CH 53

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Chapter 53

Assessment and Management
of Patients With Allergic
Disorders

Question
Is the following statement True or False?

An antigen is a protein substance developed by the body in
response to and interacting with a specific antibody.
Answer
False

An antibody, not antigen, is a protein substance developed
by the body in response to and interacting with a specific
antigen, not antibody.

Allergic Reactions
Allergy
An inappropriate often harmful response of the
immune system to normally harmless substances
Hypersensitive reaction to an allergen initiated by
immunological mechanisms which is usually
mediated by IgE antibodies
Allergen: the substance that causes the allergic response
Atopy: refers to the allergic reactions characterized by
IgE antibody action and a genetic predisposition
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, SRS-A, and neutrophil factor
These chemical substances cause the reactions seen in
allergic response
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.
Hypersensitivity
A reflection of excessive or aberrant immune response
Sensitization: initiates the buildup of antibodies
Types of hypersensitivity reactions:
Anaphylactic: Type I
Cytotoxic: Type II
Immune complex: Type III
Delayed-type: Type IV
Type I: Anaphylactic Reaction
Type II: Cytotoxic Reaction
Type III: Immune Complex Reaction
Type IV: Delayed or Cellular Reaction
Management of Patients with Allergic
Disorders
History and manifestations; comprehensive allergy
history

Diagnostic tests
CBCeosinophil count
Total serum IgE
Skin testsnote precautions!
Screening procedures

Medication
Oxygen, if respiratory need
Epinephrine used for anaphylactic reactions
Histamines
Corticosteroids
Prevention and Treatment of Anaphylaxis
Screen and prevent!
Treat respiratory problems, oxygen, intubation, and
cardiopulmonary resuscitation as needed
Epinephrine 1:1,000 SQ
Auto injection system: epiPen
May follow with IV epinephrine
IV fluids

Allergic Rhinitis
Hay Fever, seasonal allergic rhinitis
A common respiratory allergy presumed to be mediated
by a type I hypersensitivity
Affects 1025% of the population
Symptoms include sneezing and nasal congestion, clear
watery discharge, nasal itching, itching of throat ands
soft palate, dry cough, hoarseness, headache
May affect the quality of life, producing fatigue, loss of
sleep, poor concentration
Nursing Process: The Care of the Patient
with Allergic RhinitisAssessment
Health history
Include personal and family history
Allergy assessment
Subjective data includes symptoms and how the patient
feels before symptoms become obvious
Note relationship between symptoms and seasonal
changes, emotional problems, or stress
Identify nature of antigens, seasonal changes in
symptoms, and medication history
with Allergic RhinitisDiagnoses
Ineffective breathing pattern related to allergic reaction
Deficient knowledge about allergy and the recommended
modifications in lifestyle and self-care practices
Ineffective individual coping with chronicity of condition
and need for environmental modifications
Collaborative Problems/ Potential
Complications
Anaphylaxis
Impaired breathing
Nonadherance to therapeutic regimen
with Allergic RhinitisPlanning
Goals may include:
Restoration of normal breathing pattern
Increased knowledge about the causes and control of
allergic symptoms
Improved coping with alterations and modifications
Absence of complications
Improved Breathing Pattern
Modify the environment to reduce allergens
Reduce exposure to people with URI
Take deep breaths and cough frequently
Promoting Understanding/Patient
Teaching
Instruction to minimize allergens
Use of medications
Desensitization procedures

Question
What is a common second-generation nonsedating
antihistamine used to treat allergies?
A. Cetirizine (Zyrtec)
B. Chlorpheniramine (Chlor-Trimeton)
C. Diphenhydramine (Benadryl)
D. Hydroxyzine (Atarax)
Answer
A

A common second-generation nonsedating antihistamine
used to treat allergies is cetirizine (Zyrtec). First-
generation antihistamines include chlorpheniramine
(Chlor-Trimeton), diphenhydramine (Benadryl), and
hydroxyzine (Atarax).

Other Allergic Disorders
Contact dermatitis
Atopic dermatitis
Drug reactions (dermatitis medicamentosa)
Urticaria and angioneurotic edema
Food allergy
Serum sickness
Latex allergy
Question
When could a rebound anaphylactic reaction occur after
an initial attack even when epinephrine has been given?
A. One hour
B. Two hours
C. Three hours
D. Four hours

Answer
D

A "rebound anaphylactic reaction can occur four to ten
hours after an initial attack even when epinephrine has
been given.

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