HYPERSENSITIVITY REACTION AND Allergic
Disorders
Care of Clients with
Allergy
• An allergic reaction is a manifestation of
tissue injury resulting from interaction
between an antigen and an antibody.
• Chemical Mediators of Hypersensitivity
• Histamine
- Vasodilation, Smooth muscle
contraction, increased vascular
permeability, increased mucus
secretions
• Platelet-activating factor (PAF)
- Smooth muscle contraction
- Incites platelets to aggregate and
release serotonin and histamine
• Prostaglandins
- smooth muscle contraction as well as
vasodilation and increased capillary
permeability.
- The fever and pain that occur with
inflammation are due in part to the
prostaglandins
• Bradykinin
-Smooth muscle contraction, increased vascular
permeability, stimulates pain receptors,
increased mucus production
• Serotonin
- Smooth muscle contraction, increased
vascular permeability
• Leukotrienes
- initiate the inflammatory response
- Smooth muscle contraction, increased
vascular permeability
• Heparin - anticoagulant
• HYPERSENSITIVITY
• is a reflection of excessive or aberrant
immune responses
• is an abnormal, heightened reaction to
any type of stimuli
• follows a re-exposure after sensitization
in a predisposed individual
• Four Types of Hypersensitivity
• Type 1 Anaphylactic Hypersensitivity
- Most severe form
- Antigen reacts with IgE antibody bound
to surface of mast cells results in
mediator release, mediator effect
• characterized by vasodilation, increased
capillary permeability, smooth muscle
contraction, and eosinophilia
• Systemic reactions may involve
laryngeal stridor, angioedema,
hypotension, and bronchial, GI, or
uterine spasm
• local reactions are characterized by
hives.
• Examples of type I reactions include
extrinsic asthma, allergic rhinitis,
systemic anaphylaxis, and reactions to
insect stings.
• Laryngeal Stridor
• ANAPHYLAXIS
• is a clinical response to an immediate
(type I hypersensitivity) immunologic
reaction between a specific antigen and
an antibody
• can be triggered by exposure to an
antigen through inhalation, injection,
ingestion, or skin contact
• a severe, life-threatening allergic
reaction
• Pathophysiology
• Common Causes
• Foods
• Medications
• insect stings
• latex
• Clinical Manifestations
• Prevention
• Strict avoidance of potential allergens
• If avoidance of exposure to allergens is
impossible, administration of
epinephrine is a critical measure to
prevent an anaphylactic reaction.
• Medical Management
Management depends on the severity of the
reaction
- respiratory and cardiovascular functions
evaluation
- If pt in is in Cardiac arrest: CPR, O2 adm.
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 - Epinephrine, in a 11,000 dilution,
subcutaneously in the upper extremity
or thigh
• Antihistamines and corticosteroids
• IV fluids (normal saline solution),
volume expanders, and vasopressor
agents
• Aminophylline
• intravenous glucagon
• Nursing Management
• Assess for signs and symptoms of
anaphylaxis
• Assess the airway, breathing pattern,
and other vital signs
• Observe for signs of increasing edema
and respiratory distress
• The patient must be instructed about
antigens that should be avoided and
about other strategies to prevent
recurrence of anaphylaxis.
• All patients who have experienced an
anaphylactic reaction should receive
prescription for preloaded syringes of
epinephrine.
• The nurse instructs the patient and
family in their use and has the patient
and family demonstrate correct
administration
• Type 2 - Cytotoxic
• Cytotoxic
• occurs when the system mistakenly
identifies a normal constituent of the
body as foreign
• may be a result of a cross-reacting
antibody, possibly leading to cell and
tissue damage
• PATHOPHYSIOLOGY
A type II hypersensitivity reaction is associated
with several disorders
- Myasthenia gravis, the body mistakenly
generates antibodies against normal
nerve ending receptors.
