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EDAPT- Hypersensitivity Reactions
1.
Hypersensitivity Reactions
a.
The immune system functions to eliminate pathogens from the body using various mechanisms. A pathogen is just simply a bacterium, virus or other microorganism that can cause disease. These mechanisms typically create a localized inflammatory response
that effectively eliminates the pathogen without minimal damage to the surrounding tissue. Besides pathogens, individuals come into contact with numerous foreign antigens, such as plant pollen and food. Contact with these environmental antigens does not elicit an immune response in the majority of individuals. However, in certain predisposed individuals, the immune system can mount a response to these generally innocuous antigens, resulting in tissue damage that ranges from mild irritation to life-
threatening anaphylactic shock. These immune responses are referred to as allergic reactions or hypersensitivity reactions. Hypersensitivity reactions can be divided into four categories, Type I to Type IV, distinguished by the cell types and effector molecules involved.
2.
Contact Dermatitis is an example of Type 4
hypersensitivity reaction.
a.
Allergic contact dermatitis is an example of a Type IV hypersensitivity reaction mediated by T-cells. When the individual comes in contact with the antigen (e.g. poison ivy), an antigen complex is formed. On subsequent exposure to the antigen, sensitized T-cells activate the inflammatory process that causes the allergic contact dermatitis to appear.
3.
Anaphylaxis is a Type 1
hypersensitivity reaction.
a.
Type 1 hypersensitivity reactions are mediated by IgE and mast cells. An individual who is highly sensitized to the antigen may experience anaphylaxis.
4.
Type 2 (cytotoxic) hypersensitivity reactions are mediated by: IgG or IgM
.
a.
The Type 2 hypersensitivity reaction is mediated by IgG or IgM.
5.
Which of the following are considered the “first responders” of the innate immune system? Neutrophils
a.
Neutrophils appear first in any immune response.
6.
Hives (urticaria) ar an example of a: Type 1 hypersensitivity reaction
a.
Hives (urticarial) are an example of a Type 1 hypersensitivity reaction mediated by the antibody, IgE and mast cells.
7.
Type 1: Allergic Reaction
a.
On initial encounter with an allergen, the individual will first produce IgE antibodies. After the allergen is cleared, the remaining IgE molecules will be bound by mast cells, basophils, and eosinophils that contain receptors for the IgE molecules. This process is referred to as sensitization. On subsequent exposure to the allergen, the IgE molecules located on the sensitized cells induces their immediate degranulation. This causes the release of inflammatory mediators such as histamine, leukotrienes, and prostaglandins that results in vasodilation, bronchial smooth muscle contraction, and mucus production. Type I hypersensitivity reactions can be local or systemic. Systemic reactions
can result in anaphylaxis, a potentially life-threatening condition. Allergic asthma is an example of a Type I hypersensitivity reaction. On exposure to certain allergens (typically inhaled), individuals with allergic asthma experience inflammation of the airways,
characterized by tissue swelling and excessive mucus production. This narrowing of the airways makes it difficult to breathe.
i.
Example of Allergic Asthma: 1.
J.S. is a 64-year old female who presents to the primary care office with complaints of low back pain and burning on urination. She also indicates
that she has been urinating frequently and has had to wear a pad because she also is experiencing urgency and she is afraid that she might “leak”. She tells the Nurse Practitioner (NP) that she suspects that
she has a urinary tract infection (UTI). She reported that it has been at least 2 years since she had a UTI and was treated with an antibiotic but cannot remember its name. She denies any medication or food allergies. After conducting a thorough health history and physical exam, the NP diagnoses the patient with uncomplicated UTI and orders a course of sulfamethoxazole/trimethoprim (Bactrim DS).
2.
The next day, J.S. returns to the office in a panic to report she has just taken her first dose of the medication about an hour ago. She began to feel anxious followed by wheezing in the chest and dizziness. She first called her daughter, who reminded her that she is allergic to sulfa drugs.
J.S. is immediately examined by the NP.
3.
The NP performs a thorough exam and finds the following:
a.
Subjective Findings
: Anxious, Dizziness, Wheezing
b.
Objective Findings
: red rash on chest and anterior neck, swelling
around the right eye, wheezing with airflow throughout lung fields, bp 90/50, hr 112
4.
When analyzing patient symptoms, the nurse practitioner (NP) relies on pathophysiology to explain the cause of the symptoms. Once the underlying reasons for the symptoms are identified, the NP can make an
accurate diagnosis and select appropriate treatment.
5.
Note that our patient is experiencing both localized symptoms (rash on chest and anterior neck and right eye swelling) and systemic symptoms (wheezing and hypotension). 6.
