Hypersensitivity

• Caused by an excesive antigen-antibody responde when the invading organism is an

allergen rather than a simple immunogen
• Antigen - can make you sick (bacteria, virus & other substance from outside your body that
threaten your health)
• Antibody - defends your body
Symptoms:
• Allergic “shiners”
• Reddened, watery eyes
• Crease on nose; sneezing, clear nasal discharge
• Rapid heart rate, dyspnea (anaphylaxis)
• Papula, vesicular lesions (atopic dermatitis)
• Urticaria and angioedema
• Joint pain
• Itching, reddened areas (contact dermatitis)
• Classification:
• Type I : Anaphylaxis
• IgE - antibody responsible for the allergic response that is mostly found in the lungs, skin, and mucosal
membranes
• IgE attached to surface of mast cell triggers release of intracellular granules
• Mast cell - cells that are found in lining blood vessels and conective tissues, mucous membrane and
skin
• Inracellular granules - Histamine; Leukotrienes; SRS-A (slow-reacting substance of anaphylaxis)
• Histamine and Leukotrienes causes low blood pressure and edema (peripheral vasodilation and
permeability of blood vessels)
• SRS-A causes extreme bronchial contriction
• Insect bites; Drugs; Allergy testing; Food allergy
• Allergies; Asthma; Atopic dermatitis; Anaphylaxis

• Type II: Cytotoxic

• IgG - main antibody in blood
• IgM - first antibodies recruited by the immune system to fight infection
• Cells are detected as foreign immunoglobulins directly attack and destroy them without harming
surrounding tissue
• Hemolytic anemia; Transfusion reaction; Erythroblastosis fetalis
• Type III: Immune complex disease
• IgG or IgE
• Antigen-antibody complex reaction initiates inflammatory response
• Rheumatoid arthritis; Systematic lupus erythematosus

• Type IV: Delayed/ Cell-Mediated Hypersensitivty

• T lymphocytes - directly kills infected host cells, activates other immune cells, produce cytokines and
regulate the immune response
• T lymphocytes reacts with antigens and release lymphokinesis
• Lymphokinesis - circulation of lymph in the lymphatic vessels and through the lymph nodes
• An inflammatory response occurs that helps destroy the foreign tissue
• Contact dermatitis, Transplant graft reaction

Asssessment:
• History
• Laboratory Testing
• Skin Testing
 Therapeutic Management
• 3 goals:
• Reduce exposure to allergen
• Hyposentisize to produce state of increased clinical tolerance
• Modify response with pharmacologic agent

1. Environmental Control
2. Pharmacologic Theraphy
• Intranasal cromolyn sodium - prevent symptoms
• Antihistamines - block histamine release
• cetirizine
• loratadine
• Decongestants - decrease nasal edema & help enlarge breating space
• Intranasal corticosteroid - to reduce inflammation
3. Hyposensitization / Immunotherapy
• Increase plasma concentration of IgG antibodies
• Subcutaneous injections
• Sublingual immunotherapy (SLIT)
Anaphylactic Shock
• Is an immediate, life-threatening, type I hypersensitivity reaction that
occurs after exposure to an allergen

Symptoms:
• Breathing: wheezing, shortness of breath, throat tightness, cough, hoarse
voice, chest pain/tightness, trouble swallowing, itchy mouth/throat, nasal
stuffiness/congestion
• Circulation: pale/blue color, low pulse, dizziness, light-headedness/passing
out, low blood pressure, shock, loss of consciousness
• Skin: hives, swelling, itch, warmth, redness, rash
• Stomach: nausea, pain/cramps, vomiting, diarrhea
• Other: anxiety, feeling of impending doom, itchy/red/watery eyes,
headache, cramping of the uterus
Urticartia & Angioedema
• Urticartia - or hives, refers to macular wheals surrounded by erythema arising from the chorion layer
of skin; they are intensely pruritic (often described as having a burning sensation)
• Cause of urticaria is a type I or immediate hypersensitivity reaction created by the release of
histamine from an antibody–antigen reaction
• Angioedema - edema of the skin and subcutaneous tissue
• This occurs most frequently on the eyelids, hands, feet, genitalia, and lips—areas where skin is
loosely bound by subcutaneous tissue
• Immediate therapy:
• Intramuscular epinephrine injection or the administration of an oral antihistamine.
Therapeutic Management
• Check record before gving drugs
• Administer Epinephrine (IM) This relieves laryngeal edema and severe bronchospasm by
widening the airway.
• If hypoxia is present, administer oxygen by mask or nasal cannula.
• Anticipate the need for an intravenous (IV) fluid line as a route for a vasopressor such as
dopamine and fluid to help restore blood pressure
• If an insect sting was the cause of the condition, a tourniquet, applied above the site of
the bite, may be prescribed to limit absorption of the insect venom into the bloodstream
• Anticipate use of a nebulized bronchodilator such as albuterol to halt wheezing or
diphenhydramine (Benadryl) intramuscularly or IV if urticaria (itching and swelling) is
present.
• If the child is experiencing seizures, turn the child onto his or her side and prepare to
administer an antiseizure medication such as phenobarbital or diazepam.
• A corticosteroid may be administered as a second-line drug. This does not actimmediately
but does reduce inflammation. IV methylprednisolone is a typical drug given