- Goodpasture syndrome, antibodies
against lung and renal tissue are
generated, producing lung damage and
renal failure
A type II hypersensitivity reaction resulting in
red blood cell destruction is associated with
• Drug-induced immune hemolytic
anemia
• Rh-hemolytic disease of the newborn
• Incompatibility reactions in blood
transfusions
• Immuno-complex mediated
• Lupus erythematosus
• Rheumatoid arthritis
• Systemic Lupus Erythematosus
• 10 times more frequently in women
than in men
• approximately three times more
frequently in the African-American
population than in Caucasians
• is a result of disturbed immune
regulation that causes an exaggerated
production of autoantibodies
• Etiologic Factors
• Genetic
• hormonal (as evidenced by the usual
onset during the childbearing years),
• environmental factors (sunlight, thermal
burns)
• Certain medications, such as
hydralazine (Apresoline), procainamide
(Pronestyl), isoniazid (INH),
chlorpromazine (Thorazine), and some
antiseizure medications,
• Pathophysiology
• SYSTEMIC MANIFESTATIONS
• Arthralgias and arthritis (synovitis)
• Joint swelling, tenderness, and pain on
movement, accompanied by morning
stiffness.
• Several different types of skin
manifestations: subacute cutaneous
lupus erythematosus, erythematous
papules or plaques and scaling, acute
cutaneous lesion consisting of a
butterfly-shaped rash across the bridge
of the nose and cheeks
• SYSTEMIC MANIFESTATIONS
• Oral ulcers, which may accompany skin
lesions, may involve the buccal mucosa
or the hard palate.
• Pericarditis is the most common cardiac
manifestation
• atherosclerosis.
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 • hypertension • Joint pain, swelling, warmth, erythema,
• Cardiovascular Manifestations and lack of function
• Pericarditis • joints are spongy or boggy
- Sharp pain, • fever, weight loss, fatigue, anemia,
- Chest pain aggravated by coughing, lymph node enlargement, and
DBE, and change in body position Raynaud’s phenomenon
• Raynaud’s Phenomena • arteritis, neuropathy, scleritis,
• WBC, RBC, clotting factor, platelet pericarditis, splenomegaly, and
decreased Sjögren’s syndrome (dry eyes and dry
• Respiratory Manifestations mucous membranes
• Pleuritis • Presence of Rheumatoid factor
- Easy fatigability • Elevated ESR
Kidneys • decreased red blood cell count and C4
• Nephritis complement component
- HPN • (+) C-reactive protein and antinuclear
- Proteinuria antibody test
- Edema • Arthrocentesis reveals synovial fluid
• Nervous System that is cloudy, milky, or dark yellow and
• Cerebritis contains numerous leukocytes and
- Low grade fever complement
- Loss of appetite • X-ray studies show characteristic of
- Personality bony erosions and narrowed joint
- Psychosis spaces occurring later in the disease
- Seizure • TREATMENT
- Coma • The treatment of rheumatoid arthritis
• Medical Mgt. optimally involves a combination of
• Corticosteroids - patient education
• Antimalarial drugs - rest and exercise
- for managing cutaneous, musculoskeletal, and - joint protection
mild systemic features of SLE - medications, and occasionally surgery.
• Immonosuppresive agents • Medical Management
• Nursing Mgt • Pharmacologic Therapy
• Encourage to avoid sun exposure - The first-line drugs such as aspirin and
• Use of sunscreen lotion cortisone (corticosteroids)
• Healthy lifestyle • The slow-acting second-line drugs, such
• Stress management as gmethotrexate and hydrochloroquine
• Rheumatoid arthritis (Plaquenil) prevent disease remission
• is an autoimmune disease that causes and prevent progressive joint
chronic inflammation of the joints. destruction
• can also cause inflammation of the • Salicylates, NSAIDs, antirheumatic drugs
tissue around the joints, as well as other • Nonpharmacologic Therapy
organs in the body. - heat and cold
• is referred to as a systemic illness and is - assistive and supportive devices
sometimes called rheumatoid disease • Exercise and Activity
• two to three times greater incidence in • Nursing Management
women • Relieving pain and discomfort
• Clinical Manifestations • Decreasing fatigue
• Promoting restful sleep

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• Increasing mobility
• Facilitating self-care
• Improving body image and coping
• Monitoring and managing potential
complications
• Cell-mediated Hypersensitivity
• Transplant rejection
• Contact dermatitis
• Cell-mediated Hypersensitivity
• Transplant rejection
• Contact dermatitis
– Atopic disorder
• Hay fever-allergic
rhinitis
• Eczema-atopic
dermatitis
• Asthma
– Drug and food allergies
– Stinging insect allergy
• Transplant rejection
• occurs when the immune system of the
recipient of a transplant attacks the
transplanted organ or tissue.
