Good

Immune system Disorders
M A R I A C A R M E L A L . D O M O C M A T, R N , M S N
INSTRUCTOR, CURA AND REHAB NRG II
SCHOOL OF NURSING
NORTHERN LUZON ADVENTIST COLLEGE
Inflammatory and immunologic response

is normally helpful and protect against infection and can development
These responses also stimulates tissue growth and repair after injury
But if prolonged and excessive or occur at inappropriate time
Effect: normal cells, tissues or organs are damaged
Maria Carmela L.Domocmat, RN, MSN
3
WHAT HAPPENS WHEN THE IMMUNE SYSTEM
DOESNT WORK THE WAY IT SHOULD??
Overreaction
Hypersensitivity
Overreactions to invaders and
foreign antigens
Autoimmune response
When it fails to recognize selfcells and attack normal body
tissues
Underreaction
Immunodeficiency
Congenital
Acquired
Hypersensitivity Reaction
Hypersensitivity Reaction or Allergic Reaction

6
an immune malfunction whereby a person's body is hypersensitized to

react immunologically to typically non-immunogenic substances.
Definition of terms
7
Atopy: the tendency to develop allergies for which

there is a genetic disposition and that involve
immunoglobulin E (IgE) antibody formation
AKA atopic, allergic, hypersensitive
Allergy: describes the increased immune response

to the presence of an allergen (i.e., antigen)
People must progress through two-step process to

become allergic
1) sensitization
2) reexposure to the allergen
General categories of hypersensitivity reactions

10
Immediate
humoral or antigen-antibody
Delayed
cell-mediated
Types of Hypersensitivity
11
IMMEDIATE
Type I:
Immediate hypersensitivity
Type II:
Cytotoxic hypersensitivity
Type III:
Immune complex-mediated
hypersensitivity
DELAYED
Type IV:
Delayed Hypersensitivity
Hypersensitivity
12
There are four different types of hypersensitivities that result from

different responses of the immune system:
Type I: Immediate hypersensitivity
- onset within minutes of antigen challenge
- examples are allergies to molds, insect bites
Type II: Cytotoxic hypersensitivity

- onset within minutes or a few hours of antigen challenge
- examples are adult hemolytic anemia and drug allergies
Hypersensitivity
13
There are four different types of hypersensitivities that result from

different responses of the immune system:
Type III: Immune complex-mediated hypersensitivity
- onset usually within 2-6 hours
- examples include serum sickness and systemic lupus
erythematosus
Type IV: Delayed Hypersensitivity

- inflammation by 2-6 hours; peaks by 24-48 hours
- examples include poison ivy and chronic asthma
ATOPIC ALLERGIES
Allergic rhinitis or hay fever

Urticaria or Hives
ALLERGIC ASTHMA
ANAPHYLAXIS
ALLERGY TO SPECIFIC ALLERGEN
Latex allergy
bee venom, peanut, iodine, shellfish, drugs
Type I:
15
This is the type of hypersensitivity usually referred to as

allergy.
Type I:
16
occurs when an IgE antibody response is mounted against
an antigen in the environment that is usually harmless
A single exposure to antigen isnt enough to trigger
hypersensitivity, but the immune response may become
more severe with repeated exposure.
Type I hypersensitivity sensitization to an inhaled allergen

or bee sting
17
cytokines
Mast
cell
Antigens (red dots) from inhaled pollen are ingested and presented by
macrophages to T cells. Activated T cells produce cytokines leading to
the production of IgE, which binds to receptors on mast cells and causes
the release of histamine, which is responsible for allergy symptoms.
Onset is usually within minutes of contact with antigen.
18
When the antigen enters through a respiratory mucosal

surface, it is taken up, processed and displayed by antigenpresenting cells.
When the presented fragments lock on to helper T cell
receptors, the T cells become activated, secreting
cytokines.
The cytokines, in turn, stimulate IgE-producing B cells.
IgE binds to IgE-receptors on the surfaces of mast cells,
sensitizing them.
19
histamine
20
21
22
23
Allergens can be contacted in the ff ways

Inhaled
Ingested
Injected
contacted
Atopic allergy
24
Inhaled
Plant pollens
Fungal spores
Animal dander
House dust
Grass
Ragweed
Ingested
Foods
Food additives
Drugs
Injected
Bee venom
Drugs
Biologic subtances
(ex: contrast dyes,
Adenocotricotropic hormone)
Contacted
Pollens
Foods
Envt proteins
25
26
27
Common Causes of Allergy
What are common allergenic foods?

