Immunologic and Allergic Disease

7/30/2019 Immunologic and Allergic Disease

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IMMUNE SYSTEM Mission: to seek and kill

invaders or foreign bodies

(microorganisms, parasites,

cancer cells, etc.)

Must be able to distinguish

between what is self and

non-self Any substance identified as

non-self, stimulate an

immune response in the body


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Antigenmaybe contained within or on bacteria,viruses, other microorganisms or cancer cells

- They may exist on their own

e.g. food molecules, pollen

A normal immune response

Ag (antigen)activates / mobilizes forces to defend

by attacking it.

Mistake self for non-selfattack own tissues

(autoimmune disorder)


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Immune System is made up of lymphoid tissues inthe body which includes:

- bone marrow

- parts of spleenGIT

- thymus

- tonsils

- proteins and cells in the blood are also part of theimmune system


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TERMINOLOGIES: Antibody (immunoglobulin)a protein produced by

B cells

interacts with antigen

Antigenany substance that the immune system

recognizes and can stimulate an immune response

B Cell (B Lymphocyte / Bursa Cells / Humoral

Immunity)bone marrow derived or bursa

equivalent lymphocyte in a WBC that produces

antibodies specific to the Ag that stimulated their

production


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T Cell (T Lymphocyte / Thymus / CellularImmunity)

- thymus derived, WBC that is involved in specific

immunity and that maybe one of 3 types:

Helper T-Cell

Killer (Cytotoxic) T-Cell

Regulatory T-Cell

BasophilWBC that releases histamine

- produces substances to attract other WBC to a

troubled spot


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Cytokinesproteins secreted by cells that act as theimmune systems messengers and that help regulate

an immune response

EosinophilsWBC that kills bacteria

- Kills other foreign cells too big to ingest

- Help immobilize and kill parasites

- Participates in allergic reactions

- Help destroy cancer cells


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Macrophagelarge cell that develops from aWBC called monocyte

- ingests bacteria and other foreign cells

NeutrophilWBC that ingests and killsbacteria and other foreign cells

PhagocyteA cell that ingests / kills /

destroys invading microorganisms, other

cells and cell fragments


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1. The body generates an immune responseagainst itself (autoimmune disorder)

2. The body cannot generate appropriate

immune responses against invadingmicroorganisms (immunodeficiency

disorder)

3. An excessive immune response to oftenharmless foreign antigens damages normal

tissues (an allergic reaction)


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- immune system mistakenly attacks anddestroys healthy body tissue response is

a hypersensitivity reaction similar to the

response in allergic reaction.ALLERGYreaction to an outside substance

that it would normally ignore

AUTOIMMUNE DISORDERreaction tonormal body tissue that it would normally

ignore


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CAUSE: UNKNOWNTHEORY: some microorganisms

(bacteria & virus) or drugs may trigger

some of these changes, especially in

people who have genes that make

them more likely to get autoimmunedisorders.


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1. An autoimmune disorder mayresult in:

destruction of one or more typesof body tissues

abnormal growth of an organ

changes in organ function


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2. An autoimmune disorder may affect one or moreorgan or tissue types.

a. It can be organ specific:

ENDOCRINE SYSTEMthyroid gland Hashimotos thyroiditis

Graves disease

Type I & II autoimmunepolyglandular syndrome

Insulin dependent DM


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SKIN- pemphigus vulgaris

- dermatitis herpetiformis- epidermolysis bullosa

- autoimmune alopecia

- contact dermatitis


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HEMOTOLOGIC- autoimmune hemolytic anemia

- autoimmune thrombocytopenic purpura

- autoimmune neutropenia

NEURO-MUSCULAR SYSTEM

- myasthenia gravis- multiple sclerosis

- GuillainBarre Syndrome


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HEPATOBILIARY SYSTEM- autoimmune chronic active hepatitis

- primary biliary sclerosis

- sclerosing cholangitis

GIT

- pernicious anemia- inflammatory bowel disease


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b) It can be organ nonspecific CONNECTIVE TISSUE DISEASES

- systemic lupus erythematosus

- rheumatoid arthritis- scleroderma

- sjogrens syndrome

- ankylosing spondylitis- psoriasis


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VASCULITIC SYNDROMES- hypersensitivity vasculitis

- Wegeners Granulomatosis

- Takayasus Arteritis- Kawasakis Disease

- Sarcoidosis

- Graft versus host disease


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symptoms of an autoimmune disease varybased on the disease and location of the

abnormal immune response

symptoms that often occur with autoimmunediseases include

- fatigue

- fever

- body malaise


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depends on the type of disease which willgenerally include:

- ANA (antinuclear antibody tests)

- autoantibody test

- CBC

- C-Reactive Protein (CRP)

- erythrocyte sedimentation rate (ESR)


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GOALS: reduce the symptoms

control the autoimmune process

maintain the bodys ability to fight disease

1. SUPPLEMENTS

- hormonal replacement- vitamins e.g. B12- insulin injections

- thyroid supplements


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2. BLOOD TRANSFUSION3. PHYSICAL THERAPY

4. MEDICINE

- to control or reduce immune systemsresponse (immunosuppressive drugs)

- corticosteroids

- non-steroidal drugs - azathioprine- cyclophosphamide

- sirolimus

- tacrolimus


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- Depends on the disease- Can be controlled by treatment

- Symptoms can come and go

- Flare-up when symptoms worsen


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- Occurs when the bodys immune response isreduced or absent

- Occurs when T or B lymphocytes do not

work as well as they should or when the bodydoes not produce enough antibodies.