• A normal healthy human immune
system can distinguish foreign tissues
and attempts to destroy them, just as it
attempts to destroy infective organisms
such as bacteria and viruses.
• Types:
– Hyperacute
– Acute
– chronic
• Hyper acute rejection
• is a complement-mediated response in
recipients with pre-existing antibodies
to the donor (for example, ABO blood
type antibodies).
• occurs within minutes and the
transplant must be immediately
removed to prevent a severe sytemic
inflammatroy response.
• Rapid coagulation of the blood occurs.
• Commonly occurs in kidney
transplantation.
• is the likely outcome of
xenotransplanted organs.
• Acute rejection
• is antibody-mediated
• occurs around five to ten days after a
transplant if the patient is not taking
immunosuppressant drugs.
• It can destroy the transplant if it is not
recognized and treated appropriately.
• is the primary reason why transplant
patients have to take drugs for the rest
of their lives.
• Chronic rejection
• is reserved for those cases where the
process is shown to be due to a chronic
alloreactive immune response.
• signs and symptoms of transplant
rejection
• Oliguria
• Edema
• Fever
• increasing blood pressure
• weight gain
• swelling or tenderness over the
transplanted kidney or graft
• Management
• Taking of Immunosuppressant agents
such as azathioprine (Imuran),
corticosteroids (prednisone),
cyclosporine, and OKT-3 (a monoclonal
antibody)
• Contact Dermatitis
• a type IV delayed hypersensitivity
reaction
• is an acute or chronic skin inflammation
that results from direct skin contact
with chemicals or allergens
• Common allergens for allergic contact
dermatitis(CONTACT)
Cutaneous type IV reaction
Ointments and cosmetics containing lanolin
Nickel
Topical antibiotics can cause it (e.g. neomycin)
Autosensitisation can occur (secondary spread
elsewhere)
Chromates (cement, leather)/Colophony
(plasters, glues, inks)
Topical antihistamines and topical anaesthetics
(haemorrhoid creams) can cause it
• Types, Testing, and Treatment of
Contact Dermatitis
• Clinical Manifestations
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 - itching, burning, erythema, skin lesions
(vesicles), and edema, followed by
weeping, crusting, and finally drying
and peeling of the skin.
- In severe responses, hemorrhagic
bullae may develop.
• Atopic disorder
• Allergic rhinitis
• inflammation of nasal mucosa
• is the most common form of respiratory
allergy presumed to be mediated by an
immediate immunologic reaction
• induced by airborne pollens or molds
• PATHOPHYSIOLOGY
• Clinical Manifestations
• nasal congestion
• clear, watery nasal discharge
• intermittent sneezing
• nasal itching
• Itching of the throat and soft palate
• dry cough or hoarseness
• Headache, pain over the paranasal
sinuses, and epistaxis
• fatigue, loss of sleep, and poor
concentration
• Medical Management
AVOIDANCE THERAPY
• remove the allergens that act as
precipitating factors
• Simple measures and environmental
controls: use of air conditioners, air
cleaners, humidifiers and dehumidifiers,
and smoke-free environments
• PHARMACOLOGIC THERAPY
• Antihistamines
• Adrenergic Agents - vasoconstrictors of
mucosal vessels
• Nasal Decongestant
• Mast Cell Stabilizers - Intranasal
cromolyn sodium (Nasalcrom)
• Corticosteroids
• IMMUNOTHERAPY - Allergen
desensitization
• IMMUNOTHERAPY
• Allergen desensitization (allergen
immunotherapy, hyposensitization)
• is primarily used to treat IgE-mediated
diseases by injections of allergen
extracts.