Legumes (Peanuts and Soybeans)
Mollusks (snails, mussels, oysters, scallops, clams, squid)
Milk
Eggs
Fish (cod, salmon, haddock, etc.)
Crustacea (shrimp, crawfish, lobster. etc.)
Wheat
Tree nuts (almonds, walnuts, Brazil nuts, etc.)
Selected food additives
Atopic allergy
30
MOST COMMON TYPE
INCLUDES :
Allergic rhinitis or hay fever

Urticaria or hay fever
Allergic Rhinitis
31
AKA: HAY FEVER
32
Allergic Rhinitis
33
Triggered by reactions to airborne allergens

Types:
Seasonal: recur to same time of each of the year
Often coincide with timing of large environmental exposure
Chronic: or perennial rhinitis

Occur intermittently or continuous when exposed to allergen
Non-allergic rhinitis
Same manifestations are present
Although no allergic cause is identified immune system does not appear to
be involved
34
35
Urticaria
36
37
Urticaria may be acute (lasting less than 6 wk) or chronic

(lasting more than 6 wk).
38
Many substances can trigger hives, including:

Animal dander (especially cats)
Insect bites
Medications
Pollen
Shellfish, fish, nuts, eggs, milk, and other foods
Hives may also develop as a result of:

Emotional stress
Extreme cold or sun exposure
Excessive perspiration
Illness (including lupus, other autoimmune diseases, and leukemia
Infections such as mononucleosis
Symptoms
39
Itching
Swelling of the surface of the skin into red- or skin-colored
welts (called wheals) with clearly defined edges
The welts may get bigger, spread, and join together to form larger areas
of flat, raised skin.
They can also change shape, disappear, and reappear within minutes or
hours.
The welts tend to start suddenly and go away quickly. When you press
the center of a red welt, it turns white. This is called blanching.
Hives or urticaria
Hives (urticaria) on the back and buttocks

41
These are hives (urticaria) with the typical slightly-raised red

appearance, and are accompanied by itching. These are
located on the buttocks. Hives can be generalized over the
entire body or may be localized, and usually result from an
allergic reaction.
Hives (urticaria) - close-up

42
Hives (urticaria) are raised,

red, itchy welts. The
majority of urticaria
develop as a result of
allergic reactions.
Occasionally, they may be
associated with
autoimmune diseases,
infections (parasitosis),
drugs, malignancy, or
other causes.
Hives (urticaria) on the chest

43
Hives develop when histamine is

released into the small blood vessels
(capillaries). The capillaries dilate which
causes a welt, and fluid oozes into the
surrounding tissue, causing swelling.
Histamine also causes intense itching.
44
45
Latex is a milky fluid that comes from the tropical rubber

tree,Hevea brasiliensis.
Hundreds of everyday products contain latex. Some
common ones are
Gloves
Condoms
Balloons
Rubber bands
Shoe soles
Pacifiers
http://www.nlm.nih.gov/medlineplus/latexallergy.html
Latex exposure is associated with 3 clinical

syndromes
46
first syndrome - irritant dermatitis.

It is a result of mechanical disruption of the skin due to the rubbing of gloves
and accounts for the majority of latex-induced local skin rashes. It is not
immune mediated, is not associated with allergic complications
second syndrome - delayed (type IV) hypersensitivity reaction

Result in a typical contact dermatitis.
Symptoms usually develop within 24-48 hours of cutaneous or mucous
membrane exposure to latex in a sensitized person.
Third syndrome - immediate (type I) hypersensitivity

most serious, and least common
mediated by an immunoglobulin E (IgE) response specific for latex proteins.
See http://emedicine.medscape.com/article/756632-overview#showall for more
information
47
http://www.mountnittany.org/assets/images/krames/7596.jpg
Allergic asthma
48
49
See link: http://emedicine.medscape.com/article/137501-overview#showall for

additional information
http://cureasthmaguide.com/wp-content/uploads/2010/02/inflammed-airways-complex.jpg
50
http://www.dentalgentlecare.com/images/lungs-asthma.gif
Clinical
Manifestations
of Immediate
Hypersensitivity
ASTHMA
Anaphylaxis
54
55
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001847/bin/19320.jpg
56
Nursing assessment
57
H X : A C C U R A T E A N D D E TA I L E D H X
Describe onset and duration of problems

