Immune System Hypersensitivity Responses

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artificial active immunity

production of your own antibodies as a result of vaccination or immunization

passive immunity

Immunity that results when an individual receives the immune agents from some source other than his or her own body

natural passive immunity

temporary protection by receiving antibodies through breast milk

artificial passive immunity

antibodies from another person or animal that are injected into a human (ie tetanus)

innate native immunity

* Defenses we are born with
* Provides immediate protection against effects of tissue injury and foreign proteins - Critical to health and well being
*causes visible symptoms and can rid the body of harmful organism; tissue damage may result from excessive responsive.

adaptive immunity

ability of the body to defend itself against specific invading agents

active immunity

a form of acquired immunity in which the body produces its own antibodies against disease-causing antigens

natural active immunity

the body produces its own antibodies; long lasting immunity - the most effective and the longest lasting

Infection

* usually accompanied by inflammation
* occurs in response to tissue injury, invasion of organisms
*inflammation does not always mean infection is present

immunoglobulins or gama globulins

all antibodies are immunoglobulins or gama globulins
* globulin is a protein in a globular shape
* globular proteins provide immunity
* Resulting term is immunoglobulin

How are antibody types classified

size, timing, and association

cellular immunity

Also called cell-mediated immunity. This process results in the production of T cells and natural killer, NK, cells that directly attach to foreign cells. This immune response fights invasion by viruses, bacteria, fungi, and cancer.
* important in preventing the development of cancer and metastasis after exposure to carcinogens
* another type of adaptive/acquired true immunity
* helps protect body through ability to differentiate self from non-self

immune function is most efficient when people are which age?

20-30 years

Hyperacute rejection

Anti-body mediated (typeII) due to presence of pre-formed antidonor antibodies. Occurs in minutes.

acute rejection

develops after several weeks when unmatched antigens cause a reaction

chronic rejection

T-cell, antibody mediated vascular damage. Months to years after. Irreversible.

maintenance therapy

Typically does not eradicate problems that patient may have but does prevent progression of a disease or condition. It is used for the treatment of chronic illnesses such as hypertension.

rescue therapy

therapy to establish remission in a patient that has failed first line treatments or reestablish remission in a patient that has relapsed

helper/inducer T-cells

Orchestrates cell mediated immunity; activates B cells, cytotoxic cells, and NK cells; CD4; Promote the action of other immune cells and act as organizers in "calling of arms"

White Blood Cell Count

* constitutes the body's primary defense system against foreign organisms.
* includes: neutrophils, monocytes, lymphocytes, eosinophils & basophils.
* Produced in the bone marrow
* can be measured alone or as CBC with differential
NORMAL: 4.3-10.8/mm3
Elevated WBC = Leukocytosis
Decreased WBC = Leukopenia

Leukocytosis

Elevated WBC

Leukopenia

Decreased WBC

Neutrophils

* Predominant WBC type
* body's first line of defense - phagocytosis (especially against bacteria)
* contain enzymes and pyrogens that combat foreign invaders
* mature neutrophils make up 54-75% of WBC
* come from stem cells; mature in bone marrow
* mature neutrophils called segmented neutrophils - "segs"
* Immature neutrophils called band neutrophils - "bands" (0-5% of total WBC count)

Segmented Neutrophils

Mature neutrophils
"segs"

Band Neutrophils

Immature Neutrophils
"bands"
0-5% of total WBC count

Absolute Neutrophil Count

* % and actual number of mature circulating neutrophils is used to measure a persons risk for infection.
* the higher the numbers, the greater the resistance to infection and vise versa
* aka "Absolute Granulocyte Count"
* important for determining immunity

Shift to the Left

an increase in the % of immature band neutrophils relative to mature segmented neutrophils
* indicates the person's bone marrow cannot produce enough mature neutrophils to keep pace with the continuing infection
* bone marrow is releasing immature neutrophils into the blood
* immature neutrophils are of no benefit because they are not capable of phagocytosis

Monocytes

* formed in the bone marrow from the same cells as those that produce neutrophils
* constitutes only 2-8% of total WBC count
* major function is phagocytosis
* When mature move from bloodstream into the tissues and are distributed throughout the body
* Greatest concentration in liver and spleen
* constitute the immediate inflammatory response
* can easily distinguish between self and non-self
* Very effective in trapping invading cells

Lymphocytes

* are found in next highest concetration after neutrophils (25-40%)
* classified as B cells and T cells
* both types are fomed in bone marrow: B cells mature in bone marrow and T Cells mature in the thymus
* Play a major role in the body's defense system

Where do B Cells Mature?

