Management of Patients with Allergic Disorders 2024 PDF

Management of Patients with Allergic Disorders Prepared by: Mark Joseph V. Liwanag, RN, MSN, MAN (u) OUTLINE ❏ Hypersensitivity ❏ Antihistamine ❏ Anaphylaxis ❏ Contact Dermatitis ❏ Atopic Dermatitis ❏ Dermatitis Medicamentosa (Drug Reactio...

Management of Patients with Allergic Disorders Prepared by: Mark Joseph V. Liwanag, RN, MSN, MAN (u) OUTLINE ❏ Hypersensitivity ❏ Antihistamine ❏ Anaphylaxis ❏ Contact Dermatitis ❏ Atopic Dermatitis ❏ Dermatitis Medicamentosa (Drug Reactions) ❏ Food Allergy Hypersensitivity a reaction of excessive or aberrant immune response to any type of stimulus (Abbas & Lichtman, 2011). It usually does not occur with the first exposure to an allergen. the reaction follows a re-exposure after sensitization, or buildup of antibodies, in a predisposed person. Anaphylactic (Type I) Hypersensitivity most severe hypersensitivity reaction unanticipated severe reaction that is rapid in onset characterized by edema in many tissues, including the larynx, and is often accompanied by hypotension, bronchospasm, and cardiovascular collapse in severe cases. immediate reaction beginning within minutes of exposure to an antigen. Anaphylactic (Type I) Hypersensitivity Primary chemical mediators are responsible for the symptoms of type I hypersensitivity because of their effects on the skin, lungs, and gastrointestinal tract. Clinical symptoms are determined by the amount of the allergen, the amount of mediator released, the sensitivity of the target organ, and the route of allergen entry. include both local and systemic anaphylaxis. Cytotoxic (Type II) Hypersensitivity occurs when the system mistakenly identifies a normal constituent of the body as foreign. associated with several disorders. ○ myasthenia gravis, the body mistakenly generates antibodies against normal nerve ending receptors. Immune Complex (Type III) Hypersensitivity involves immune complexes that are formed when antigens bind to antibodies. These complexes are cleared from the circulation by phagocytic action. If these type III complexes are deposited in tissues or vascular endothelium, two factors contribute to injury: the increased amount of circulating complexes and the presence of vasoactive amines. As a result, there is an increase in vascular permeability and tissue injury. Delayed-Type (Type IV) Hypersensitivity also known as cellular hypersensitivity occurs 24 to 72 hours after exposure to an allergen. It is mediated by sensitized T cells that cause cell and tissue damage (Port & Matn, 2009). Symptoms include itching, erythema, and raised lesions. Diagnostic Evaluation Complete Blood Count With Differential - Eosinophils: level between 5% and 15% is non specific but does suggest allergic reaction. Higher percentages = moderate to severe eosinophilia. Eosinophil Count obtained from blood samples or smears of secretions (Fischbach & Dunning, 2009). patients with allergies usually reveal eosinophils, indicating an active allergic response. Diagnostic Evaluation Total Serum Immunoglobulin E - Levels High total serum IgE levels support the diagnosis of allergic disease (Fischbach & Dunning, 2009). Skin Tests - entails the intradermal injection or superficial application (epicutaneous) of solutions at several sites. ○ several different solutions may be applied at separate sites. Diagnostic Evaluation Radioallergosorbent Test a radioimmunoassay that measures allergen-specific IgE. A sample of the patient’s serum is exposed to a variety of suspected allergen particle complexes. ANTIHISTAMINE First Generation and Second Generation ANTIHISTAMINES block the release of histamine (= inflammation) > increases secretions & narrows airways. H1 blockers or H1 antagonists, compete with histamine for receptor sites, preventing a histamine response. Types of histamine receptors ▪ H1 receptor - extravascular smooth muscles (lining the nasal cavity) ▪ H2 receptor – GIT = increase in gastric secretions  Classification Generic name Brand name FIRST-GENERATION - diphenhydramine Benadryl cause drowsiness, dry hydroxyzine Vistaril, others mouth, and other meclizine Antivert anticholinergic symptoms promethazine Phenergan SECOND-GENERATION - cetirizine Zyrtec have fewer anticholinergic levocetirizine Xyzal effects and a lower incidence of drowsiness loratadine Claritin Antihistamines are indicated for the following: ▪ Relief of symptoms - allergic conjunctivitis, uncomplicated urticarial, and angioedema. ▪ Relief of nasal and non-nasal symptoms of seasonal and perennial allergic rhinitis. ▪ used as adjunctive therapy in anaphylactic reactions. ▪ Relief of nausea and vomiting associated with motion sickness - meclizine Nursing Implementation with Rationale ▪ Administration - 1 hr before or 2 hrs after meals ▪ For dry mouth. suggest sugarless candies or lozenges to relieve some of the discomfort. ▪ Safety measures. to prevent patient injury. ▪ Increase fluid intake. to decrease the problem of thickened secretions and dry nasal mucosa. ▪ Skin care. to prevent skin breakdown. ▪ Avoid alcohol. serious sedation can occur. Anaphylaxis a severe, life-threatening, systemic hypersensitivity reaction resulting in decreased blood pressure, airway obstruction, and severe hypoxia. Commonly caused by exposure to latex materials, administration of penicillin, or local anesthetic injections reaction usually occurs within minutes of the exposure. Pathophysiology Large amounts of chemical mediators are released from mast cells into the general circulation quickly, resulting in two serious problems. General or systemic vasodilation occurs with a sudden, severe decrease in blood pressure. In the lungs, edema of the mucosa and constriction of the bronchi and bronchioles occur, obstructing airflow The marked lack of oxygen that results from both respiratory and circulatory impairment causes loss of consciousness within minutes. Initial Signs and Symptoms generalized itching or tingling sensation over the body Coughing difficulty in breathing. This is quickly followed by feelings of weakness, dizziness or fainting, and a sense of fear and panic Edema may be observed around the eyes, lips, tongue, hands, and feet. Hives, or urticaria, may appear on the