Seminar on Anaphylaxis 7-6-12

7/31/2019 Seminar on Anaphylaxis 7-6-12

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SEMINAR ON ANAPHYLAXIS

BY

LIDIYAMOL.P.V

1ST YEAR M.SC NURSINGGOVT. CON , THRISSUR


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HISTORY OF IMMUNOLOGY:-

Immunology is a science that examines the

structure and function of the immune system.

The earliest known reference to immunity was

during the plague of Athens in 430 BC.

. Thucydides noted that people who had

recovered from a previous bout of the disease

could nurse the sick without contracting the

illness a second time.
http://en.wikipedia.org/wiki/Immunologyhttp://en.wikipedia.org/wiki/Plague_of_Athenshttp://en.wikipedia.org/wiki/Thucydideshttp://en.wikipedia.org/wiki/Thucydideshttp://en.wikipedia.org/wiki/Plague_of_Athenshttp://en.wikipedia.org/wiki/Immunology


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HISTORY OF IMMUNOLOGY:-

CONTD

Immunology made a great advance towards

the end of the 19th century, through rapid

developments, in the study ofhumoral

immunity and cellular immunity. Particularly

important was the work ofPaul Ehrlich, who

proposed the side-chain theory to explain the

specificity of the antigen-antibody reaction
http://en.wikipedia.org/wiki/Humoral_immunityhttp://en.wikipedia.org/wiki/Humoral_immunityhttp://en.wikipedia.org/wiki/Cell-mediated_immunityhttp://en.wikipedia.org/wiki/Paul_Ehrlichhttp://en.wikipedia.org/wiki/Side-chain_theoryhttp://en.wikipedia.org/wiki/Side-chain_theoryhttp://en.wikipedia.org/wiki/Side-chain_theoryhttp://en.wikipedia.org/wiki/Side-chain_theoryhttp://en.wikipedia.org/wiki/Paul_Ehrlichhttp://en.wikipedia.org/wiki/Cell-mediated_immunityhttp://en.wikipedia.org/wiki/Humoral_immunityhttp://en.wikipedia.org/wiki/Humoral_immunityhttp://en.wikipedia.org/wiki/Humoral_immunity


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FACTORS THAT DETERMINE AN

ALLERGIC RESPONSE:-

Responsiveness of the host to the allergen:

Amount of allergen:

Nature of the allergen: Route of entrance of the allergen

Timing of exposure to the allergen

Site of the allergen immune mediatorreaction


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FACTORS THAT DETERMINE AN

ALLERGIC RESPONSE:- CONTD

Hosts threshold of reactivity

The hosts immune system can be

changed by factors such as stress, fatigue, or

infection, all of which can decrease the

responsiveness of immune system to potential

allergens.


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CLASSIFICATION OF HYPERSENSITIVITY

REACTIONS:-

IMMEDIATE HYPERSENSITIVITY (B-CELL ORANTIBODY MEDIATED)

Anaphylaxis

Atopy Antibody mediated cell damage

Arthus phenomenon

Serum sickness

DELAYED HYPERSENSITIVITY (T- CELL MEDIATED) Infection (tuberculin)

Contact dermatitis


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Coombs and Gell (1963) classification

of hypersensitivity reactions

Type I (anaphylactic, IgE or reagin dependent):

Antibodies (cytotropic IgE antibodies ) are

fixed on the surface of tissue cells ( mast cells

and basophils ) in sensitised individuals. The

antigen combines with the cell fixed antibody

leading to release of vasoactive amines which

produces clinical reactions.


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Type II (cytotoxic or cell stimulating):

This type of reaction is initiated by IgE (OR

rarely IgM) antibodies that reacts with the

cell surface or tissue antigen. Cell or

tissuedamage occurs in the presence of

complement or mononuclear cells. Type II

reactions are intermediate betweenhypersensitivity and auto immunity.