Bone Marrow

Where to T Cells Mature?

Thymus

Eosinophils

*constitute only 1-4% of total WBC Count
* contain many different substances including those that can cause inflammation adn those that can limit inflammation
* become active in later stages of infection
* respond to parasitic diseases
* respond to allergic reactions

Basophils

* found in small numbers (1% of total WBC)
* have a phagocytic function; are similar to eosinophils
* contain granules that release heparin, histamine, serotonin, and kinin
* causes the manifestations of inflammation

What is the purpose of inflammation and immunity?

to meet the human need for protection by neutralizing, eliminating, or destroying organisms invading the internal environment

White Blood Cells

Leukocytes
Protect the body from effects of invasion by organisms

Human Leukocyte Antigens (HLA)

* antigens are a normal part of the person and act as antigens if they enter another persons immune system
* Found on the surface of most body cells
* determine tissue type of a person
Key for recognition and self-tolerance

Inflammation

* provides immediate protection against the effects of tissue injury and foreign proteins. The capability for inflammatory response is critical to health and well being
* causes visible symptoms and can rid the body of harmful organisms. Tissue damage may result from excessive inflammatory response

What are the 5 cardinal manifestations of inflammation?

Warmth, Redness, Swelling, Pain, Decreased Function

What is the sequence of inflammatory responses?

Stage 1 (vascular) - change in blood vessels:
Phase 1 - constriction
Phase 2 - hyperemia & edema
Stage 2 (cellular exudate) - neutrophilia, pus
Stage 3 (tissue repair and replacement) - WBCs trigger new blood vessel and growth (angiogenesis) and scar tissue formation

What Cell types are involved in inflammation

neutrophils
macrophages
basophils
eosinophils

Where to Stem Cells generate?

Stem cells generate from bone marrow and bone matrix

Type 1 Hypersensitivity Reaction

IMMEDIATE - MOST COMMON TYPE - reaction of IgE antibody on mast cells with antigen, which results in release of mediators, especially histamine (hay fever, allergic asthma, anaphylaxis)

Type 1 Hypersensity Reactions
How can allergens be contacted?

- inhaled (plant pollens, fungal spores, animal dander, house dust, grass, ragweed)
- ingested (foods, food additives, drugs)
- Injected (bee venom, drugs, biologic substances)
- contacted (latex, pollens, foods, environmental proteins

Allergic Rhinitis

AKA - Hay fever
occur just in the areas exposed to the antigen, mucous membranes of the nose & eyes causing symptoms of rhinorrhea, sneezing, itchy watery eyes.

Anaphylaxis

involves all blood vessels and bronchiolar smooth muscle, causing widespread blood vessel dilation, decreased cardiac output and bronchoconstriction.
Life-threatening example of Type I hypersensitivity reaction. Occurs rapidly & systemically affecting many organs withing seconds/minutes.

Acute Allergic Rhinitis

Seasonal

Chronic Allergic Rhinitis

perennial or intermittent

Continuious Rhinitis

likely non-allergic rhinitis

Clinical manifestations of Allergic Rhinitis

runny nose, stuffy nose, itchy, watery eyes. Pt. may breath through the mouth, and voice has a nasal sound. Drainage from the nose is usually clear or white. Nasal mucosa appears swollen and pink. Pt. may have a headache or feel pressure over the frontal maxillary sinuses. Placing a penlight directly on the skin over the sinuses and observing for a glow (transillumination) usually shows reduced glow when rhinitis is present.

Allergen

an antigen that provokes allergic sensitization

Rhinorrhea

Runndy nose

What to ask for in a History for Allergic Rhinitis

onset and duration of problems related to possible allergen exposure. Ask about work, school, home environments, exposure through hobbies, leisure time, or sports. Also because Type I allergic responses can be inherited ask about history of close relatives.

Allergic Rhinitis Lab Assessment

CBC w/ Differential will indicate an increase in eosinophils. Pt with severe seasonal Allergic Rhinitis may have a count as high as 12% (normal 1-2%), Total WBC count increases but % of neutrophils remain normal.
Other Labs: IgE levels, Radioallergosorbent test (RAST), Radioimmunosorbent test (RIST)

Allergy Testing

Skin testing can show which specific allergens are the cause of most type I reactions. Skin testing can be performed as scratch testing and intradermal testing

Scratch testing

Placement of an appropriate dilution of a test material suspected of being an allergen in a lightly scratched area of the skin

intradermal testing

Injection of test substances into the skin layer to observe a reaction

Patch Testing

Used for contact dermatitis and other Type IV hypersensitivities.
A method used to identify a patient's sensitivity to contact materials (e.g., soaps, pollens, dyes).

