Seminar On Anaphylaxis 7-6-12
Seminar On Anaphylaxis 7-6-12
Seminar On Anaphylaxis 7-6-12
HISTORY OF IMMUNOLOGY: Immunology is a science that examines the structure and function of the immune system. The earliest known reference to immunity was during the plague of Athens in 430 BC. . Thucydides noted that people who had recovered from a previous bout of the disease could nurse the sick without contracting the illness a second time.
HISTORY OF IMMUNOLOGY:CONTD
Immunology made a great advance towards the end of the 19th century, through rapid developments, in the study of humoral immunity and cellular immunity. Particularly important was the work of Paul Ehrlich, who proposed the side-chain theory to explain the specificity of the antigen-antibody reaction
FACTORS THAT DETERMINE AN ALLERGIC RESPONSE: Responsiveness of the host to the allergen: Amount of allergen: Nature of the allergen: Route of entrance of the allergen Timing of exposure to the allergen Site of the allergen immune mediator reaction
CLASSIFICATION OF HYPERSENSITIVITY REACTIONS:IMMEDIATE HYPERSENSITIVITY (B-CELL OR ANTIBODY MEDIATED) Anaphylaxis Atopy Antibody mediated cell damage Arthus phenomenon Serum sickness DELAYED HYPERSENSITIVITY (T- CELL MEDIATED) Infection (tuberculin) Contact dermatitis
DEFINITION
Type I Reactions: These occur in two forms : the acute, potentially fatal, systemic form called anaphylaxis and the chronic or recurrent, nonfatal, typically localised form called atopy.
DEFINITION: . Anaphylaxis is defined as "a serious allergic reaction that is rapid in onset and may cause death". It typically results in a number of symptoms including an itchy rash, throat swelling, and low blood pressure. Common causes include insect bites, foods, and medications.
DEFINITION
. Anaphylaxis is an acute, potentially fatal, multiorgan system reaction caused by the release of chemical mediators from mast cells and basophils. The classic form involves prior sensitization to an allergen with later reexposure, producing symptoms via an immunologic mechanism.
DEFINITION
Anaphylaxis is a clinical response to an immediate (type I hypersensitivity) immunological reaction between a specific antigen and antibody. The reaction result from IgE antibody.
ETIOLOGY
Food Medication Venom Risk factors People with atopic diseases such as asthma, eczema, or allergic rhinitis are at high risk of anaphylaxis from food, latex, and radiocontrast
immune system
LAYERED DEFENSE: physical barriers prevent pathogens such as bacteria and viruses from entering the organism. If a pathogen breaches these barriers, the innate immune system provides an immediate, but non-specific response
immune system
If pathogens successfully evade the innate response, vertebrates possess a second layer of protection, the adaptive immune system, which is activated by the innate response.
IMMUNE SYSTEM
SURFACE BARRIERS Mechanical, chemical, and biological barriers. INNATE IMMUNE SYSTEM The innate response is usually triggered when microbes are identified by pattern recognition receptors
Humoral and chemical barriers Inflammation Inflammation is one of the first responses of the immune system to infection. The symptoms of inflammation are redness, swelling, heat, and pain, which are caused by increased blood flow into tissue.