• This type of therapy provides an adjunct
to symptomatic pharmacologic therapy
and can be used when allergen
avoidance is not possible
• Goals of immunotherapy
• reducing the level of circulating IgE
• increasing the level of blocking antibody
IgG
• reducing mediator cell sensitivity
• Nursing Management
Improving Breathing pattern
- reduce exposure to people with upper
respiratory infection
- encourage to take deep breaths and
cough frequently to ensure adequate
gas exchange and prevent atelectasis
- Compliance with medications and other
treatment regimens
Promoting understanding of allergy and
allergy control
- strategies to minimize exposure to
allergens, desensitization procedures,
and correct use of medications
- medications for allergy control should
be used only when the allergy is
apparent
Coping with a chronic disorder
- modification of the lifestyle or
environment to prevent recurrence of
symptoms
- encourage to verbalize feelings and
concerns in a supportive environment
and to identify strategies to deal with
them effectively.
MONITORING AND MANAGING POTENTIAL
COMPLICATIONS
1. Anaphylaxis and Impaired Breathing
- monitoring the respiratory rate and
pattern
- Assess for breathing difficulties or
abnormal lung sounds
- Monitor pulse rate and rhythm and
blood pressure
- Prepare emergency meds and
equipment at bedside
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2. Nonadherence to Therapeutic Regimen
- Have the patient identify potential barriers and
explore acceptable solutions for effective
management of the condition
• Eczema atopic dermatitis
• Dermatitis (Eczema) is an inflammation
of the upper layers of the skin, causing
blisters, redness, swelling, oozing,
scabbing, scaling and itching.
• family history is common
• Atopic dermatitis is chronic, with
remissions and exacerbations.
• has a tendency to recur, with remission
from adolescence to age 20
• Treatment must be individualized
• Clinical Manifestations
• elevations of serum IgE and peripheral
eosinophilia.
• Pruritus and hyperirritability of large
amounts of histamine in the skin
• Excessive dryness of the skin with
itching
• In response to stroking of the skin,
immediate redness appears on the skin,
and is followed in 15 to 30 seconds by
pallor, which persists for 1 to 3 minutes.
• Lesions develop secondary to the
trauma of scratching and appear in
areas of increased sweating and
hypervascularity.
• Atopic contact dermatitis
• a common test for allergies may involve
Patch Testing carried out by your
Dermatologist.
• This test tries to determine the
substances that provoke an allergic
response so that these substances can
be eliminated.
• Medical Management
• wearing cotton fabrics
• washing with a mild detergent
• humidifying dry heat in winter,
maintaining room temperature at 20°C
to 22.2°C (68°F to 72°F),
• using antihistamines such as
diphenhydramine (Benadryl)
• avoiding animals, dust, sprays, and
perfumes.
• Keeping the skin moisturized with daily
baths to hydrate the skin
• Adm of topical skin moisturizers
• Topical corticosteroids are used to
prevent inflammation
• antibiotics to eliminate Staphylococcus
aureus when indicated.
• Use of low doses of immunosuppressive
agent such as cyclosporine (Neoral,
Sandimmune)
• DERMATITIS MEDICAMENTOSA
(DRUG REACTIONS)
• Is the term applied to skin rashes
induced by the internal administration
of certain medications
• Drug and food allergy
• Cosmetics, Nickel, Plants (poison ivy,
poison oak, poison sumac, ragweed,
primrose, etc.),
• Pharmaceutical drugs in creams and
ointments including:
- Antibiotics (penicillin, sulfonamides,
neomycin, etc.)
- Antihistamines (diphenhydramine,
promethazine, pyribenzamine)
- Anesthetics (benzocaine)
- Antiseptics (thimerosal)
- Antifungal ointments (one confirmed
case known to the author).
• Industrial chemicals including:
Tanning agents, Rubber accelerators
and Antioxidants (used in gloves, shoes,
etc.)
• Food allergy
• A food allergy is an exaggerated
immune response triggered by eggs,
peanuts, milk, or some other specific
food.
• Any food can cause an allergic reaction,
but a few foods are the main culprits. In
children, the most common food
allergies are to:
– eggs
– peanuts
– milk
– soy
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 – tree nuts
– wheat
– shellfish (shrimp, crab, lobster,
snails, clams)
• Medical Mgt
• elimination of the food or drugs
responsible for the hypersensitivity
• Medication therapy involves the use of
H1- and H2-blockers, antihistamines,
adrenergic agents, corticosteroids, and
cromolyn sodium.
