GROUP 3 - ALLERGIES

Hypersensitivity

An excessive or inappropriate immune reaction that can damage the body

Allergen

A substance that triggers an allergic reaction

Antigen

A substance recognized by the immune system

Antibody

A protein made by the immune system to recognize specific targets

Immunoglobulin E

An antibody involved in many immediate allergic reactions

Mast cells

Immune cells that release histamine and other inflammatory chemicals

Basophils

White blood cells that can release histamine during allergic reactions

Histamine

A chemical that causes itching, swelling, increased mucus, and blood vessel changes

Sensitization

The process in which the immune system becomes prepared to react to a particular allergen

Cytokines

Small signaling proteins and chemical messengers released by immune and non-immune cells to coordinate cell-to-cell communication, inflammation, and immune responses

T cells (T lymphocytes)

A type of white blood cell that forms a core part of the adaptive immune system

Anaphylaxis

A clinical response to an immediate immunologic reaction between a specific antigen and an antibody. The reaction results from a rapid release of IgE-mediated chemicals, which can induce a severe, life-threatening reaction

• Tingling

• Itching

• Flushing

• Facial or airway swelling

• Wheezing

• Dyspnea

• Difficulty swallowing

• Cyanosis

• Hypotension

• Abdominal cramps

• Vomiting

• Diarrhea

• Seizures

• Possible cardiac arrest or coma

Key assessments of anaphylaxis:

• Immediate ABC assessment

• O2 administration, IV insertion, and preparation for possible intubation

• Educate patient to avoid antigen exposure and administration of prescribed injectable epinephrine device

Nursing management for anaphylaxis

• Cardiopulmonary resuscitation and oxygenation

• Maintain stable blood pressure and administer IV fluids

• Monitor patient for any delayed anaphylaxis reaction for 4-8 hours after initial reaction

Medical management for anaphylaxis

• Administer epinephrine (first-line)

• Administer antihistamines and corticosteroids

• Administer aminophylline with corticosteroids

Pharmacological management for anaphylaxis

Allergic rhinitis

• Also known as hay fever or seasonal allergic rhinitis

• The most common form of respiratory allergy, which is mediated by an immediate (type I hypersensitivity) immunologic reaction

• Main causes and triggers include seasonal allergens, perennial allergens, occupational allergens, and irritants

• Repeated sneezing

• Watery nasal discharge

• Nasal itching and congestion

• Itchy and watery eyes

• Postnasal drip

• Cough

• Fatigue

• Headache

• Dark circles under the eyes (allergic shiners)

• Horizontal nasa crease (allergic salute)

Key assessments for allergic rhinitis

• Instruct the patient to avoid their specific triggers

• Educate on correct administration of prescribed therapies

• Assess contraindications and side effects

Nursing management for allergic rhinitis

• Identify precipitating allergens and plan treatment based on environment

• Initiate pharmacologic therapy and immunotherapy

• Provide comprehensive information and instruction

Medical management of allergic rhinitis

• Corticosteroid nasal sprays (first-line)

• Second generation antihistamines

• Administer decongestant

Pharmacological management of allergic rhinitis

Contact dermatitis

An inflammatory reaction of the skin due to contact with an exogenous substance

Atopic dermatitis

A chronic, inflammatory allergic skin disorder that is triggered by environmental factors in individuals who are genetically susceptible

Atopic dermatitis

Commonly called eczema

• Localized itching

• Burning

• Redness

• Blisters

• Oozing lesions

• Scaling

• Skin thickening

• Lichenification

• Changes in skin pigmentation

• Possible secondary bacterial infection from scratching

Key assessments for contact dermatitis

• Dry

• Itchy

• Hypersensitive skin

• Red bumps

• Inflammation

• Excoriations

• Skin redness

• Thickening

• Fissures

• Skin breakdown due to persistent scratching

• Commonly affects the hands, wrists, elbows, ankles, knees, face, and neck in adults

Key assessments for atopic dermatitis

• Educate patient on strict skin moisturization routine

• Instruct the patient on itch management and trigger avoidance

• Provide psychosocial support and infection education

Nursing management for dermatitis

• Create plan to help the patient identify and avoid factors affecting dermatitis

• Manage using moisturization and topical anti-inflammatory agents

• Monitor patients for secondary bacterial infections

Medical management for dermatitis

• Topical corticosteroids and calcineurin inhibitors

• Biologics and systemic corticosteroids

• Antibiotic and antihistamine therapy

Pharmacological management for dermatitis

Drug hypersensitivity

Can be immediate (Type I), cytotoxic (Type II), immune-complex-mediated (Type III), or T-cell-mediated (Type IV)

• Drug-related rashes

• Itching

• Hives

• Swelling

• Fever

• Posible anaphylaxis

• Blood cell abnormalities such as hemolytic anemia, thrombocytopenia, or neutropenia

• Serum sickness or vasculitis

• Severe reactions such as DRESS or SJS/TEN with mucosal involvement, blisters, and skin peeling

Key assessments for drug hypersensitivity

• Observe patients receiving parenteral medications

• Monitor for early warning signs of life-threatening reactions

• Assess for delayed reactions (days to weeks)

Nursing management for drug hypersensitivity

• Identify and stop medication leading to drug hypersensitivity

• Evaluate patients for systemic complications

• Utilize pharmacogenetic testing to identify genetic predispositions

Medical management of drug hypersensitivity

• Caution on high-risk IV drugs

• Avoid re-administering drugs highly implicated in severe type IV delayed reactions