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Type III ([mmune complex or toxic complex

disease)

Here the damage is caused by antigen

antibody complexes. These may precipitate in

and around small blood vessels, causing

damage to cells secondarily, or on

membranes, interfering with their function


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Type IV (ddelayed or cell mediated )

This is a cell mediated response. The

antigen activates specifically sensitised CD4

AND CD8 T cells, leading to the secretion of

lymphokines, with fluid and phagocyte

accumulation.


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DEFINITION

Type I Reactions:-

These occur in two forms : the acute,potentially fatal, systemic form called

anaphylaxis and the chronic or recurrent, non-

fatal, typically localised form called atopy.


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DEFINITION:-

. Anaphylaxis is defined as "a

serious allergic reaction that is rapid in onset

and may cause death". It typically results in a

number of symptoms including an itchy rash,

throat swelling, and low blood pressure.

Common causes include insect bites, foods,

and medications.
http://en.wikipedia.org/wiki/Allergic_reactionhttp://en.wikipedia.org/wiki/Blood_pressurehttp://en.wikipedia.org/wiki/Blood_pressurehttp://en.wikipedia.org/wiki/Allergic_reaction


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DEFINITION

. Anaphylaxis is an acute, potentially fatal,

multiorgan system reaction caused by the

release of chemical mediators from mast cells

and basophils. The classic form involves priorsensitization to an allergen with later re-

exposure, producing symptoms via an

immunologic mechanism.


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DEFINITION

Anaphylaxis is a clinical response to an

immediate (type I hypersensitivity)

immunological reaction between a specific

antigen and antibody. The reaction result fromIgE antibody.


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ETIOLOGY

Food

Medication

Venom Risk factors

People with atopic diseases such

as asthma, eczema, or allergic rhinitis are athigh risk of anaphylaxis from food, latex,

and radiocontrast
http://en.wikipedia.org/wiki/Atopichttp://en.wikipedia.org/wiki/Asthmahttp://en.wikipedia.org/wiki/Eczemahttp://en.wikipedia.org/wiki/Allergic_rhinitishttp://en.wikipedia.org/wiki/Latexhttp://en.wikipedia.org/wiki/Radiocontrasthttp://en.wikipedia.org/wiki/Radiocontrasthttp://en.wikipedia.org/wiki/Latexhttp://en.wikipedia.org/wiki/Allergic_rhinitishttp://en.wikipedia.org/wiki/Eczemahttp://en.wikipedia.org/wiki/Asthmahttp://en.wikipedia.org/wiki/Atopic


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immune system

LAYERED DEFENSE:-

physical barriers prevent pathogens such

as bacteria and viruses from entering the

organism. If a pathogen breaches these

barriers, the innate immune system provides

an immediate, but non-specific response
http://en.wikipedia.org/wiki/Bacteriahttp://en.wikipedia.org/wiki/Virushttp://en.wikipedia.org/wiki/Innate_immune_systemhttp://en.wikipedia.org/wiki/Innate_immune_systemhttp://en.wikipedia.org/wiki/Virushttp://en.wikipedia.org/wiki/Bacteria


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immune system

If pathogens successfully evade the innate

response, vertebrates possess a second layer

of protection, the adaptive immune system,

which is activated by the innate response.
http://en.wikipedia.org/wiki/Adaptive_immune_systemhttp://en.wikipedia.org/wiki/Adaptive_immune_system


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IMMUNE SYSTEM

SURFACE BARRIERS

Mechanical, chemical, and biological

barriers.