The NP quickly identifies this as an allergic reaction and immediately asks the patient again, if she is aware of any prior allergies to medications. The patient tells the NP that her daughter reminded her that she is allergic to sulfa drugs. The Bactrim, in this case, is considered the allergen to which the patient has become sensitized from the last time she was treated for a UTI.
7.
At the time that she became sensitized, the IgE antibodies attached to the cells that became sensitized and then at the time of further exposure, IgE caused the sensitized cells to degranulate. When degranulation occurs, inflammatory mediators like histamine, leukotrienes and prostaglandins are released to produce several effects on the body. Vasodilation occurs which explains the patient’s hypotension, dizziness and rash).
8.
At this point, inflammatory mediators are released. These include histamine, leukotrienes, and prostaglandins. Constriction of bronchial smooth muscle also occurs, which explains her respiratory symptom of wheezing. Based on the localized and systemic symptoms, the NP can diagnose the patient with anaphylactic reaction, a Type 1 hypersensitivity reaction.
8.
Type 2 Hypersensitivity Reaction
a.
Type II hypersensitivity reaction is tissue-specific and usually occurs as a result of haptens that cause an IgG antibody or IgM antibody mediated response. The antibodies are specifically directed to the antigen located on the cell membrane. A hapten is a small molecule that can cause an immune response when it attaches to a protein. Macrophages are the primary effector cells of Type II responses. Typical examples of Type II reactions are drug allergies, as well as allergies against infectious agents. The Type II response begins with the antibody binding to the antigen and may cause the following.
i.
The cell to be destroyed by the antibody
ii.
Cell destruction through phagocytosis by macrophages
iii.
Damage to the cell by neutrophils triggering phagocytosis
iv.
Natural killer cells to release toxic substances that destroy the target cell
v.
Malfunction of the cell without destruction
b.
Examples of type II reactions include drug allergies, hemolytic anemia, blood transfusion
mismatch with resulting transfusion reaction and Rh hemolytic disease.
i.
Ex: Clinical Application of Delayed Hemolytic transfusion reaction
1.
M.G., a 27-year old healthy female required a blood transfusion 4 hours post-partum after undergoing a C-section. Twenty-four hours later, she and her newborn were released from the hospital in good health. Approximately 1 week later, she came to the primary care office complaining of fever, chills, shortness of breath (dyspnea) and a backache.
2.
The NP conducts an exam and the subjective and objective findings reveal the following:
a.
Subjective
: fever, chills, shortness of breath, backache
b.
Objective
: Fever 100.1, bp 100/64, pulse 110bpm, rr20/min, scleral icterus
c.
Lab work
: hemoglobin 6.2, platelet and leukocyte count are normal, positive direct and indirect Coombs Test (revealed the presence of antibodies).
3.
Once again, let’s rely on our knowledge of pathophysiology to explain why she is presenting with these symptoms. The NP notes that the only new occurrence with the patient was the blood transfusion that she received approximately a week ago post-partum. In delving deeper into
the patient’s history, the NP learned that M.G. had a blood transfusion during her first C-section two years ago. This provides a great clue for the NP to consider the cause of M.G.’s current symptoms.
4.
At the time of the first transfusion, M.G.’s RBC’s became sensitized. Upon the second transfusion two years later, IgG recognized the sensitized cells and initiated an immune response. In essence, IgG recognized the sensitized cells as non-self-antigens. The destruction of the RBCs resulted in her jaundice (scleral icterus), low hemoglobin level and fever. Treatment for a delayed hemolytic reaction will most likely require a blood transfusion that does not contain the antigen. Eventually, the mismatched blood is replaced with blood that is compatible with M.G.’s blood.
9.
Type 3 Immune-Complex Reaction
a.
The Type III hypersensitivity reaction is also an antigen-antibody response. The major difference between Type II and Type III responses is that in a Type II response, the antibody binds to the antigen on the cell surface, but in Type III responses, the antibody binds to the antigen in the blood or body fluids and then circulates to the tissue. Type III reactions are not organ specific and use neutrophils as the primary effector cell. In type III hypersensitivity reactions immune-complex deposition (ICD) causes autoimmune diseases, which is often a complication. As the disease progresses a more accumulation of immune-complexes occurs, and when the body becomes overloaded the complexes are deposited in the tissues and cause inflammation as the mononuclear phagocytes, erythrocytes, and complement system fail to remove immune complexes from the blood. One of the classic Type III reactions is serum sickness.
i.
Ex: Clinical Application of Serum Sickness
1.