• Stinging insect allergy
• Biting insects have also been reported
to cause allergic reactions.
• These include the kissing bug, bedbug,
mosquito, blackfly, deerfly, horsefly and
flea.
• Treatment: Benadryl
• Signs and symptoms
• Itching and hives over large areas of the
body
• Swelling in the throat or tongue
• Difficulty breathing
• Dizziness
• Stomach cramps
• Nausea
• Diarrhea
• In severe cases, a rapid fall in blood
pressure may result in shock or loss of
consciousness
• Treatment
• carefully remove the stinger, if it is left
behind.
• Wash the bite/sting area gently with
soap and water.
• Apply ice to the site of sting.
• avoid situations in which they are likely
to get stung or bitten.
• Mild reactions, such as pain, itching,
and swelling, can be treated with an
over-the counter antihistamine, pain
reliever and topical corticosteroid
creams.
• Treatment
• Anaphylactic shock is treated with an
injection of epinephrine combined with
an injection of an antihistamine
• Those who are known to have severe
insect venom allergies should carry a
self-injection kit, including
antihistamine tablets, for emergency
treatment.
• People who are severely allergic to the
venom of stinging insects, such as bees,
yellow jackets, hornets, wasps or fire
ants may, undergo a desensitization.
• Prevention
• Stay out of the "territory" of stinging
insects' nests
• Hire a trained exterminator to destroy
nest and hives near your home
• Don't drink from a straw or can that you
cannot see inside of, this is a favorite
place for insects to hide
• Do not swat at stinging insects if
encountered by them
• Avoid wearing heavy perfume and
brightly colored clothing outdoors
• Keep all food covered outside until
eaten
Deficiencies of the Complement System
• The complement system is part of the
innate immune system.
• The complement system plays an
important part in defense against
pyogenic organisms. It promotes the
inflammatory response, eliminates
pathogens, and enhances the immune
response.
• Deficiencies in the complement cascade
can lead to overwhelming infection and
sepsis.
• In addition to playing an important role
in host defense against infection, the
complement system is a mediator in
both the pathogenesis and prevention
of immune complex diseases, such as
systemic lupus erythematosus (SLE).
• Causes
• Most complement deficiencies are
caused by a genetic defect in one of the
genes that code for the various
complement proteins.
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• No clear environmental or drug-related infection, especially with encapsulated
causes have been identified. organisms such as N meningitidis. In
• Clinical Manifestation most cases of meningococcal disease,
• No specific physical findings are treatment with meningeal doses of a
pathognomonic for complement third-generation cephalosporin covers
deficiencies. Rather, clinical most strains of N meningitidis.
manifestations are representative of the • For other patients, the complement
infections and immune complex deficiency may manifest as episodic
diseases to which patients are flares of autoimmune diseases;
predisposed. treatment of these patients focuses on
• Because N meningitides is the immunosuppressive therapy of these
overwhelmingly prevalent bacterial diseases.
pathogen in these patients, knowledge • Medications
of the physical characteristics of • Cephalosporins are often used for
disseminated meningococcal disease is treatment of N meningitidis infection in
important. patients with complement deficiency.
• The characteristic maculopapular rash • Third- or fourth-generation
that occurs in up to 75% of individuals cephalosporins are used for coverage of
with meningococcemia occurs soon infection with any of the encapsulated
after disease onset. bacteria.
• Clinical Manifestation
• The rash consists of pink lesions on the
trunk and extremities; lesions are
approximately 2-10 mm in diameter.
The rash can quickly progress to
hemorrhagic lesions. Petechiae are also
a prominent finding and can occur on
the skin of the trunk and extremities or
on mucous membranes, such as the
palate and conjunctivae.
• Noninfectious diseases, such as SLE,
that are associated with complement
deficiencies can also have a
characteristic physical presentation.
• Complement deficiencies associated
with the deposition of immune
complexes in various tissues can result
in many of the sequelae of SLE, such as
glomerulonephritis, arthralgia, uveitis,
and vasculitic rash.
• Treatment
• Definitive treatment of complement
deficiencies requires replacing the
missing component of the cascade,
either through direct infusion of the
protein or through gene therapy.
• For many patients, treatment must be
focused on eradicating a particular

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