INNATE IMMUNE SYSTEM

The innate response is usually triggered

when microbes are identified by pattern

recognition receptors
http://en.wikipedia.org/wiki/Pattern_recognition_receptorshttp://en.wikipedia.org/wiki/Pattern_recognition_receptorshttp://en.wikipedia.org/wiki/Pattern_recognition_receptorshttp://en.wikipedia.org/wiki/Pattern_recognition_receptors


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Humoral and chemical barriers

Inflammation

Inflammation is one of the first responses ofthe immune system to infection. The

symptoms of inflammation are redness,

swelling, heat, and pain, which are caused by

increased blood flow into tissue.
http://en.wikipedia.org/wiki/Bloodhttp://en.wikipedia.org/wiki/Blood


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. Complement system

The complement system is a biochemical

cascade that attacks the surfaces of foreign

cells

Complement is the major humoral component

of the innate immune response
http://en.wikipedia.org/wiki/Biochemical_cascadehttp://en.wikipedia.org/wiki/Biochemical_cascadehttp://en.wikipedia.org/wiki/Humoral_immunityhttp://en.wikipedia.org/wiki/Humoral_immunityhttp://en.wikipedia.org/wiki/Biochemical_cascadehttp://en.wikipedia.org/wiki/Biochemical_cascade


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In humans, this response is activated by

complement binding to antibodies that have

attached to these microbes or the binding of

complement proteins to carbohydrates on thesurfaces ofmicrobes. This

recognition signal triggers a rapid killing

response
http://en.wikipedia.org/wiki/Carbohydratehttp://en.wikipedia.org/wiki/Microbehttp://en.wikipedia.org/wiki/Cell_signalinghttp://en.wikipedia.org/wiki/Cell_signalinghttp://en.wikipedia.org/wiki/Microbehttp://en.wikipedia.org/wiki/Carbohydrate


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Adaptive immune system

The adaptive immune response is antigen-

specific and requires the recognition of

specific "non-self" antigens during a process

called antigen presentation. Antigenspecificity allows for the generation of

responses that are tailored to specific

pathogens or pathogen-infected cells.
http://en.wikipedia.org/wiki/Antigen_presentationhttp://en.wikipedia.org/wiki/Antigen_presentation


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Lymphocytes

The cells of the adaptive immune system arespecial types of leukocytes,

called lymphocytes. B cells and T cells are themajor types of lymphocytes and are derivedfrom hematopoietic stem cells in the bonemarrow. B cells are involved in the humoralimmune response, whereas T cells areinvolved in cell-mediated immune response
http://en.wikipedia.org/wiki/Lymphocytehttp://en.wikipedia.org/wiki/B_cellhttp://en.wikipedia.org/wiki/T_cellhttp://en.wikipedia.org/wiki/Hematopoietic_stem_cellhttp://en.wikipedia.org/wiki/Bone_marrowhttp://en.wikipedia.org/wiki/Bone_marrowhttp://en.wikipedia.org/wiki/Humoral_immunityhttp://en.wikipedia.org/wiki/Humoral_immunityhttp://en.wikipedia.org/wiki/Cell-mediated_immunityhttp://en.wikipedia.org/wiki/Cell-mediated_immunityhttp://en.wikipedia.org/wiki/Cell-mediated_immunityhttp://en.wikipedia.org/wiki/Cell-mediated_immunityhttp://en.wikipedia.org/wiki/Humoral_immunityhttp://en.wikipedia.org/wiki/Humoral_immunityhttp://en.wikipedia.org/wiki/Humoral_immunityhttp://en.wikipedia.org/wiki/Bone_marrowhttp://en.wikipedia.org/wiki/Bone_marrowhttp://en.wikipedia.org/wiki/Hematopoietic_stem_cellhttp://en.wikipedia.org/wiki/T_cellhttp://en.wikipedia.org/wiki/B_cellhttp://en.wikipedia.org/wiki/Lymphocyte


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Killer T cells

Killer T cell are a sub-group of T cells that kill

cells that are infected with viruses (and other

pathogens), or are otherwise damaged or

dysfunctional.
http://en.wikipedia.org/wiki/Cytotoxic_T_cellhttp://en.wikipedia.org/wiki/Cytotoxic_T_cell


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Helper T cells

Helper T cells regulate both the innate and

adaptive immune responses and help determinewhich immune responses the body makes to aparticular pathogen. These cells have no cytotoxicactivity and do not kill infected cells or clear

pathogens directly. They instead control theimmune response by directing other cells toperform these tasks.
http://en.wikipedia.org/wiki/T_helper_cellhttp://en.wikipedia.org/wiki/T_helper_cell


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T cells

T cells possess an alternative T cell

receptor (TCR) as opposed to CD4+ and CD8+

() T cells and share the characteristics of

helper T cells, cytotoxic T cells and NK cells.