A young mother brings her 5-year old daughter to the primary care clinic with a fever of 102 degrees, swollen hands and knees, “achy” joints and a red rash on her legs. The NP remembers that she recently diagnosed the patient with strep throat and started her on Amoxicillin for 10 days. The mom confirms that she started the amoxicillin on the same day that her daughter was diagnosed and has been taking it for the last 7 days. Mom indicated that she stopped giving the patient the antibiotic yesterday for fear that she may be having a drug reaction. However, the presenting symptoms continue. Patient’s temperature in the office is 102 degrees. The NP diagnoses the patient with serum sickness.
2.
The NP conducts an exam and the subjective and objective findings reveal the following:
a.
Subjective
: fever, rash, generalized joint pain, swollen hands and feet.
b.
Objective
: fever, non-blanching red rash, swollen fingers bilaterally, swollen knees bilaterally.
3.
This patient presents with the classic symptoms of serum sickness. Immune complexes are formed in response to an antigen (amoxicillin) that has been taken into the body. These complexes deposit themselves
into the vascular endothelium causing vasculitis and tissue injury as a
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Related Questions
production
e. basis of secondary
allergy
immune response
f. nonprotective
immune response
CRITICAL THINKING
New research suggests a link between some microbes
that normally live in the body and seemingly unrelated
major illnesses. The gum disease called periodontitis itself
is not life-threatening, for instance, but it is a fairly good
predictor for heart attacks. Bacteria that cause gum disease
can trigger inflammation. Thinking back to your reading in
Chapter 7, how do you suppose that this response also may
be harmful to the heart?
1.
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1. In phagocytosis, the digestion of phagocytes is always complete
2. The second line of defense is a specific immune response that responds against a specific type (species or strain) of pathogen.
3. Eosinophils can phagocytize and this is their usual mode of attack.
4. The body’s initial line of defense is made up of chemicals, and processes that work together to prevent pathogens from entering the body in the first place.
5. In general, beta and gamma interferons are present early in viral infections, whereas alpha interferon appears somewhat later in the course of infection.
6. The second line of defense is chiefly composed of external physical barriers to pathogens, especially the skin and mucous membranes.
7. The chemicals involved assist phagocytic cells either by directly attacking pathogens or by enhancing other features of specific resistance.
8. The combination of the barrier function of the dermis including its continual replacement and the presence of phagocytic…
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9
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None
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5. A patient receives a donor kidney to replace diseased kidney tissue. Consider and answer the
following:
B) list two similarities and two differences between response mechanisms of natural killer cells and
cytotoxic T cells to the tissue graft in the absence of immune suppression.
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1. What cells in the innate immunity are responsible for causing phagocytosis? Explain briefly and elaborate the cell involved.
2. What are the major cells involved in eliciting the actions of adaptive immunity? Explain briefly and elaborate the cells involved.
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True or False
1. In phagocytosis, the digestion of phagocytes is always complete
2. The second line of defense is a specific immune response that responds against a specific type (species or strain) of pathogen.
3. Eosinophils can phagocytize and this is their usual mode of attack.
4. The body’s initial line of defense is made up of chemicals, and processes that work together to prevent pathogens from entering the body in the first place.
5. In general, beta and gamma interferons are present early in viral infections, whereas alpha interferon appears somewhat later in the course of infection.
6. The second line of defense is chiefly composed of external physical barriers to pathogens, especially the skin and mucous membranes.
7. The chemicals involved assist phagocytic cells either by directly attacking pathogens or by enhancing other features of specific resistance.
8. The combination of the barrier function of the dermis including its continual replacement and the presence of…
arrow_forward
Identification:
1. When activated, Complement system will enhance the phagocytosis of phagocytes by what process?
2. Macrophages will present the antigen on its surface in what PATHWAY of antigen presentation?
3. Co-stimulation of both B and T cells will be facilitated by the release of what group of substance?
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i. Draw a schematic diagram of a typical IgG molecule and label each of the following parts: H chains, L chains, intrachain disulfide bonds, hinge, Fab, Fc, and all the domains. Indicate which domains are involved in antigen binding.
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Answer it. Nursing
The nurse is conducting a class on drugs for malignant tumors for a group of new oncology staff members. Which best describes the action of interferons in the management of malignant tumors?a )Interferons increase the production of specific anticancer enzymes.b) Interferons have antiviral and antitumor properties and strengthen the immune system.c) Interferons stimulate the production and activation of T lymphocytes and cytotoxic T cells.d )Interferons help improve the cell-killing action of T cells because they are retrieved from healthy donors
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1. What physical barrier and non-specific defenses help to prevent infection? How is a "non-
specific" defense different from a "specific" defense?
