Allergies and Asthma Overview

Medical Nursing II - Immune System and Allergic Diseases and Nursing Care

• Course information: Medical Nursing II, taught by Asst. Prof. Dr. Ufuk Kaya, Spring Term 2023-2024, at Cyprus International University.

Definitions Related to the Subject

• Allergen: A substance that causes allergies.
• Atopic Body: A hypersensitive body.
• Hypersensitivity: An exaggerated response of the immune system to a harmless substance.
• Shock Organ/Target Organ: The organ where the sensitive cell is located.
• Autoimmune: The immune system's response against its own proteins.
• Allergic Answer: Sensitivity to substances normally harmless to an organism.
• Mast Cell/Basophil Cell: Susceptible cells in connective tissue containing heparin and histamine granules.
• Anaphylaxis: A sudden, immediate reaction caused by the combination of antigen and antibody.

Allergy and Hypersensitivity

• Allergy is the body's overreaction to a foreign substance (allergen).
• The immune system's overreaction causes symptoms in the patient.
• Allergies are a personal situation. Different substances trigger different allergies.

What are the most common allergens?

• Allergens vary from person to person.
• Common allergens include house dust mites, pollen, mold, fungi, food allergens, animal allergens, and drug allergens.

If the allergen is in the air...

• Allergens in the air cause symptoms in eyes, nose, lungs (e.g., watering eyes, runny nose, cough).
• Allergens swallowed cause reactions in the mouth, stomach, intestines (e.g., constipation, gas, diarrhea).
• Allergic response can become severe. Release of mast cells leads to low blood pressure, shock, loss of consciousness, and potentially death (anaphylactic shock).

How are allergic diseases diagnosed?

• Patient history is crucial. Symptoms after allergen exposure should be completely normal between attacks.
• Skin testing helps diagnosis (Many allergens may not be detected with skin test alone).
• High IgE levels in the blood are a common indication.
• Diagnostic methods vary based on the disease type.

Treatment in Allergic Diseases

• Prevention is most effective. Avoid allergens as much as possible (e.g., pets, dust-containing items, irritants).
• Indoor precautions: avoid dusty environments, adjust temperature/humidity, keep windows closed during high pollen seasons, use leather/vinyl instead of carpets/rugs/blankets, minimize house dust.
• Further precautions: Remove allergens from living environments (house dust), keep few items in the room, frequently clean with wet cloth, refrain from cleaning when people are in the room.
• Other preventative steps: avoid plants/pets in the house; use specially prepared bedding, washing linens regularly.
• Take precautions in settings and environments where symptoms are triggered/worsened.

Treatment in Allergic Diseases (Drug Treatment)

• Antihistamines: Prevent histamine's effects but can cause drowsiness.
• Corticosteroids: Suppress the immune system. Effective in emergencies but have many long-term side effects, such as an increased susceptibility to infections, elevated blood sugar. Possible issues such as stomach complaints and ulcers.
• Mast Cell Stabilizers: Used in Asthma, and some bronchodilator medications.
• Vaccine Treatment: Effective for some, but with a limited patient group; involves repeated small doses of the allergen to decrease sensitivity.

Allergic Rhinitis

• Inflammation of the nasal mucous membrane is rhinitis.
• Allergic rhinitis is caused by allergic factors.

Symptoms of Allergic Rhinitis

• Continuous or sporadic sneezing.
• Itching in the nose,
• Runny nose.
• Nasal congestion.
• Post-nasal drip.
• Tickle in the throat.
• Eyes that tear, are reddish, and itchy,
• Ear fullness, rustle-like sensation.
• Head/ear pain.
• Impaired sense of smell.

Treatment of Allergic Rhinitis

• Allergen protection (elimination).
• Drug therapy.
• Immunotherapy (vaccination treatment).

Asthma

• Symptoms vary depending on the affected areas.
• Common symptoms: dry cough, wheezing, tightness in the chest, shortness of breath.
• Other symptoms: bronchiole narrowing, bronchi narrowing, mucus clogging the airway.
• Triggers: Upper respiratory tract infections, polluted air, pollen, exercise, some nutrients, additives, and changes in the air.