The conditions that produce responses from

T cells are not fully understood
http://en.wikipedia.org/wiki/Gamma/delta_T_cellshttp://en.wikipedia.org/wiki/Gamma/delta_T_cellshttp://en.wikipedia.org/wiki/T_cell_receptorhttp://en.wikipedia.org/wiki/T_cell_receptorhttp://en.wikipedia.org/wiki/T_cell_receptorhttp://en.wikipedia.org/wiki/T_cell_receptorhttp://en.wikipedia.org/wiki/Gamma/delta_T_cellshttp://en.wikipedia.org/wiki/Gamma/delta_T_cellshttp://en.wikipedia.org/wiki/Gamma/delta_T_cells


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B lymphocytes and antibodies

A B cell identifies pathogens when antibodies onits surface bind to a specific foreign antigen. This

antigen/antibody complex is taken up by the Bcell and processed by proteolysis into peptides.The B cell then displays these antigenic peptideson its surface MHC class II molecules. This

combination of MHC and antigen attracts amatching helper T cell, whichreleases lymphokines and activates the B cell.
http://en.wikipedia.org/wiki/B_cellhttp://en.wikipedia.org/wiki/Proteolysishttp://en.wikipedia.org/wiki/Lymphokinehttp://en.wikipedia.org/wiki/Lymphokinehttp://en.wikipedia.org/wiki/Proteolysishttp://en.wikipedia.org/wiki/B_cell


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Immunological memory

When B cells and T cells are activated and

begin to replicate, some of their offspring

become long-lived memory cells. Throughout

the lifetime of an animal, these memory cells

remember each specific pathogen

encountered and can mount a strongresponse if the pathogen is detected again.


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PATHOPHYSIOLOGY:-

Type I hypersensitivity are mediated by the IgE

class of immunoglobulin. In genetically, pre

disposed people, initial exposure to an

allergen prompts B lymphocytes to produceIgE antibodies, which sensitize the person to

the allergen. This initial contact with the

allergen is known as the sensitizing dose


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PATHOPHYSIOLOGY

Once the person is fully sensitized, subsequentexposure ( termed the shocking dose orchallenging dose) results in the allergencombined with the specific IgE antibodies thatare bound to receptor sites on tissue mast cellsand blood basophils. This antigen antibodyreaction results in a rapid release of potent vaso

active mediators such as histamines, kinins,chemo tactic factors, and active products ofarachidonic acid metabolism


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PATHOPHYSIOLOGY

Anaphylaxis is caused by the interaction of aforeign antigen with specific IgE antibodies foundon the surface membrane of mast cells andperipheral blood basophils. The subsequentrelease of histamine and other bioactivemediators cause activation of platelets,eosinophils, and neutrophils and coagulation

cascade. Smooth muscle spasm, bronchospasm,mucosal eddema, and inflammation, andincreased capillary permeability


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CLINICAL FEATURES Localised reactions:-

Hives angioedema

Systemic anaphylaxis:-

Apprehension

Edema of the hands, face, or other parts of the body Dyspnoea

Respiratory collapse

Vascular collapse with shock Rapid, regular pulse Falling blood pressure

Cyanosis

Death


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DIAGNOSTIC MEASURES

The health history including an environmental

assessment,

Skin testing and radio allergo sorbent test

(RAST) may be helpful


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MEDICAL MANAGEMENT

Management depends on the severity of the

reaction. Initially, respiratory and

cardiovascular functions are evaluated


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TREATMENT

Simple BLS (O2, position, etc)

Anti Histamines

Benadryl (IV 25-50 mg, PO 50 mg adult, 25 mg ped)

Corticosteroids

Decadron, Solu-medrol, etc

Treat Hypotension

IV fluids

Dopamine 5-20 mcg/min

Epi Drip 2-10 mcg/min


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TREATMENT

Broncheodiators

Albuterol MDI or Neb

Observe for a minimum 8-12 hours

Benadryl for 24 hours.