skin. General collapse soon follows with loss of consciousness, usually within minutes. MANAGEMENT an epinephrine injection be administered immediately. Antihistamine drugs (diphenhydramine [Benadryl] or chlorpheniramine [Chlor-Trimeton]) are useful in the early stages of an allergic reaction. Glucocorticoids or cortisone derivatives may be used for severe or prolonged reactions because they reduce the immune response and stabilize the vascular system. MANAGEMENT Skin tests can be performed to determine the specific cause of an allergy. ○ This procedure involves scratching the skin and dropping a small amount of purified antigen on the scratch. Avoidance of the suspected antigen will keep the person symptom free. Desensitization treatments involving repeated injections of small amounts of antigen to create a blocking antibody may reduce the allergic response. EMERGENCY TREATMENT FOR ANAPHYLAXIS Inject epinephrine immediately if it is available. Epinephrine acts to increase blood pressure by stimulating the sympathetic nervous system; ○ it causes vasoconstriction ○ relaxes the bronchial smooth muscle, opening the airway. oxygen should be administered immediately along with an injectable antihistamine. Cardiopulmonary resuscitation (CPR) should be initiated if necessary. Contact Dermatitis caused by exposure to an allergen or by direct chemical or mechanical irritation of the skin. Allergic dermatitis may result from exposure to any of a multitude of substances, including metals, cosmetics, soaps, chemicals, and plants. Pathophysiology Sensitization occurs on the first exposure (type IV cell - mediated hypersensitivity), and on subsequent exposures, manifestations such as a pruritic rash develop at the site a few hours after exposure to that allergen. The location of the lesions is usually a clue to the identity of the allergen For example, poison ivy may cause lesions, often linear, on the ankles or hands, or a necklace may cause a rash around the neck. Signs and Symptoms Typical allergic dermatitis manifestations include the following: Pruritic area Erythematous (reddened) area Edematous (swollen) area Area often covered with small vesicles Treatment Removal of the irritant as soon as possible and reduction of the inflammation with topical glucocorticoids are usually an effective treatment. Atopic Dermatitis a type I immediate hypersensitivity disorder characterized by inflammation and hyperreactivity of the skin. Other terms used to describe this skin disorder include atopic eczema, atopic dermatitis Pathophysiology Chronic inflammation results from the response to allergens Eosinophilia and increased serum IgE levels indicate the allergenic basis for atopic dermatitis (type I hypersensitivity). Potential complications include secondary infections due to scratching Affected areas also become more sensitive to many irritants such as soaps and certain fabrics. Marked changes in temperature and humidity tend to aggravate the dermatitis ○ leading to more exacerbations in patients living in areas with dry winter months or hot, humid summers. Signs and Symptoms usually located symmetrically on the face, neck, extensor surfaces of the arms and legs, and buttocks. Skin appears dry and scaling. Thick and leathery patches called lichenification are present. Skin folds may be moist and red. Pruritus is common. Treatment Identification and elimination of the aggravating agents Topical corticosteroids are used to prevent inflammation infection is treated with antibiotics to eliminate Staphylococcus aureus when indicated. Antihistamines may reduce pruritus, and avoidance of skin irritants diphenhydramine (Benadryl) immunosuppressive agents, such as cyclosporine (Neoral, Sandimmune), tacrolimus (Prograf, Protopic), and pimecrolimus (Elidel), may be effective in inhibiting T cells and mast cells involved Dermatitis Medicamentosa (Drug Reactions) type I hypersensitivity disorder, is the term applied to skin rashes associated with certain medications. people react differently to each medication, certain medications tend to induce eruptions of similar types. Rashes are among the most common Dermatitis Medicamentosa drug reactions appear suddenly, have a particularly vivid color disappear rapidly after the medication is withdrawn (Karch 2012). Rashes may be accompanied by systemic or generalized symptoms. patients are warned that they have a hypersensitivity to a particular medication and are advised not to take it again. Patients should carry information identifying the hypersensitivity with them at all times. Food Allergy IgE-mediated food allergy, a type I hypersensitivity reaction, occurs in about 2% of the adult population; occur in people who have a genetic predisposition combined with exposure to allergens early in life through the gastrointestinal or respiratory tract or nasal mucosa. most common offenders seafood (lobster, shrimp, crab, clams, fish), legumes (peanuts, peas, beans, licorice), seeds (sesame, cottonseed, caraway, mustard, axseed, sunower), tree nuts, berries, egg white, buckwheat, milk, and chocolate. Peanut and tree nut (e.g., cashew, walnut) responsible for the most severe food allergy reactions (Fitzharris & Sinclair, 2011) Clinical Manifestations classic allergic symptoms (urticaria, dermatitis, wheezing, cough, laryngeal edema, angioedema) gastrointestinal symptoms (itching; swelling of lips, tongue, and palate; abdominal pain; nausea; cramps; vomiting; and diarrhea). Medical Management elimination of the food responsible for the hypersensitivity Medication therapy involves the use of H1 blockers, antihistamines, adrenergic agents, and corticosteroids patients with food allergies, especially seafood and nuts, should have an EpiPen device prescribed. educating patients and family members about how to recognize and manage the early stages of an acute anaphylactic reaction (Boyce et al., 2010). Nursing Management focuses on preventing future exposure of the patient to the food allergen. instruct the patient and family about strategies to prevent its recurrence food allergies should be noted on their medical records, because there may be risk of allergic reactions to some medications containing similar substances (Fitzharris & Sinclair, 2011).