Ask abt work, school, home, environment, possible exposures
through hobbies, leisure time or sports activities
Ask presence of allergies among relatives
PHYSICAL ASSESSMENT
Clinical Manifestations of
Immediate Hypersensitivity
Allergy is characterized by a local or systemic

inflammatory response to allergens
59
Local symptoms:
Nose: swelling of the nasal mucosa, rhinorrhea
Eyes: redness and itching of the conjunctiva (allergic
conjunctivitis)
Airways: bronchoconstriction, wheezing, sometimes
outright attacks of asthma
Ears: feeling of fullness, possibly pain, and impaired
hearing due to the lack of eustachian tube drainage.
Skin: various rashes, such as eczema, hives and contact
dermatitis.
Head: while not as common, headaches are seen in some
with environmental or chemical allergies.
Allergy is characterized by a local or systemic

inflammatory response to allergens
60
Systemic allergic response

Is also called anaphylaxis
Depending of the rate of severity, it can cause cutaneous
reactions, bronchoconstriction, edema, hypotension, coma
and even death.
Hives Symptoms
61
Itching
Swelling of the surface of the skin into red- or skin-colored
welts (called wheals) with clearly defined edges
The welts may get bigger, spread, and join together to form larger areas
of flat, raised skin.
They can also change shape, disappear, and reappear within minutes or
hours.
The welts tend to start suddenly and go away quickly. When you press
the center of a red welt, it turns white. This is called blanching.
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001848/
Food allergies
62
The body's immune system normally

reacts to the presence of toxins, bacteria
or viruses by producing a chemical
reaction to fight these invaders.
However, sometimes the immune
system reacts to ordinarily benign
substances such as food or pollen, to
which it has become sensitive. This
overreaction can cause symptoms from
the mild (hives) to the severe
(anaphylactic shock) upon subsequent
exposure to the substance. An actual
food allergy, as opposed to simple
intolerance due to the lack of digesting
enzymes, is indicated by the production
of antibodies to the food allergen, and
by the release of histamines and other
chemicals into the blood.
Food Allergy - Symptoms

Nausea
Diarrhea
Abdominal cramps
Pruritic rashes
Angioedema
Asthma/rhinitis
Vomiting
Hives
Laryngeal edema
Anaphylaxis
64
Allergy tests
65
SKIN TESTS
Scratch or prick test

Intradermal test
O R A L F O O D C H A L L E N G E O R E L I M I N A T I O N D I E T
L A B O R A T O R Y
TESTS
CBC
Increased serum IgE
RAST (radioallergosorbent test)
66
Skin Tests
Individual is inoculated with allergen by scraping or injection
Fast: results within 30
67
Prep
Discontinue Glucocorticoids and antihistamine 5 days b4 test (to avoid
suppressing allergic response during the test)
Nasal sprays to reduce mucous membrane swelling can be continued
but shld be discontinued if with antihistamine
Skin Tests: ID
Skin Tests: Intradermal or Scratch test

69
The allergens are either injected intradermally or into small
scratchings made into the patient's skin

If the patient is allergic to the substance, then a visible inflammatory
reaction will usually occur within 30 minutes.
This response will range from slight reddening of the skin to full-blown
hives in extremely sensitive patients.
Problems: some people may display a delayed-type hypersensitivity
(DTH) reaction which can occur as far as 6 hours after application of
the allergen and last up to 24 hours. This can also cause serious longlasting tissue damage to the affected area. These types of serious
reactions are quite rare.
http://www.allergyclinic.co.uk/images/pricktest.jpg
70
71
Oral Food Challenge

72
Used to identify specific allergen if skin testing is not

conclusive and if keeping a food diary has failed to
determine the offending food items
Prep - eliminate suspected foods 7-14 days b4 test
Eat defined suspected allergen for at least 1 day
Monitor s/s of allergy
If with many food allergies eat only 1 food type/day of
testing
73
Laboratory tests
CBC
Increased eosinophils 12% (normal 1-2%)
Increased WBC count, but percentage of neutrophils is normal (55-70%)
Note: if acute infection occurs with rhinitis both WBC and neutrophils
are increased)
Increased serum IgE

Only confirms the presence of infection
But does not indicate specific allergen
RAST (radioallergosorbent test)