- Can be congenital, spontaneously acquired or

iatrogenic- Unusual susceptibility to infection and

frequently to autoimmune diseases and

lymphoreticular malignancies.


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- Ataxia telangiectasia- Chediak-Higashi Syndrome

- Combined immunodeficiency disease

- Complement deficiencies- Di George Syndrome

- Hypogammaglobulinemia

- Panhypogammaglobulinemia- Selective deficiency of IgA

- Wiscott-Aldrich Syndrome


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- Acquired Immuno Deficiency Syndrome(AIDS)

- Iatrogenic

- Idiopathic CD4 and T lymphocytopenia


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depend on the disorderTELL-TALE SIGNS: chronic infection severe infection from bacteria or other

forms that do not usually cause severeinfection poor response to treatment

delayed or incomplete recovery from illness certain types of cancers (Kaposis sarcomaor non-Hodgkins lymphoma certain infections


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Complement levels in blood HIV Test

Blood immunoglobulin levels

CHON electrophoresis

T lymphocyte count

WBC Count


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GOALto prevent infections and treat anydisease and infections that do develop.

1. Avoid contact with persons who have

infections or contagious disorders2. Avoid people who have been vaccinated

with live virus vaccine within the past 2

weeks3. Aggressive Treatmentlong term use of

Abtx. or antifungal

- Prophylactic Tx


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4. Interferontx viral infection andsome types of cancer

- immunostimulant drug

5. Bone Marrow Transplant

6. Passive Immunity

7. Immunoglobulin Infusions


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4 Types of Hypersensitivity Reactions:

TYPE I: immediate Ig-E mediated

which causes rapid degranulation of

mast cells

- IgE binds to the mast cells via a highaffinity Fc receptor.

- Early Phase: within minutes

- Late Phase: hours after initial response

e.g. allergic rhinitis, food allergy,

allergic or atopic asthma.


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TYPE II: Antibody mediated- Ab binds to cells and causes

damage or impairment of

functionse.g. transfusion reactions,

hemolytic anemias, graft

rejection, myasthenia gravis,

good pastures syndrome

TYPE III: imm ne comple


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TYPE III: immune complex

mediated

- Occurs when IgG or IgM binds

with Ag and the complexes are

deposited in tissues

e.g. serum sickness,

glomerulonephritis, arthritis

TYPE IV: T-Cell mediated

(delayed hypersensitivity)

- First exposure: T-cell is

sensitized subsequent exposure:

allergen is recognized anddetected, thereby these cells are

lysed by T Cells.

e.g. contact dermatitis,

granulomatous diseases


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ALLERGYexaggeratedimmunologic response to an

otherwise innocuous agent, which

causes harm to the host

ALLERGENinciting agent


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PATHOPHYSIOLOGY:

IgE binds to surface of mast cells and

basophils

Cross linking ofIgE by Ag causes cellular

activation release of mediators histamines

prostaglandins

leukotrienesSRS-A (slow-

reacting substance of

anaphylaxis


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- Anaphylaxis

- Serum Sickness

- Generalized Drug Reactions

- Food Allergy

- Insect Venom- Mastocytosis


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- Allergic rhinitis- Asthma

- Hypersensitivity

pneumonitis

- Urticaria- Angioedema

- Eczema

- Atopic dermatitis


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-

Allergic conjunctivitis- Atopic keratoconjunctivitis

- Giant papillary conjunctivitis

- Contact allergy


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DEFINITION: the life threateninganaphylactic response of a sensitized

human appears within minutes after

administration of specific Ag and ismanifested by respiratory distress, often

followed by vascular collapse or by

shock without antecedent respiratory

difficulty.


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Hallmark of anaphylactic reaction: onset of

S/S within seconds to minutes after

introduction of the Ag

S/S: laryngeal edemalump in throat,

hoarseness or stridor

bronchial obstructiontightness in the chest

or wheezing

cutaneous whealserythematous, raised,

serpiginous borders and blanched centers;

pruritic


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-

Early recognition- Mild symptoms (pruritis and urticaria)

0.2 ml to 0.5 ml of 1:1000

epinephrine SQ- Hypotensionvolume expanders

vasopressor agents

(dopamine)

- O2


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URTICARIAinvolves the superficial

portion of the dermis-well-circumscribed wheals

ANGIOEDEMAwell demarcated localizededema involving the deeper areas / layers of

the skin, including the subQ tissues

ACUTErecurrent episodes of lessthan 6 weeks

CHRONICattacks persisting

beyond 6 weeks


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- Urticarial eruptions are pruritic, appear in

crops of 2472o duration

- Most common sites: extremities, external

genitalia, face

- History

- Skin testing

- Laboratory exam: complement levels,

ESR


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-

Avoidance of offending agents- H1 and H2 antihistamines

ranitidine 150 mg p.o. BID

diphenhydramine 25-50 mg p.o. QID hydroxyzine 25-50 mg p.o QID

-


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- Inflammatory condition of the

nose characterized by sneezing,

rhinorrhea and obstruction of

nasal passages

PATHOPHYSIOLOGY:

impingement of allergens on nasal mucosa Ig-E

dependent triggering of mast cells release ofmediators hyperemia, swelling, fluid

transudation


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- Accurate history

- physical examination: boggy nasal mucosa- nasal smearlarge # of eosinophils

- Antihistamines

- Oral Sympathomimetics: pseudoephedrine 30-

60mg p.o. QID

- topical nasal steroids: beclomethasone 2 spraysin each nostril BIDTID

- topical nasal cromolyn sodium 1-2 sprays in

each nostril QID.


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GOOD DAY!!!

Immunologic and Allergic Disease

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