• Identify and discontinue specific hematologic triggers in type II cytotoxic reactions

Pharmacological management for drug hypersensitivity

Urticaria

Common causes of this include allergic reactions to medications or contact allergens, foods, insect stings and bites; reactions to medications that cause non-allergic mast cell activation (e.g., opioids); latex allergy; transfusions; and NSAIDs

Angioedema

Allergic reaction that involves infiltration of fluid in subcutaneous tissues and mucous membranes resulting in diffuse swelling; Release of chemicals such as histamine and bradykinin

• Sudden, diffuse, non-itchy swelling of the lips, eyelids, face, tongue, hands, feet, genitalia, or throat

• Hereditary angioedema typically causes recurrent swelling without hives and may involve severe abdominal pain due to gastrointestinal edema

• Assess for throat tightness, laryngeal swelling, difficulty breathing, hypotension, and possible airway obstruction or asphyxiation

Key assessments for angioedema

• Sudden, intensely itchy pink or red papules that develop into raised wheals and large, erythematous plaques

• Assess onset, duration, possible triggers such as food, medications, insect stings, infections, or physical stimuli, and associated symptoms such as angioedema

Key assessments for urticaria

• Observe patient for early signs of laryngeal obstruction and ensure tracheostomy and intubation tray is available at bedside

• Educate the patient on avoiding specific triggers

• Instruct patients to inform surgical and medical personnel regarding their conditions

Nursing management for urticaria and angioedema

• Airway management and ensure patient is prescribed with injectable epinephrine device

• Identify the specific underlying type of urticaria or angioedema

• Initiate high-dose trials of second generation antihistamines or advanced therapies for refractory cases

Medical management for urticaria and angioedema

• Administer specific agents for hereditary angioedema

• Ensure access to injectable epinephrine

• Use prophylactic antihistamine prior to trigger or prescribe advanced immunomodulators

Pharmacological management for urticaria and angioedema

Food allergy

An adverse reaction to certain foods due to immunologic mechanisms. These are categorized as either IgE-mediate non-IgE-mediated allergies

• Acute urticaria and angioedema of the mouth, face, lips, tongue, or throat occurring minutes to hours after eating

• Assess for wheezing, cough, laryngeal edema, abdominal pain, nausea, vomiting, cramps, diarrhea, and possible anaphylaxis

Key assessments of food allergy

• Educate patient and family on acute anaphylactic reaction

• Instruct the patient on avoidance on specific food that triggers allergic reaction

• Document all food allergies and inform healthcare workers during hospitalization

Nursing management of food allergy

• Strictly avoid food that triggers hypersensitivity

• Ensure patients are prescribed with autoinjectable epinephrine device

• Initiate oral immunotherapy

Medical management of food allergy

• Emergency epinephrine

• Administer H1 blockers, antihistamines, adrenergic agents, corticosteroids, and cromolyn sodium

• Oral immunotherapy

Pharmacological management of food allergy

Latex allergy

The sap of the rubber tree (Hevea brasiliensis) contains 250 different polypeptides that can react with IgE. The polypeptides and proteins in natural rubber latex (Hevea proteins) or the various chemicals that are used in the manufacturing process are thought to be the source of the allergic reactions

• Irritant reactions with erythema and itching

• Delayed reactions may cause localized vesicles, papules, itching, edema, redness, crusting, and skin thickening, usually appearing on the hands 1-4 days after exposure

Key assessments of latex allergy

• Assess patients for history of latex allergy

• Ensure completely latex-safe environment during patient care

• Educate patient on how to identify hidden latex in everyday products

Nursing management for latex allergy

• Avoid latex and utilize alternatives

• Ensure patient always reports latex allergy before medical, dental, gynecologic, or surgical procedures

• Prescribe injectable epinephrine device

Medical management for latex allergy

• Emergency epinephrine

• Ensure all pharmacological and medical supplies are latex-free

• Recommend non-latex contraceptives

Pharmacological management of latex allergy

• Avoid known allergens and carry prescribed emergency medication, such as an epinephrine auto-injector.

• Seek emergency medical help immediately for difficulty breathing or swelling of the throat.

Health education for anaphylaxis

• Minimize exposure to triggers such as dust, pollen, mold, and pet dander.

• Take prescribed medications and maintain a clean environment to reduce symptoms

Health education for allergic rhinitis

• Avoid skin irritants and allergens, and use fragrance-free moisturizers to protect the skin.

• Avoid scratching and use prescribed creams as directed to prevent skin damage.

Health education for contact and atopic dermatitis

• Inform healthcare providers about previous drug allergies and the medications that caused them.

• Avoid taking the suspected medication again until evaluated by a healthcare professional.

Health education for drug hypersensitivity

• Identify and avoid triggers, and take prescribed medications as directed.

• For hereditary angioedema, follow the specialist' s treatment plan; for cold urticaria, avoid sudden cold exposure, especially cold-water swimming.

Health education for urticaria and angioedema

• Avoid known food allergens, read food labels, and prevent cross-contact during food preparation.

• Carry prescribed emergency medication and seek immediate help if signs of a severe allergic reaction occur.

Health education for food allergy

• Avoid latex-containing products and inform healthcare providers about the allergy.

• Be aware that some people with latex allergy may also react to certain foods, such as banana, avocado, or kiwi, et

Health education for latex allergy