Shows blood level of IgE directed against a specific antigen
Can determine specific allergies
Expensive
Management of Type I
Hypersensitivity Reaction
74
Allergy management
75
Avoidance therapy - identify and prevent exposure to

allergen, control of environment
2. Symptomatic therapy
1.
1.
3.
Teach how to use Epi-pen
Desensitization therapy
1. Avoidance therapy
76
Avoid direct contact with allergen

Airborne allergen
Air-conditioning and air cleaning units
Remove cloth drapes, upholstered furniture, carpet
Cover mattress and pillows with plastic or cotton fine mesh
Pet-induced allergy
Keep pet out of bedroom
Thoroughly clean room to remove hair and dander
Frequent bathing of pet
1. Avoidance therapy
77
Avoid direct contact with allergen

Latex allergy
Avoid products with latex;
use synthetic substances that do not contain latex protein
Ex: Elastylite glove
Note: always use latex-free products in the care of client

with known latex allergy
78
Drug therapy or Pharmaceutical approaches to allergy

treatment involve
Decongestants
Antihistamine
Corticosteroids
Mast cell stabilizers
Leukotrine Antagonists
Complementary and alternative Therapies

Aromatherapy
Eat unprocessed honey
79
Nasal Decongestants
Action: prevent release of mediators such as histamine but do not
clear the allergen
Have similar action to adrenergic agents - cause vasoconstriction in
inflamed tissues
Often contain ephedrine, phenylephrine, or pseudoephedrine
Phenylephrine 1 spray/nostril 4-6x/day ; Oxymetazoline -1
spray/nostril 2x/day ; pseudoephedrine (Sudafed)
Note: caution not to use more frequently than directed or for longer
than 4 days (overuse or continued use causes a rebound nasal
congestion or rebound rhinitis and worsens the symptoms)
S/E: dry mouth, increased BP, sleep difficulties
Nasal Spray
80
Nasal Decongestants:
Nursing Implications
Decongestants may cause hypertension, palpitations, and
CNS stimulationavoid in patients with these conditions
Patients on medication therapy for hypertension should
check with their physician before taking OTC
decongestants
Assess for drug allergies
Mosby items and derived items 2005, 2002 by Mosby, Inc.
Nasal Decongestants:
Patients should avoid caffeine and caffeine-containing
products
Report a fever, cough, or other symptoms lasting longer
than a week
Monitor for intended therapeutic effects
83
Antihistamine
Compete with histamine at receptor site and block histamine from
binding to the receptor prevents vasodilation and capillary leak
first generation antihistamines
diphenhydramine (Benadryl) and chlorpheniramine (Chloratrimeton)
common side effect : sedation, drowsiness, and dry mouth
Use at night before bedtime to avoid feeling tired the next day.
second-generation antihistamines
loratadine (Claritin), fexofenadine (Allegra), and certirizine (Zyrtec)
less likely to cause drowsiness and can be taken during the daytime.
Antihistamines:
Gather data about the condition or allergic reaction that
required treatment; also assess for drug allergies
Contraindicated in the presence of acute asthma attacks
and lower respiratory diseases
Use with caution in increased intraocular pressure, cardiac
or renal disease, hypertension, asthma, COPD, peptic
ulcer disease, BPH, or pregnancy
http://www.chipola.edu/instruct/healthsciences/PowerPointPresentations/Pharmacology/Chapter_035.ppt
Antihistamines:
Instruct patients to report excessive sedation, confusion, or
hypotension
Avoid driving or operating heavy machinery, and do not
consume alcohol or other CNS depressants
Do not take these medications with other prescribed or
OTC medications without checking with prescriber
Mosby items and derived items 2005, 2002 by Mosby,

Inc.
Antihistamines:
Best tolerated when taken with mealsreduces GI upset
If dry mouth occurs, teach patient to perform frequent
mouth care, chew gum, or suck on hard candy (preferably
sugarless) to ease discomfort
Monitor for intended therapeutic effects
87
Combined products
Claritin-D.
loratadine (Claritin) and pseudoephedrine (Sudafed) are combined in the
over-the-counter product
This allergy relief medicine gives the benefit of the antihistamine to
prevent nasal allergies and the decongestant to open swollen nasal passages.
88
Corticosteroids
Decreased inflam and immune response in many ways
One way prevent synthesis of mediators
Nasal spray prevent symtpoms of rhinitis
Systemic can produce severe S/E; avoised for rhinites; used inly
in short-term basis for other probmels assoc wth type I hypersen.
Beclomethasone (Beconase)
1-2 metered spray /nostril ; 1-2x/day
fluticasone (Flovent, Flonase)