Rebound or persitant S/S

Repeat epinephrine if Sx persist or increase after 10-15

minutes

Repeat antihistamine H2 blocker if Sx persist


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TREATMENT

Avoidance therapy, in which the patient is

thought to reduce exposure to trigerring

antigens, is the most effective treatment to

decrease allergic attacks

Immunotherapy is often useful in reducing

symptoms in patients who cannot avoid

antigens such as dust mites or pollen


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PREVENTION

EDUCATE

Teach avoidance measures

Accidents are never planned

Stress importance of:

Immediate treatment

Emphasize the need for follow-up care


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NURSING MANAGEMENT

ASSESSMENT:-

Health history:-

Assessment data to be collected as part of thehealth history of a patient with allergy includes:

History of allergic reactions in the past ( e.g., type,frequency or perceived causes)

Familial history of allergies

Recent exposure to sensitizing substances (chemicals,drugs)

Changes in living, working, or environmental conditions


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NURSING MANAGEMENT

Characteristics of present environment (house, clothing,plants, trees or animals)

Increased stress in recent past ( stress aggrevates asthmaticresponse)

Types of symptoms experienced: respiratory, dermal,gastrointestinal or general

Alleviating factors, either prescribed, herbal, or over thecounter

All patients should be questioned about allergies and

sensitivities to drugs before any drug therapy is initiated. Ifthere is a positive history, the physician is consulted beforea new drug is given, the patient is monitored closely forallergic responses.


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Physical examination:-

Important aspects of the physical examination ofthe patient with allergy include inspection andobservation for :

Rashes (location, and colour) Mouth breathing (nasal obstruction)

Flaring nares

Difficulty hearing (plugged Eustachian tubes)

Pale, bluish turbinates that are oedematous withclear secretions


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PHYSICAL EXAMINATION

Tearing

Dark areas under the eyes ( venous dilation ofthe skin)

Scleral or conjunctival infections Increased respiratory rate

Audible wheezing

Use of accessory muscles for breathing Anxious depression


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NURSING DIAGNOSES:-

Ineffective airway clearance related to excess

secretion production and bronchoconstriction.

Decreased cardiac output related to

inadequate venous return to heart, peripheral

vasodilation.

Deficient knowledge related to inadequate

information about allergy control andtreatments.


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Airway clearence:-

Cardiac output:-

Nurse should be alert for the clinical manifstatios

of anaphylactic shock. At the first sign ofanaphylaxis, the patient is given epinephrine1:1000 solution 0.3 to 0.5 ml s/c or im

Risk for allergy response:-

High risk patients are instructed to wear aidentification bracelet.


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INTERVENTIONS

Provide supplemental oxygen and observe. Ifhypoxia continues, prepare to help insert anartificial airway.

Insert an I.V. line for giving emergency drugs and

volume expanders. Continually reassure the patient and explain all

tests and treatments to reduce fear and anxiety.

If the patient undergoes skin or scratch testing.Keep emergency resuscitation equipment nearbyduring and after the test.


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INTERVENTIONS

Continuously assess the patients response to

treatment.

Monitor vital signs and cardiopulmonary

and neurologic function. Observe for complications associated with

anaphylaxis, such as vascular collapse and acuterespiratory insufficiency or obstruction.

Closely observe a patient with known allergies foranaphylaxis when giving a drug with highanaphylactic potential.


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COMPLICATIONS

The primary complication of type I

hypersensitivity are anaphylactic shock, which

can leads to death within minutes without

emergency treatment.


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Seminar on Anaphylaxis 7-6-12

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Transcript of Seminar on Anaphylaxis 7-6-12