cimetidine (Tagamet)
Ranitidine (Zantac)
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2. Eosinophil Chemotactic Factor of Anaphylaxis (ECF-A)

o Affects the movement of eosinophils to the site of allergens
3. Platelet Activating Factor (PAF)
o Initiates platelet aggregation and leukocyte infiltration causing
bronchoconstriction and increased vascular permeability
4. Prostaglandins
o cause smooth muscle contraction, vasodilation and increased
capillary permeability, fever and pain
SECONDARY CHEMICAL MEDIATORS

1. Leukotrienes
o Initiates inflammatory response:
▪ Smooth muscle contraction
▪ Bronchial constriction
▪ Mucus secretions in the airways
▪ Typical wheal-and-flare reaction of the skin
2. Bradykinin
▪ Increased vascular permeability
▪ Vasodilation
▪ Hypotension
▪ Contraction of many smooth muscles (bronchi)
▪ Increased capillary permeability (edema)
▪ Stimulation of nerve cell fibers (pain)
3. Serotonin
o a potent vasoconstrictor; contraction of bronchial smooth muscle
HYPERSENSITIVITY
• an abnormal reaction in response to the exposure to allergen
• sensitization – initiates the buildup of antibodies
• Types of hypersensitivity reactions:
o Anaphylactic – type 1
o Cytotoxic – type 2
o Immune Complex – type 3
o Delayed type – type 4 (Cellular hypersensitivity)
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TYPE 1 – ANAPHYLACTIC REACTION
TYPE 2 – CYTOTOXIC REACTION

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TYPE 3 – IMMUNE COMPLEX REACTION
TYPE 4 – DELAYED OR CELLULAR REACTION

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DIAGNOSTIC TESTS
1. CBC with differential – eosinophil count
2. Total Serum IgE
3. Skin tests
4. Provocative Testing – direct administration of suspected allergen to
sensitive tissue / GI
5. Radioallergosorbent Test (RAST) – 5-7 mL of venous blood with suspected
specific allergy + specific allergen (radio-labelled) then incubated and the
number of IgE is measured
ALLERGIC DISORDERS
ANAPHYLAXIS
- The immediate response to an immediate immunological reaction between
a specific antigen and antibody
- Results from a rapid release of immunoglobulin which can induce a severe,
life-threatening allergic reaction
Pathophysiology
Sensitized client -> exposure to sensitizing agent (antigen)
CLINICAL MANIFESTATIONS
Mild Systemic Reaction (Onset: first 2 hrs. after exposure)
1. Peripheral tingling
2. Sensation of warmth
3. Sensation of fullness in the mouth & throat
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4. Nasal congestion
5. Periorbital swelling
6. Pruritus
7. Sneezing
8. Tearing of the eyes
Moderate Systemic Reaction (Onset: same w/mild)

1. Flushing and warmth
2. Anxiety
3. Itching
More serious reactions:
1. bronchospasm
2. edema of the airways or larynx
Severe Systemic Reactions (Onset: Abrupt)

1. Bronchospasm 8. Vomiting
2. Laryngeal edema 9. Diarrhea
3. Severe dyspnea 10. Seizure
4. Cyanosis 11. Cardiac arrest
5. Hypotension 12. Coma
6. Dyphagia
7. Abdominal cramping
PREVENTION AND TREATMENT OF ANAPHYLAXIS

• Avoidance of potential allergens
• Avoid areas populated by insects
• Use appropriate clothing & insect repellent
• Auto injection system: EpiPen
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• May follow with IV epinephrine

• IV fluids
• Screening for allergies before medication administration
SELF-ADMINISTRATION OF EPINEPHRINE
MEDICAL MANAGEMENT
For cardiac arrest:
1. CPR
2. O2 therapy
3. Epinephrine
Additional Management:
1. Antihistamine
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2. Corticosteroids
3. Volume expanders & vasopressor agents
For bronchospasm, asthma & COPD:

1. Aminophylline
2. Corticosteroids
If hypotension is unresponsive to vasopressors:
1. Glucagon
CONTECT DERMATITIS
- An acute or chronic skin inflammation that results from direct skin contact
with chemicals or allergens
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ATOPIC DERMATITIS (ATOPIC ECZEMA)

- characterized by inflammation & hypersensitivity of the skin
Clinical Manifestations:
1. Pruritus & hyperirritability of the skin
2. Excessive dryness of the skin
3. Redness followed by pallor
4. Lesions
Laboratory Findings:
1. Elevated serum IgE
2. Elevated peripheral eosinophilia
Management:
1. Wear cotton fabrics, use mild detergent, maintaining room temp. at 20 –
22.2°C – to decrease itching
2. Avoid animals, dust, sprays & perfumes
3. Keep the skin moisturized
Pharmacological:
4. Antihistamine
5. Corticosteroids
6. Antibiotics
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NURSING MANAGEMENT
• Instructions & counseling on strategies to incorporate preventive
measures & treatments
• Teach on side effects of the medications used in treatment
• To avoid the risk of developing eczema vaccinatum (a localized or
generalized cutaneous dissemination of vaccinia virus), patients and close
contacts of patients with atopic dermatitis should be cautioned to avoid
vaccination with smallpox or contact with someone who has recently
received smallpox vaccination.

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1

ASSESSMENT AND MANAGEMENT OF PATIENT’S WITH ALLERGIC REACTIONS

PATHOPHYSIOLOGY OF AN ALLERGIC REACTION

ANTIGEN (Foreign Substance)

Lymphocytes will respond to the Antigen

HARMLESS SUBSTANCES IN THE ENVIRONMENT

POLLEN ANIMAL DANDER DUST MITE

INSECT STINGS MOLDS FOOD

LATEX MEDICATIONS FRAGRANCE

IMMUNOGLOBULINS AND ALLERGIC RESPONSE

PRIMARY CHEMICAL MEDIATORS

2. Eosinophil Chemotactic Factor of Anaphylaxis (ECF-A)

SECONDARY CHEMICAL MEDIATORS

• Types of hypersensitivity reactions:

TYPE 1 – ANAPHYLACTIC REACTION

TYPE 2 – CYTOTOXIC REACTION

TYPE 3 – IMMUNE COMPLEX REACTION

TYPE 4 – DELAYED OR CELLULAR REACTION

Moderate Systemic Reaction (Onset: same w/mild)

Severe Systemic Reactions (Onset: Abrupt)

PREVENTION AND TREATMENT OF ANAPHYLAXIS

• May follow with IV epinephrine

For bronchospasm, asthma & COPD:

ATOPIC DERMATITIS (ATOPIC ECZEMA)

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