2 metered spray /nostril/day
Inhaled Corticosteroids:
Contraindicated in patients with psychosis, fungal
infections, AIDS, TB
Cautious use in patients with diabetes, glaucoma,
osteoporosis, PUD, renal disease, HF, edema
Teach patients to gargle and rinse the mouth with water
afterward to prevent the development of oral fungal
infections
Inhaled Corticosteroids:
Abruptly discontinuing these medications can lead to
serious problems
If discontinuing, should be weaned for 1 to 2 weeks, only
if recommended by physician
Report any weight gain of more than 5 pounds a week or
the occurrence of chest pain
http://www.chipola.edu/instruct/healthsciences/PowerPointPresentations/Pharmacology/Chapter_036.p
91
Mast cell stabilizers

Prevent mast cell membranes from opening when allergen bnds to
the IgE
Prevent symptomes of rhinits but not useful during acute episodes
cromolyn (NasalCrom, Intal)
1 spray/nostril/4-6x/day
Use as directed (effectiveness depends on regular use)
Start therapy 2-4 weeks b4 expected allergy season
Mast Cell Stabilizers:

For prophylactic use only
Contraindicated for acute exacerbations
Not recommended for children younger than age 5
Therapeutic effects may not be seen for up to 4 weeks
Teach patients to gargle and rinse the mouth with water
afterward to minimize irritation to the throat and oral
mucosa
Mosby items and derived items 2005, 2002 by Mosby,

Inc.
93
or Antileukotrienes
Also called leukotriene receptor antagonists (LRTAs)
Currently available agents

montelukast (Singulair)
zafirlukast (Accolate)
zileuton (Zyflo)
600mg 4x/day
Do not take with terfenadine or theophylline Zyflo increases plasma
concentrations of these drugs
94
Leukotrine
Substances in the body that cause inflammation, bronchoconstriction,
and mucus production
Result: coughing, wheezing, shortness of breath
Includes:
zileuton (Zyflo)
95
zileuton (Zyflo)
600mg 4x/day
Do not take with terfenadine or theophylline Zyflo increases plasma
concentrations of these drugs
2. Symptomatic therapy; Leukotrine Antagonists

96
20 mg BID
Take 1 hr b4 or 2 hrs after eating (food
slows absorption of drug)
There is an increased incidence of URI
when co-administered with inhaled
corticosteroids (drug reduced local
inflam and immune response)
Reduce dose if also taking aspirin
(aspirin increases plasea concentration
of Accolate)
Antileukotrienes: Drug Effects

Keep bronchial airways relaxed (open)
Decrease mucus secretion
Prevent vascular permeability
Preventing inflammation
Mosby items and derived items 2005,

2002 by Mosby, Inc.
98
zileuton
Headache
Dyspepsia
Nausea
Dizziness
Insomnia
Liver dysfunction
montelukast has fewer side
effects
zafirlukast
Headache
Nausea
Diarrhea
Liver dysfunction
Antileukotrienes:
Ensure that the drug is being used for chronic management
of asthma, not
acute asthma
Teach the patient the purpose of the therapy
Improvement should be seen in about
1 week

2002 by Mosby, Inc.
Antileukotrienes:
Check with physician before taking any
OTC or prescribed medicationsmany
drug interactions
Assess liver function before beginning therapy
Medications should be taken every night on a continuous
schedule, even if symptoms improve

2002 by Mosby, Inc.
101
Complementary and alternative Therapies

Aromatherapy
Possible mechanism of action competition and desensitization
Eat unprocessed honey

Indicated for those who have pollen allergies
3. Desensitization therapy
102
AKA:
Hyposensitization
Allergy shots
Indicated when allergens are identified

and cannot be avoided easily
Immunize with increasing doses of
allergen
Mechanism of action competition
3. Desensitization therapy
103
Injection given
weekly -1st year
q other week 2nd year
q 3-4 wks 3rd year
5 years- recommended course of treatment
Or rally
Sublingual immunotherapy (SLIT)
Desensitization or Hyposensitization
104
has been effective for a few antigens, particularly bee

venom.
is designed to cause an IgG response instead of an IgE
response.
The allergen is either ingested or injected into the subject
starting in small amounts and increased to larger amounts.
Desensitization or Hyposensitization
105
This treatment can have 2 effects:

