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Immunology
Anatomy, Allergic and Anaphylaxis, Anaphylactoid
reactions, Collagen Vascular disease, and transplanted
related problems, communicable disease
Immune System

Terms
◦ Immune system-the body system responsible for
combating infection
 Immune response-complex cascade of events that works
towards the destruction of pathogens or abnormal cells.
◦ Antigens-a marker on the surface of cell that
identifies it as “self” or “non-self”
◦ Antibody-a substance produced by B lymphocytes
in response to the presence of a foreign antigen
that will combine with and control the antigen,
thus preventing infection
◦ Immunity-a long term condition of protection
from infection or disease
Immunity types

Natural VS. Acquired
◦ -Natural=not part of the immune response,
inborn part of your genetic make-up
◦ -Acquired=develops as an outcome of the
immune response
 Passive-transferred to a person from outside
source.
 Active-generated by the immune response after
exposure to a antigen
Immunity types

Humoral VS. Cell-Mediated
◦ Lymphocytes
 WBC
 Recognizing foreign antigens
 Producing Antibodies
 Developing Memory
◦ B&T Lymphocytes
 B-Do not attack Antigens directly produce
antibodies-confer long term immunity=Humoral
 T-Attack antigens directly=Cell-Mediated
Humoral Immunity

Basically a chemical attack of an invading
substance
◦ Basic fighter=Antibodies
AKA=IMMUNOGLOBINS
 Speclized Cells (B-Cells) 5 types
 IgA
 IgD
 IgE-most important for allergic reactions
 IgG
 IgM
Humoral Response

Primary-Never exposed to antigen before.
◦ Antigen enters body
 Body respond by producing Antibodies
 Specifically IgE
◦ Antibodies remain
 The patient is primed for another exposure to that
antigen
 THIS IS SENSITZATION

Secondary- the body remembers Antigen
and attacks it quickly
Allergy

Initial exposure of antigen is referred to
as sensitization
◦ Subsequent exposure induce a faster and
stronger response

Some individuals become
HYPERSENSITIVE to particular antigens
◦ Unexpected and exaggerated reaction to a
particular antigen. Used synonymously with
allergy.
Hypersensitive

Two types
◦ Delayed
 No cellular immunity
 Hours and days following-skin rash
 Example-Poison Ivy
◦ Immediate
 Large quantaties of IgE
 Antigen that does this is referred to as Allergen
 Allergen can enter the body through various routes
 Large majority of Anaphylactic reaction result from injection
or envenomation
Anaphylaxis


An exaggerated allergic reaction to a foreign
protein or other substance
Common substances
◦
◦
◦
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
PCN
Insect stings
Radio-contrast dye
Food-peanuts/shellfish
Systems effected
◦
◦
◦
◦
Cardiac
Respiratory
GI
Skin
Anaphylaxis
Antigen introduced
IgE bind to
Mast/Basophillis cells
IgE binds to the
antigen and Mast
Degranulate
• Degranulation is
the process of
releasing
chemicals from
the cell
Histamine,
heparin and other
mediators are
release
• Histamine is
the main
chemical
mediator
Anaphylaxis
Histamine Effects
Increased Capillary Permeability
 Vasodilation
 Bronchoconstriction
 Increased Mucus secreation
 Two classes

◦ H1-cause bronchoconstriction and GI
contraction.
◦ H2-cause peripheral vasodilation and
increased capillary permeability

SRS-bronchoconstiction/potentiates
Histamine
Anaphylaxis
Anaphylactic S/SX

Generalized
◦ Itchy, watery, red eyes
◦ Runny nose

CNS
◦
◦
◦
◦

Anxiety/restlessness
Confusion
HA
SZR
Skin
◦
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Itching and tingling
Uticara(hives)
Flushed or red skin
Swelling of the hands or face
S/SX

Respiratory
◦ Chest and throat tightness
◦ Increase RR/Labored breathing
◦ Stridor, Hoarness

Cardio
◦ Tachycardia
◦ Hypotension
◦ Weak pulses

GI
◦ N/V
◦ Diarrhea
◦ Cramping
Hives
Angioneurotic edema
Treatments
Mild/Moderate/Severe
 Airway(monitor for horseness, edema,
stridor)
 02,,EKG BVM prn
 IV fluids maintain >90 BP
 EPI 0.3mg SQ/0.1-0.3mg SIVP
 Benadrly 50mg
 Solu-medrol 125mg
 Albuterol/Atrovent 2.5-5mg/.5mg
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EPINEPHRINE
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NamesActions-Adrenergic stimulant A&B receptors.
Increased HR, Cardiac contractile force,
vasoconstriction
Indications-Anaphylaxis/Hives
◦ Dosage
 1:1000/0.3mg/SQ adult .01mg/kg pediatric SQ
 1:10000/0.1-0.3mg/SIVP