. Complement system The complement system is a biochemical cascade that attacks the surfaces of foreign cells Complement is the major humoral component of the innate immune response
In humans, this response is activated by complement binding to antibodies that have attached to these microbes or the binding of complement proteins to carbohydrates on the surfaces ofmicrobes. This recognition signal triggers a rapid killing response
PATHOPHYSIOLOGY: Type I hypersensitivity are mediated by the IgE class of immunoglobulin. In genetically, pre disposed people, initial exposure to an allergen prompts B lymphocytes to produce IgE antibodies, which sensitize the person to the allergen. This initial contact with the allergen is known as the sensitizing dose
PATHOPHYSIOLOGY
Once the person is fully sensitized, subsequent exposure ( termed the shocking dose or challenging dose) results in the allergen combined with the specific IgE antibodies that are bound to receptor sites on tissue mast cells and blood basophils. This antigen antibody reaction results in a rapid release of potent vaso active mediators such as histamines, kinins, chemo tactic factors, and active products of arachidonic acid metabolism
PATHOPHYSIOLOGY
Anaphylaxis is caused by the interaction of a foreign antigen with specific IgE antibodies found on the surface membrane of mast cells and peripheral blood basophils. The subsequent release of histamine and other bioactive mediators cause activation of platelets, eosinophils, and neutrophils and coagulation cascade. Smooth muscle spasm, bronchospasm, mucosal eddema, and inflammation, and increased capillary permeability
CLINICAL FEATURES
Localised reactions:Hives angioedema Systemic anaphylaxis:Apprehension Edema of the hands, face, or other parts of the body Dyspnoea Respiratory collapse Vascular collapse with shock
Rapid, regular pulse Falling blood pressure Cyanosis
Death
DIAGNOSTIC MEASURES
The health history including an environmental assessment, Skin testing and radio allergo sorbent test (RAST) may be helpful
MEDICAL MANAGEMENT
Management depends on the severity of the reaction. Initially, respiratory and cardiovascular functions are evaluated
TREATMENT
Simple BLS (O2, position, etc) Anti Histamines
Benadryl (IV 25-50 mg, PO 50 mg adult, 25 mg ped)
Corticosteroids
Decadron, Solu-medrol, etc
Treat Hypotension
IV fluids
Dopamine 5-20 mcg/min Epi Drip 2-10 mcg/min
TREATMENT
Broncheodiators
Albuterol MDI or Neb
TREATMENT
Avoidance therapy, in which the patient is thought to reduce exposure to trigerring antigens, is the most effective treatment to decrease allergic attacks Immunotherapy is often useful in reducing symptoms in patients who cannot avoid antigens such as dust mites or pollen
PREVENTION
EDUCATE
NURSING MANAGEMENT
ASSESSMENT: Health history: Assessment data to be collected as part of the health history of a patient with allergy includes: History of allergic reactions in the past ( e.g., type, frequency or perceived causes) Familial history of allergies Recent exposure to sensitizing substances (chemicals, drugs) Changes in living, working, or environmental conditions
NURSING MANAGEMENT
Characteristics of present environment (house, clothing, plants, trees or animals) Increased stress in recent past ( stress aggrevates asthmatic response) Types of symptoms experienced: respiratory, dermal, gastrointestinal or general Alleviating factors, either prescribed, herbal, or over the counter All patients should be questioned about allergies and sensitivities to drugs before any drug therapy is initiated. If there is a positive history, the physician is consulted before a new drug is given, the patient is monitored closely for allergic responses.
Physical examination: Important aspects of the physical examination of the patient with allergy include inspection and observation for : Rashes (location, and colour) Mouth breathing (nasal obstruction) Flaring nares Difficulty hearing (plugged Eustachian tubes) Pale, bluish turbinates that are oedematous with clear secretions
PHYSICAL EXAMINATION
Tearing Dark areas under the eyes ( venous dilation of the skin) Scleral or conjunctival infections Increased respiratory rate Audible wheezing Use of accessory muscles for breathing Anxious depression
NURSING DIAGNOSES: Ineffective airway clearance related to excess secretion production and bronchoconstriction. Decreased cardiac output related to inadequate venous return to heart, peripheral vasodilation. Deficient knowledge related to inadequate information about allergy control and treatments.
Airway clearence: Cardiac output: Nurse should be alert for the clinical manifstatios of anaphylactic shock. At the first sign of anaphylaxis, the patient is given epinephrine 1:1000 solution 0.3 to 0.5 ml s/c or im Risk for allergy response: High risk patients are instructed to wear a identification bracelet.
INTERVENTIONS
Provide supplemental oxygen and observe. If hypoxia continues, prepare to help insert an artificial airway. Insert an I.V. line for giving emergency drugs and volume expanders. Continually reassure the patient and explain all tests and treatments to reduce fear and anxiety. If the patient undergoes skin or scratch testing. Keep emergency resuscitation equipment nearby during and after the test.
INTERVENTIONS
Continuously assess the patients response to treatment. Monitor vital signs and cardiopulmonary and neurologic function. Observe for complications associated with anaphylaxis, such as vascular collapse and acute respiratory insufficiency or obstruction. Closely observe a patient with known allergies for anaphylaxis when giving a drug with high anaphylactic potential.
COMPLICATIONS
The primary complication of type I hypersensitivity are anaphylactic shock, which can leads to death within minutes without emergency treatment.