1. T-helper 1 cells produce more IgG which binds to the
antigen so that it cant bind to IgE receptors on mast
cells and cause release of histamines. (Competition)
2. IgG binds to and removes the antigen before it binds to
T-helper 2 cells. The T- helper 2 cells will then not be
able to produce the B cells that will produce IgE.
Control of Type I Hypersensitivity Reactions

106
Epinephrine
Increases cAMP levels and inhibits degranulation,
relaxes smooth muscles, increases cardiac output, and decreases
vascular permeability
Antihistamines
block the H1 and H2 histamine receptors on cells and
prevent degranulation
107
Type II:
Cytotoxic hypersensitivity
109
Antibody-mediated Cytotoxic Hypersensitivity

Complement-mediated lysis
Antibody dependent cell-mediated
cytotoxicity (ADCC)
Opsonization
110
111
Hemolytic anemias
Hemolytic Transfusion Reactions
Hemolytic Disease of the Newborn
Drug-Induced Hemolytic Anemia
Transfusion Reactions
112
Due to antibodies that react with antigens on red blood cells

Transfused cells are killed by complement-mediated lysis
113
ABO Blood Group System
Table 19.2
Figure 19.4

116
Maternal IgG specific for red blood cell antigens crosses the
placenta and causes lysis.
The most severe form of the disease, called erythroblastosis
fetalis, develops in an Rh+ fetus carried in an Rh- mother.
Rh is an antigen found on red blood cells.
117
Child with Rh hemolytic disease of the

newborn
118
Why is the fetus edematous?

The child has hydrops fetalis.
Patients with Rh hemolytic disease
have severe anemias, which lead to
high output failure and both left
and right heart failure, the latter
responsible for peripheral edema
and ascites. The liver in this fetus
had massive hepatomegaly
secondary to extramedullary
hematopoiesis.
http://www.duke.edu/~ema5/Golian/Slides/5/hematology11_files/Hem282.jpg
119
Brain of the above fetus. What

is causing the yellowish
discoloration?
The yellow pigment is
unconjugated, lipid soluble
bilirubin derived from
macrophage destruction of the
Rh-sensitized fetal RBCs. The
condition is called kernicterus.
Kleihauer-Betke test in maternal blood postdelivery

120
The mother is O negative

and the baby is O positive.
Who do the normal
colored RBCs belong to
and what should the
mother be given to
prevent sensitization?
The normal staining cells

contain Hgb F and represent
fetal RBCs, while the pale
staining cells contain Hgb A
from the mother. She should
be given Rh immune
globulin (anti-D) to prevent
sensitization to the D
antigen.
Drug Induced Hemolytic Anemia

121
Antibiotics covalently attach to proteins on red blood cells

Penicillin, cephalosporin, Streptomycin
This essentially creates a hapten-carrier complex that can

result in a B cell response to the drug
Red-blood cells bound to the drug are killed by
complement-mediated lysis
122
Drug (p=penicillin)
modified red blood cells
induce the production of
antibodies, because the
bound drug makes them
look foreign to the
immune system. When
these antibodies are
bound to them, the red
blood cells are more
susceptible to lysis or
phagocytosis. Onset is
dependent on the
presence of specific
antibodies.
123
Symptoms:
Fever, chills, nausea, clotting within vessels and lower back pain.
Treatment:
Stop the transfusion! Or discontinue offending drug
Plasmapheresis
Filtration of plasam to remove specific subtances to remove antibodies
Symptomatic treatment
Provide diuretic to increase urine output and reduce buildup of hemoglobin
For Rh mother
Should be given Rh immune globulin (anti-D) or RhoGam
124
If mother has not yet been sensitized or exposed to the

Rh+ fetus,
She will be given an injection of Rh-immune globulin (Rhogam)at
about 28 weeks of pregnancy,
and within 72 hours after a birth, miscarriage, abortion, or amniocentesis.
If receive injection at 28 weeks and after delivery, sensitization will be

prevented and Rh incompatibility should not be a problem during your
next pregnancy.
http://www.pregnancy.org/article/rh-incompatibility-and-why-you-need-rhogam?page=1
125
The Rh-immune globulin contains antibodies to the Rh D

factor.
These antibodies will destroy any red blood cells from the baby that
have entered the mothers blood.
The mother will not have a chance to form own antibodies to the Rh D
factor.
126
It is important to receive Rh-immune globulin in all cases

when the baby's blood could leak into the mothers system,
including:
All pregnancies including ectopic (tubal) pregnancies
Early miscarriages
After chorionic villus sampling
After amniocentesis
127
How Long Will the Effects Last?