Asthma Etiology

• Extrinsic Asthma: IgE-mediated, common between 2-50 years of age. Allergens like pollen, fungal spores, house dust mites, animal hair and skin debris.
• Intrinsic Asthma: Bacterial allergens are implicated. Common before age 2 and after 50.
• Aspirin-induced asthma: Manifestations: runny nose, nausea, vomiting, wheezing, dyspnea, up to cyanosis. Onset within 20 minutes to 2 hours of aspirin ingestion.
• Exercise-Induced Asthma: Strenuous exercise can trigger bronchospasm in some people. Symptoms: fatigue, wheezing, dyspnea occur in the periods when the individual is tired.

Asthma Signs and Symptoms

• Difficulty in expiration, wheezing, and dyspnea.
• Residual volume increases as the disease progresses.
• Lung expansion and chest expansion.
• Possible barrel-chest formation in certain cases.

Asthma Signs and Symptoms (more detail)

• Alveoli and ventilation-perfusion ratio are affected. Acid-base balance is disturbed.
• Respiratory alkalosis usually occurs initially due to hyperventilation.
• Respiratory acidosis may follow if the airways become blocked.
• Eosinophils may be present in sputum.
• Thick, sticky sputum during attacks may contain 5 mm-2 cm gelatin-like substance (crushman spirals).

Asthma Treatment

• Protecting from allergens.
• Drug treatment.
• Immunotherapy/vaccination treatments.

Anaphylaxis

• Sudden, severe, systemic reaction to an allergen.
• Occurs within minutes of exposure.
• Requires immediate intervention.
• Triggering substances: Parenteral drug, vaccine, serum applications, proteins (hormones, enzymes), some nutrients.

Anaphylaxis Symptoms

• Local symptoms include redness, urticaria, itching, angioedema (swelling).
• Cardiovascular, respiratory, gastrointestinal, skin, mucous membrane symptoms appear within 30 minutes.

Anaphylaxis Treatment

• It's an emergency.
• Eliminate contact with allergen (e.g., epinephrine for vasoconstriction).
• Antihistamines to eliminate capillary permeability by addressing histamine's effects.
• Corticosteroids for anti-inflammatory action (e.g., urticaria and angioneurotic edema).
• Aminophylline for bronchospasm.

HIV

• HIV (Human Immunodeficiency Virus) is a virus that weakens the immune system by settling within it.
• The number of CD4+ lymphocytes (the virus' target) progressively decreases.
• AIDS (Acquired Immunodeficiency Syndrome) is a contagious viral disease caused by HIV.
• HIV affects and destroys the body's immune system, reducing its ability to fight germs.

How is AIDS Transmitted?

• Primarily through unprotected sexual intercourse (80-85% of transmissions).
• Transmitted through semen (men) or vaginal secretions (women).
• Transmission through damaged tissues during intercourse (man-to-woman, woman-to-man, among others).
• Transmission through contact with blood: uncontrolled blood transfusions, non-sterile medical sharps, shared needles.
• Transmission from mother to baby during pregnancy, childbirth, and/or breastfeeding.

Prevention of AIDS

• Use condoms during sexual intercourse.
• Ensure blood products are properly tested.
• Use sterile medical instruments, and don't share needles or other sharp objects.

Methods that do not transmit HIV

• Daily contact (same room, school, air).
• Contact with saliva, tears, sweat, sneezing, coughing, urine, stool.
• Handshakes, skin contact, caressing, hugging, cheek/hand kisses.
• Food, drinks, eating utensils, glasses, plates, telephones, toilet, showers, faucets, swimming pools, saunas.
• Bites from mosquitoes, other insects, or pets.

AIDS Test

• Detects HIV antibodies in the blood using the ELISA method.
• Requires 3 months to show.
• A positive test doesn't definitively confirm HIV.
• Further confirmation with Western Blot required to diagnose HIV.

Clinical Symptoms: Respiratory System

• Pneumonia (fungal) is the common lung disease in HIV patients.
• Tuberculosis incidence is significantly greater among HIV-positive patients.
• Treatment drugs need careful consideration between the patient's HIV medication and tuberculosis regimen because of potential interactions.

Clinical Symptoms: Oral Cavity

• Many lesions can occur in the oral cavity, including fungal infections (thrush).
• Difficulty swallowing and impaired taste are common symptoms.
• Esophageal candidiasis (fungal infection) is a common complaint.
• Stomach/small intestine problems causing nausea, vomiting, and abdominal pain are frequent problems.