2. Non-specific immunity is also called_immunity while specific immunity is called
3. Describe the roles of complement proteins, cilia (in lungs), natural killer cells and phagocytes.
How are these non-specific defenses?
4. Describe the inflammatory response. Describe how this happens.
5. How is the immune system (and inflammation) related to allergies?
6. What is an antigen? How does your immune system recognize it?
7. What is an antibody?
8. Know the difference between B cells, killer T cells, and helper T cells. What do they do? Where
are they produced, what type of immunity they provide, how do they kill foreign organisms.
9. Describe how the immune system responds to an infection..basically know how a B cell is
activated and how it makes antibodies.
10. What is the difference between a primary and a secondary immune response?
11. What…
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uple Choice. Write the letter of the correct response that best answers each question.
17. What type of immunity is responsible for agglutination of viruses?
A. passive immunity
B. cell mediated immunity
C. nonspecific immunity
D. antibody immunity
18. Which of the following best describes the immunity gained from a vaccine?
A. nonspecific
B. active
C. passive
D. artificial
The din
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13.Which is NOT an example of innate defense? 13.Which is NOT an example of innate defense? Note: This is a multiple question, choose the correct answer below:
secretion of interferons
The arrival of neutrophils in an area of injury
a macrophage phagocytizing a bacterium
an antibody that neutralizes an antigen
secretion of interferons
The arrival of neutrophils in an area of injury
a macrophage phagocytizing a bacterium
an antibody that neutralizes an antigen
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C3
Why is C3 tested on all complement components?
What are the three complement pathways used by the body? How is each activated?
What are processes involved in each pathway that leads to cell lysis?
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19
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2. Plasma cells are which type of lymphocyte? Explain, No more than 3-6 sentences.
A). T cells
B). B cells
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O antibodies.
Question 6
Your patient is experiencing peripheral edema because of inflammation.
A) Name the four signs of inflammation.
B) Which capillary pressure would change AND which direction would you expect fluid to
flow (in capillary OR out of capillary)?
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12pt
Paragraph v BIU.
Question 7
11
Does a vaccine cause a B cell or T cell response and why?
T² :
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Questio:-
1. Which one of the following is NOT associated with type IV hypersensitivity reaction?
Select one:
a. plays a crucial role in our body's ability to fight various intracellular pathogens
b. Involves CD8+Tcells, CD4 TH1 cells, macrophages activation
c. one of the mechanisms that causes tissue injury and disease in response to antigens
d. antibody-mediated response
e. Involves cytokine-mediated inflammation in tissue
f. takes several days to develop
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4
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Give explanation answer...no need handwritten answer
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State immunity
1) Distinguish between absolute immunity and restrictive immunity
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Answer both .
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5. IDENTIFY THE DESCRIPTIONS OF NON-SPECIFIC DEFENSES OF THE BODY BY MATCHING COLUMN A WITH COLUMN B.
Column A Column B
1) Part of the first line of defense A. Acids
2) Entraps microorganisms entering the B. Lysozyme respiratory passages.
3) Provide chemical barriers C. Mucosae
4) Provide mechanical barriers D. Mucus
5) Have antimicrobial activity E. Protein-digesting enzymes
F. Skin G. Sebum
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TRUE OR FALSE
1. Inflammation is only caused by exogenous substances/organisms
2. Medical laboratory scientists test the presence of active inflammation
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Explain the complement system under the following headlines: 1. Types 2. Activation 3. Complement fixation test
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●
.
.
●
Which of the following is considered an innate immunity:
Production of antibodies via B lymphocytes
Killing virally infected cells by cytotoxic T lymphocyte
The protective action of lysozymes in tears and saliva
●
All of the above
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Clinical Application: Immune System and Autoimmunity Disease
Lymphocytes may be involved in two major types of responses to the presence of potentially threatening foreign substances. In anti- body-mediated immunity, B lymphocytes may produce antibodies that react with specific antigens on an invading cell or molecule. In cell-mediated immunity, T lymphocytes secrete lymphokines that signal other immune responses and often destroy antigen- containing cells directly.
The antibody-antigen reactions associated with immune responses have been used by clinical biologists for years. Several examples are given. Think about each example and answer the questions.
1. Biologists often use antibodies to test for the presence of certain antigens in a particular substance. In Lab Exercise 33- Hormones and Lab Exercise 34-Blood, you witnessed demon- strations of this technique. For each antigen listed, indicate the substance tested (e.g., blood, urine) and give a brief summary of the…
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