Sensitization usually doesn't happen until after the birth of an Rhpositive baby.
Therefore, in most cases Rh incompatibility is not a problem during
a woman's first pregnancy and delivery of an Rh-positive baby.
However, later pregnancies and deliveries may be affected unless the
mother is treated with Rh-immune globulin after EVERY birth,
miscarriage, and abortion. Sensitization is permanent and the
effects are usually worse with each subsequent pregnancy.
Type III:
Immune complex-mediated
hypersensitivity
SERUM SICKNESS
SLE
RHEUMATOID ARTHRITIS
AGE
Type III hypersensitivity

129
Involve reactions against soluble antigens circulating in

serum.
Usually involve IgM, IgG antibodies.
Antibody-Antigen immune complexes are deposited in
organs, activate complement, and cause inflammatory
damage.
Glomerulonephritis: Inflammatory kidney damage.
Occurs with slightly high antigen-antibody ratio is present.
Type III hypersensitivity immune complex formation

and deposition
130
Immune complexes of
antigen (red dots) and
antibody form in
target organ
Immune complexes
activate complement
(green dots- C3a, C4a,
and C5a), and mast cells
(yellow cell) degranulate.
Inflammation and
edema occur, and
organ is damaged
Type III hypersensitivity immune complex formation and

deposition
131
In sensitized individuals, allergen (antigen) combined with

antibody leads to the formation of immune complexes,
which activate complement and the inflammatory
response.
The location of the inflammation depends on the location
of the antigen - inhaled, under skin, systemic.
Onset is usually within 2-6 hours.
Type III (Immune Complex) Reactions
Figure 19.6
IgG antibodies and antigens form complexes that lodge in

basement membranes.
Serum sickness
133
Group of symptoms that occur after receiving serum or

certain drugs
Most common causes:
Penicillin
Other antibiotics
Some animal-based drugs
Less common- vaccines
Serum - does not contain white or red blood cells nor a clotting factor
134
s/s
7-12 days after receiving the causative agent
Fever arthralgia (achy joints)
Rash
Lymphadenopathy
Malaise
Polyarthritis and nephritis
SLE
135
Caused by immune-complexes lodged in :

Vessels(vasculitis)
Glomeruli (nephritis)
Joints (arthralgia, arthritis)
Other organs and tissues
Rheumatoid arthritis
136
Caused by immune-complexes lodged in joint spaces

followed by destruction of tissue , and later, scarring and
fibrous changes
Management
137
Usually self-limiting
Symptoms subside after several days
Antihistamine for itching
Aspirin for arthralgia
Prednisone if severe symptoms
Type IV:
Delayed Hypersensitivity
P P D ( P O S I T I V E P ROT E I N D E R I VA T I V E ) T E S T F O R T B
C O N TA C T D E R M A T I T I S
POISON IVY RASHES
LOCAL RESPONSE TO INSECT STINGS
TISSUE TRANSPLANT REJECTIONS
Type IV hypersensitivity delayed-type or contact

139
Antigen (red dots)

are processed by
local APCs
T cells (blue cells) that

recognize antigen are
activated and release
cytokines
Inflammatory
response causes
tissue injury.
Antigen is presented by APCs to antigen-specific memory T cells that become activated and
produce chemicals that cause inflammatory cells to move into the area, leading to tissue injury.
Maria
Carmela L.Domocmat,
MSN peaks by 24-48 hours.
Inflammation
by 2-6RN,
hours;
Type IV hypersensitivity
140
the only type that is not antibody-mediated.