Clinical Symptoms: Cardiac Involvement

• Fluid accumulation in the pericardium (pericardial effusion) is a common cardiac problem in HIV patients.
• Hematological disorders (e.g., anemia) can be present.
• Gastrointestinal and neurological symptoms may also occur.

Clinical Symptoms; Opportunistic Infections

• Toxoplasmosis: Caused by Toxoplasma gondii. Symptoms include fever, headaches, and weakness.
• Cryptococcosis: Caused by Cryptococcus neoformans. Meningitis is a frequent symptom.
• Cytomegalovirus (CMV) infection: A common infection in HIV patients. This can affect the retina, causing vision problems. It often presents with neurological symptoms .
• AIDS-Dementia Complex: A syndrome that causes mental, motor, and/or behavioral problems.

Clinical Symptoms; Cancers

• Kaposi's Sarcoma (KS): One of the most common cancers in HIV patients. It often presents reddish/violet skin lesions that can become widespread.
• Lymphoma: A cancer that arises from lymph cells. Fever, weight loss, and enlarged lymph nodes are possible symptoms.
• Anal Cancer: Also frequently found in HIV patients.

Treatment of HIV Infection

• No treatment exists that completely eliminates the virus, however.
• Antiretroviral therapy (ART) is used to control viral replication.
• ART involves a variety of medications.

Protection from AIDS

• Condoms should always be used during sexual intercourse.
• Ensure that blood products undergo proper testing.
• Sterile instruments should be used for needle applications etc.
• Control of blood and blood products, tissue and organ transplants are managed by health institutions; sharings of piercing/cutting tools (e.g., needles, etc.) should be avoided.
• HIV-positive women should be carefully counseled about pregnancy.

Food Allergy

• Systemic reactions to food in sensitive individuals.
• Body mistakes food components (mostly proteins) as harmful, prompting an immune response (antibody).

Food Allergy Etiology

• Any food can be an allergen.
• Cooking methods and the individual's atopic nature influence the allergic reaction.
• Long-term cooking may reduce allergenicity, while methods like frying might create new allergens.
• Allergic reactions can occur within 12 hours of ingestion.

Food Allergy Symptoms

• Skin: Itching, burning, redness, fever, chills, tingling, sweating, red spots, pimples.
• Eyes: Blurred vision, pain, watering, strabismus, light intolerance, redness, swelling.
• Cardiovascular: Palpitations in the heart, increased pulse rate, fever, chills, bruising in hands, fainting, pain in the vertebrae.
• Digestive system: Dryness in the mouth, increased salivation, bitterness in the tongue, toothache, heartburn, indigestion, nausea, vomiting, abdominal pain, diarrhea.
• Nervous system: Headaches, migraines, drowsiness, slowness, malaise, crying spells, tension, hyperactivity, nervousness, concentration disorders, laughing, stuttering.
• Respiratory system: Shortness of breath, wheezing, coughing, bronchial mucus formation, nasal congestion, sneezing, itching in the nose, sore throat.
• Urogenital system: Frequent and painful urination, inability to control urination, itching.
• Movement system: Fatigue, muscle weakness, joint and muscle aches tension, chest and back pain

Food Allergy Diagnosis

• Patient history is critical in diagnosis.
• An elimination diet is used, where foods are gradually reintroduced, one at a time to identify the triggering substance(s). The diet cuts out all nutrients, starting with the least allergenic foods and introducing one new nutrient each time.

Food Allergy Treatment and Care

• Elimination: Removing allergenic foods from the diet.
• Symptomatic Drug Therapy: Addressing symptoms in the affected organ with drugs.
• Immunotherapy (vaccine treatment): This is less commonly used now.

Gastrointestinal Allergy (GIA)

• Shock organ is the gastrointestinal tract.

GIA Etiology

• Foods (e.g., eggs, cow's milk, wheat, fish, tomatoes, nuts, chocolate) are common causes.
• Also, oral/injection of drugs like insulin, penicillin, and others.
• Hormones, infections, emotional factors, extreme fatigue, changes in weather, hot/cold/spicy/raw foods, too oily/too pulpy foods.