Contraindications/Precautions-Patients with
underlying heart disease. Those in profound
anphylaxis may be peripheral
vasoconstricted so SubQ epi may not work
Diphenhydramine
Names-Benadryl
 Actions-antihistamine blocks both H1 and
H2 receptors
 Indications-Anaphylaxis/allergic/dsytonic
reactions

◦ Dosage-25-50 mg SIVP or IM

Contraindications-not used in asthma. In
severe cases be sure to use EPI first. Can
cause hypotension, HA, palpitations
SOLUMEDROL
Names-Methylprednisone
 Actions-steriod with anti-inflammatory
properties
 Indications-Severe Anaphylaxis
 Dosage and routes-125 to 250mg IV or
IM
 Contraindications/Precautions-None for
anaphylaxis. One dose for patients.

Albuterol
Names-Proventil, ventolin
 Action-Cause bronchodilation strong b2
properties with minimal side effects
 Indications-Asthma, Anaphylaxis
 Dosage/routes-2.5-5mg Neb
 Contraindication/Precautions-Can cause
palpitations, anxiety, dizziness, HA,
nervousness.

Atrovent
Names-Ipratropium
 Action-Anticholinergic, bronchodilator.
Dries respiratory secreations
 Indications-Asthma, Anaphylaxis
 Dosage/routes-.5mg NEB
 Contraindication/Precautions-few
interactions with other meds. Breathing
treatment should behind EPI and Benadryl
with Anaphylaxis

IM and SQ injections
Anaphylactoid Reactions
No previous Antigen exposure
 Not the typical Antigen-Antibody
exposure
 The substance that the patient is taking in,
is causing the breakdown of basophilis
and mast cells
 First time exposure may present as a
Anaphylactic reaction
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Anaphylactoid
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Common susbstances
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NSAIDS
ASA
Opiates
Thiamine
Collagen Vascular Disease

Collagen vascular disease occurs when
problems with the immune system affect
collagen
◦ Collagen is a tough strong protein that comprises
most of the body’s connective tissue
 Fibroblast-specialized cells that form collagen

In a class of diseases known as autoimmune
disorders, the body's immune system attacks
its own tissues
Examples of CVD
Systemic lupus erythematosus (SLE) – inflammation
of the connective tissues, can afflict every organ
system. It is more common in women than men.
 Rheumatoid arthritis – a systemic disorder in which
immune cells attack and inflame the membrane
around joints. It also can affect the heart, lungs, and
eyes.
 Scleroderma – activation of immune cells that
produces scar tissue in the skin, internal organs, and
small blood vessels.
 Sjögren's syndrome – aka Sjögren's disease, is a
chronic, slowly progressing inability to secrete saliva
and tears. It can occur alone or with rheumatoid
arthritis, scleroderma, or systemic lupus
erythematosus.

Transplant related Problems

Organs that can be transplanted are the heart,
kidneys, liver, lungs, pancreas, intestine, and
thymus. Tissues include bones, tendons (both
referred to as musculoskeletal grafts), cornea,
skin, heart valves, and veins. Worldwide, the
kidneys are the most commonly transplanted
organs, followed closely by the liver and then the
heart. The cornea and musculoskeletal grafts are
the most commonly transplanted tissues; these
outnumber organ transplants by more than
tenfold.
Problems

Transplant rejection occurs when
transplanted tissue is rejected by the
recipient's immune system, which
destroys the transplanted tissue.
◦ Less by matching donors and
immunospressive drugs

Rejection categories include
Hyperacute, Acute and Chronic
TB
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What is it?

How is it spread?
◦ Does everyone act as carrier?
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What are the Signs and SX?
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How to Protect yourself?
Pertussis (Whooping Cough)
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What is it?

How is it spread?
◦ Does everyone act as carrier?
◦ Does the Vaccine last for a lifetime?

What are the Signs and SX?

How to Protect yourself?
Ebola
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What is it?

How is it spread?
◦ Does everyone act as carrier?

What are the Signs and SX?

How to Protect yourself
Ebola Checklist
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http://www.cdc.gov/vhf/ebola/pdf/emschecklist-ebola-preparedness.pdf
Ohio DHS Handouts
THE END