Avoidance therapy

can be effective when specific allergens have been identified. Urge the patient to avoid direct or close contact with allergen. Many airborne allergens can be reduced by air contiditioning and air cleaning units. Also removing cloth drapes, upholstered furniture and carpeting.

Complementary and Alternative therapy

Broad range of healing philosophies, approaches, and therapies that Western (conventional) medicine does not commonly use to promote well-being or treat health conditions. Examples include acupuncture, herbs, aromatherapy etc.

Desensitization Therapy

"allergy shots" involves sub-q injections of small amounts of allergens and increasing over time reduces allergic responses by competition.
Shots given 1/week for 1st year, every other week for 2nd year, every 3-4 weeks for 3rd year. Recommended for 5 years.

What is the most common cause of anaphylaxis?

drugs and dyes

Antihistamines

Block histamines from binding with histamine receptor sites in tissues. prevents vasodilation and capillary leak. can also decrease secretions (benadryl (sedation), Clarinex, Zyrtec, Allegra)

Decongestant

reduces nasal congestion and/or swelling; produces vasoconstriction. Side Effects: dry mouth, increased BP, sleep difficulties (Afrin, Sudafed)
Because Oral Meds have a systemic effect, teach patients with high BP, glaucoma, or urinary retention to consult a DR before taking.

Corticosteroids

decrease inflammatory and immune responses by preventing synthesis of mediators. Systemic corticosteroids can produce severe side effects.
Avoided for Rhinitis and used only on a short-term basis for other problems associated with Type 1 reactions

Mast Cell Stabilizers

inhibit the release of inflammatory chemicals from mast cells and make the airways less likely to narrow. (nasalcrom)
Not useful during an acute episode

Leukotriene modifiers

resp anti-inflammatory - stops allergic reponse by blocking leukotriene receptors that cause bronchospasms -- Singulair and Accolate

Type II Hypersensitivity Reaction

CYTOTOXIC - reaction of IgG with host cell membrane or antigen absorbed by host cell membrane (Autoimmune hemolytic anemia, Goodpasture's syndrome, Myasthenia gravis)

Type III Hypersensitivity Reaction

IMMUNE COMPLES-MEDIATED
formation of immune complex of antigen and antibody, which deposits in walls of blood vessels and results in complement release and inflammation (Serum sickness, vasculitis, systemic lupus erythematosus, rheumatoid arthritis)

Type IV Hypersensitivity Reaction

DELAYED
reaction of sensitized T-cells with antigen and release of lymphokines, which activates macrophages and induces inflammation (Poison Ivy, graft rejection, Positive TB skin test, sarcoidosis)

Type V Hypersensitivity Reaction

STIMULATED
Reaction of autoantibodies with normal cell-surface receptors, which stimulates a continual overreaction of the target cell (graves' disease, B-cell gamopathies)

What are interventions to Anaphylaxis?

EpiPen or Twinject, Assess respiratory function; establish airway, CPR, Epinephrine, Antihistamines (for angioedema and urticaria), oxygen, treat bronchospasm, IV fluids

Sjogren's syndrome

often appears with other autoimmune disorders
* dry eyes, dry mucous membranes of nose and mouth, vaginal dryness
*insufficient tears causing inflammation/ulceration of cornea
* no cure; intensity and progression can be slowed

Goodpasture's Syndrome

*autoantibodies made against glomerular basement membrane and neutrophils
*lungs and kidneys
*SOB, hemoptysis, decreased urine output, weight gain, edema, hypertension, tachycardia, treatment: high-dose corticosteroids

A laboratory test that indicates the status of a person's immune system is:
A. Hemoglobin
B. Leukocyte count
C. Hemocrit
D. Cardiac Enzymes

B - Leukocyte count

Active immunity can be acquired by?
A. A newborn receiving antibodies from his mother
B. An injection of gamma globulin
C. An injection of blood serum or antibodies for a particular antigen
D. Vaccination with weakened or altered pathogens

D. Vaccination with weakened or altered pathogens

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