GIA Signs and Symptoms

• Recurrent abdominal pain is a common feature.
• Insomnia, restlessness.
• Oral/pharyngeal issues (dermatitis, edema, aphthae, bad breath, taste disturbance).
• Difficulty swallowing, pain in the esophagus or gastrointestinal tract.
• Epigastric pain or heaviness.
• Nausea, vomiting
• Cardiospasm, pyloric spasm.
• Intestinal symptoms (diarrhea, constipation, colic).
• Rectal/anal symptoms (dermatitis, pruritis, bleeding).
• Other possible signs are possible.

GIA Diagnosis

• Family history of allergies and recurring symptoms/signs.
• Presence of eosinophils in blood, stool, and gastrointestinal (GI) mucus.

GIA Treatment and Care

• Preventing the triggering substance(s).
• Medications: e.g., drugs that could be involved in addressing related issues.
• Use of normal hygiene in regards to diet, and/or treatments.
• Removal of allergenic food from the diet.
• Treatment of symptoms for the affected shock organ.
• Immunotherapy (vaccination treatment) is less common now.

Urticaria (Hives)

• Common skin lesion, not a disease itself.
• Itchy and swollen (edematous) plaques of varying sizes (ranging from millimeters to centimeters).
• Surrounded by redness.
• Can occur due to allergies, infections.

Urticaria and Angioedema

• Urticaria involves skin rash, whereas angioedema relates to deep skin/internal organ swelling.
• Urticaria is an itchy swelling on the skin with red bumps or blisters.
• Angioedema involves swelling in the deeper tissues of the skin, potentially affecting internal organs like the throat, lips, eyes, or genital area.
• Both can result from allergic reactions, infections, or other factors.
• Diagnosis and treatment often involve history, physical exams, and tests.

Urticaria Treatment

• Identifying and removing the cause is key.
• Antihistamines or corticosteroids address symptoms.

Atopic Dermatitis (Eczema)

• Chronic, recurrent, pink-colored, itchy rashes with a rough surface.
• Lesions can be widespread or localized to an area.
• Frequently worsened by scratches.
• Possible skin changes: thickening, streaking, peeling, or darkening of the skin.

Atopic Dermatitis (Eczema) Treatment

• Protecting the skin (keeping it moisturized).
• Avoiding causative allergens.
• Topical corticosteroids for active periods.
• Anti-itch medications (antihistamines).

Latex Allergy

• A new form of allergy, increasing in prevalence.
• Person must be exposed to latex for a prolonged time (e.g., 3-5 years).
• IgE antibodies form against latex proteins.
• Symptoms manifest when exposed to latex-containing products.
• Symptoms include redness, itching, discomfort, potentially severe reactions like asthma.

Latex Allergy Treatment

• Avoidance of latex contact.
• Identification and appropriate precautions.
• Emergency treatment (e.g., automatic adrenaline/epinephrine injection) for individuals with severe reactions should have a visible marker.

Who is at risk for Latex Allergy

• People with atopic predisposition.
• Individuals with a history of multiple surgeries (especially congenital ones relating to urological issues or urinary tract problems).
• Those requiring frequent use of urinary catheters.
• People in professions involving latex (e.g., healthcare workers, rubber industry).
• Individuals with other allergies or skin conditions.

Immune Deficiency Diseases

• Congenital Immune Deficiency: Deficiencies present from birth.
• Post-Secondary Immune Deficiency: Developing later in life due to factors like severe illnesses, immunosuppressive therapies, or nutritional insufficiency.
• Examples: immunosuppressive therapy, Hodgkin lymphoma, HIV, malnutrition.

Autoimmune Diseases

• Body's immune system identifies its own tissues as "foreign" and attacks them.
• Rheumatic fever: Immune response affecting joint tissues, specifically heart valve tissues.
• Glomerulonephritis: Immune response targeting the glomeruli of the kidneys.
• Myasthenia gravis: Immune response affecting acetylcholine receptors.
• Lupus erythematosus: Immune response targeting many body tissues simultaneously.

This quiz explores key concepts related to allergies and asthma, including definitions, physiological responses, and management strategies. Participants will answer questions on allergens, the role of mast cells, symptoms of asthma, and the significance of various treatments. It's a comprehensive overview for anyone seeking to understand these respiratory conditions.