Chapter 31: Allergies & Anaphylaxis

Allergic Reaction- an exaggerated response by the immune system to a foreign substance. Anaphylaxis- an unusual or exaggerated allergic reaction to a foreign protein or other substance. Anaphylaxis means the opposite of phylaxis or protection. Anaphylaxis is the most severe form of allergic reaction and is often life threatening. Hymenoptera- any of an order of highly specialized insects such as bees and wasps. Immune System- the body system responsible for combating infection. Immune Response- complex of events within the body that works toward the destruction or inactivation of pathogens, abnormal cells, or foreign molecules. o Variables of the Immune Response Pathogen- a disease producing agent or invading substance. Toxin- any poisonous chemical secreted by bacteria or released following destruction of the bacteria. Antibody- principal agent of a chemical attack of an invading substance. Immunoglobulin- alternative term for antibody. Antigen- any substance that is capable, under appropriate conditions, of inducing a specific immune response. o Mechanisms of the Immune System Cellular immunity- immunity resulting from a direct attack of a foreign substance by specialized cells of the immune system. Humoral immunity- immunity resulting form attack of an invading substance by antibodies. o 2 Types of Immune Response Primary response- initial, generalized response to an antigen. Secondary response- response by the immune system that takes place if the body is exposed to the same antigen again; in secondary response, antibodies specific for the offending antigen are released. o Types of Immunity Natural immunity- genetically predetermined immunity that is present at birth; innate immunity Acquired immunity- immunity that develops over time and results from exposure to an antigen. Naturally acquired immunity- immunity that begins to develop after birth and is continually enhanced by exposure to new pathogens and antigens throughout life. Induced Active Immunity- immunity achieved through vaccination given to generate an immune response that results in the development of antibodies specific for the injected antigen; artificially acquired immunity.

Active Immunity- acquired immunity that occurs following exposure to an antigen and results in the production of antibodies specific for the antigen. Passive Immunity- acquired immunity that results from administration of antibodies either form mother to thre infant across the placental barrier (natural passive immunity) or through vaccination (induced passive immunity).

Allergies Sensitization- initial exposure of a person to an antigen that results in an immune response. Hypersensitivity- an unexpected and exaggerated reaction to a particular antigen. It is used synonymously w/the term allergy. Allergy- a hypersensitive state acquired through exposure to a particular allergen. Delayed Hypersensitivity Reaction- a hypersensitivity reaction that takes place after the elapse of some time following reexposure to an antigen. They are usually less severe than immediate reactions. Immediate Hypersensitivity Reaction- a hypersensitivity reaction that occurs swiftly following reexposure to an antigen. They are usually more severe than delayed reactions. The swiftest and most severe of such reactions is Anaphylaxis. Allergen- a substance capable of inducing allergy of specific hypersensitivity. Allergens may be protein or non-protein, although most are proteins. Basophil- type of white blood cell that participates in allergic responses. Mast Cell- specialized cell of the immune system which contains chemicals that assist in the immune response. Histamine- a product of mast cells and basophiles that causes vasodilation, capillary permeability, broncho-constriction, and contraction of the gut. Angioneurotic Edema- marked edema of the skin that usually involves the head, neck, face and upper airway; a common manifestation of severe allergic reactions and anaphylaxis. Anaphylaxis Anaphylaxis usually occurs when a specific allergen is injected directly into the circulation. Slow-Reacting Substance of Anaphylaxis (SRS-A)- stance released from basophiles and mast cells that causes spasm of the bronchiole smooth muscle, resulting in an asthma-like attack and occasionally asphyxia. Assessment Findings of Anaphylaxis The signs and symptoms of anaphylaxis begin within 30-60sec following exposure. Angioneurotic Edema and Laryngeal edema are frequently complications and can threaten the airway. Uticaria/Hives- the raised areas, or wheals, that occur on the skin, associated w/vasodilation due to histamine release. Management of Anaphylaxis o Protect the Airway o Administer Medications

O2 Epinephrine- is a sympathetic agonist. it causes a increase in HR, an increase in the strength of the cardiac contractile force, and peripheral vasoconstriction. 1:10,000 dose is 0.3-0.5mg IV; Pedi 0.01mg/kg 1:1,000 dose is 0.3-0.5mg IM Antihistamines- such as Benadryl 25-50mg IV or IM Corticosteroids- such as Solu-Medrol Vasopressors- such as Dopamine, Norepinephrine, and Epinephrine. These are administered to support B/P and cardiac output. Beta Agonists- (Bronchodilation) such as Albuterol 2.5mg Other Agents Aminophylline- a Bronchodilation unrelated to the beta agonists. Cromolyn Sodium- helps to stabilize the membranes of the mast cells, thus reducing the amount of histamine and other mediators released when these cells are stimulated.