This is the type involved in
contact hypersensitivity (poison ivy, reactions to metals in jewelry);
tuberculin-type hypersensitivity (the tuberculosis skin test);
and granulomatous hypersensitivity (leprosy, tuberculosis,
schistosomiasis and Crohns disease).
141
It is called delayed because its onset may vary;

the length of the delay varies from 72 hours in contact and
tuberculin-type to 21-28 days in granulomatous hypersensitivity.
142
In Type IV hypersensitivity, antigen presented by APCs

activates antigen-specific memory T cells (which have
been sensitized by prior exposure), causing them to
release cytokines that activate and attract other T cells and
phagocytic cells to the area. Where the source of antigen
is at the skin surface, the APC migrates from the dermis,
through lymphatic vessels to a lymph node in order to
present antigen to a T cell.
143
In the TB skin test, a small amount of soluble antigen

(tuberculin) is injected into the skin.
The T cells that are activated by the antigen secrete
cytokines that draw other cells to the site.
Within four hours, neutrophils have arrived, followed by
an influx of monocytes and T cells at about 12 hours.
The peak of activity is at about 48-72 hours, at which
point the area has become red and swollen.
144
145
Contact Hypersentivity
History and physical
examination provide
diagnostic clues
Jelly Fish Hypersensitivity

In this case, the
erythematous reaction
developed one week
after the contact with a
jelly fish
Acute Graft Rejection is a manifestation of

delayed hypersensitivity
Fluid Accumulation in Delayed Hypersensitivity Reactions
Fluid Accumulation in Delayed Hypersensitivity Reactions
Patch test to identify the allergen for contact

eczema
151
Dendritic cell
Management
153
Removal of offending allergen

Reaction is self-limiting 5-7 days
Monitor reaction site and sites distal for circulation adequacy
Corticosteroids or other anti-inflam
Benadryl is not recommended bcoz histamine is not the main
mediator and IgE is not the cause
154
Have an allergy-free day!
155

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Immune system Disorders

Inflammatory and immunologic response

Maria Carmela L.Domocmat, RN, MSN

Maria Carmela L.Domocmat, RN, MSN

Maria Carmela L.Domocmat, RN, MSN

Hypersensitivity Reaction or Allergic Reaction

an immune malfunction whereby a person's body is hypersensitized to

Maria Carmela L.Domocmat, RN, MSN

Atopy: the tendency to develop allergies for which

Allergy: describes the increased immune response

Maria Carmela L.Domocmat, RN, MSN

Maria Carmela L.Domocmat, RN, MSN

People must progress through two-step process to

Maria Carmela L.Domocmat, RN, MSN

General categories of hypersensitivity reactions

Maria Carmela L.Domocmat, RN, MSN

Maria Carmela L.Domocmat, RN, MSN

There are four different types of hypersensitivities that result from

Type II: Cytotoxic hypersensitivity

Maria Carmela L.Domocmat, RN, MSN

There are four different types of hypersensitivities that result from

Type IV: Delayed Hypersensitivity

Maria Carmela L.Domocmat, RN, MSN

Allergic rhinitis or hay fever

This is the type of hypersensitivity usually referred to as

Maria Carmela L.Domocmat, RN, MSN

Maria Carmela L.Domocmat, RN, MSN

Type I hypersensitivity sensitization to an inhaled allergen

When the antigen enters through a respiratory mucosal

Maria Carmela L.Domocmat, RN, MSN

Maria Carmela L.Domocmat, RN, MSN

Maria Carmela L.Domocmat, RN, MSN

Maria Carmela L.Domocmat, RN, MSN

Allergens can be contacted in the ff ways

Maria Carmela L.Domocmat, RN, MSN

Maria Carmela L.Domocmat, RN, MSN

Maria Carmela L.Domocmat, RN, MSN

Maria Carmela L.Domocmat, RN, MSN

Maria Carmela L.Domocmat, RN, MSN

Common Causes of Allergy

What are common allergenic foods?

Allergic rhinitis or hay fever

Maria Carmela L.Domocmat, RN, MSN

Maria Carmela L.Domocmat, RN, MSN

Maria Carmela L.Domocmat, RN, MSN

Triggered by reactions to airborne allergens

Chronic: or perennial rhinitis

Maria Carmela L.Domocmat, RN, MSN

Maria Carmela L.Domocmat, RN, MSN

Maria Carmela L.Domocmat, RN, MSN

Maria Carmela L.Domocmat, RN, MSN

Urticaria may be acute (lasting less than 6 wk) or chronic

Maria Carmela L.Domocmat, RN, MSN

Many substances can trigger hives, including:

Hives may also develop as a result of:

Maria Carmela L.Domocmat, RN, MSN

Maria Carmela L.Domocmat, RN, MSN

Hives (urticaria) on the back and buttocks

These are hives (urticaria) with the typical slightly-raised red

Hives (urticaria) - close-up

Hives (urticaria) are raised,

Hives (urticaria) on the chest

Hives develop when histamine is

Maria Carmela L.Domocmat, RN, MSN