Anaphylaxis Reactions

7/28/2019 Anaphylaxis Reactions

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Allergic Reactions/ Anaphylaxis

Presented by: Mary Anne Javierto,RN Man


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An allergic reaction is a manifestation of tissueinjury resulting from an interaction between anantigen and an antibody.It is an inappropriate, often a harmful response of the immune system to normally harmless

substances.PATHOPHYSIOLOGY

When the body is invaded by an antigen andthe body recognizes as foreign, a series of events happen to render the antigenharmless, to destroy it or remove it from the

body.


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CHEMICAL MEDIATORS

When mast cells (located in the connective tissues)are stimulated by antigens, strong and powerfulchemical mediators are released to cause eventsand produce symptoms ranging to mild to life

threatening. Also found in the basophiles.B Cells

B lymphocytes are programmed to produce one

specific antibody. On encountering a specificantigen, a B cell stimulates the production of plasma cells ( the site of antibody production.)


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The result is the production of large amounts of antibodies

T CellsThe T cells or the T lymphocyte, assists the Bcells in producing antibodies known as

lymphokines that encourage cell growth,direct the flow of cellular activities, andstimulate the macrophages. A) stimulates the

immune response. B) digest the antigens, C)assist in removing the dead cells and other debris D) prepare the area for healing


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Lymphocytes originate from the stemcells of the bone marrow. The B cellsmature in the red marrow, the T cells inthe thymus gland. Once matured, theyare released in the blood cells.

from the red cells, the in they populatein the lymphatic tissues, they can stay

there or remains in the blood or other tissues


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Antigens Influences the production of B cells. Theymaybe known as Complete e.g. animaldanders, dust and pollen. They stimulate acomplete anaphylactic response. They maybealso known as Low molecular weightsubstances e.g. as medications or food. They

function as haptens. The bind to tissues or proteins as carriers and produce a allergicreactions.


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Chemical Mediators of Hypersensitivity

I. Primary MediatorsHistam ines - effects -

-Plays a role in the immune response. Maximalintensity is reached within 15 minutes after antigen contact. The following effects follows:

Vasodilationerythemalocalized edema in the form of wheals and

prurituscontraction of the bronchial smooth muscle

resulting to wheezing, difficulty of breathingIncreased secretions of gastric and mucosal

cells resulting to diarrhea, abdominal pain


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Eos inoph i ls Chem otac ti c Fac to r o f

Anaphylax i s

inh ib i t s the ac t ion of leukot r in es and h is tamines

affec t s m ovem ent o f eos inop hi l s

Platelet act iv at ing Facto r

respo ns ib le for in i t iat ing p la telet aggregat ion on s i tes of hy persens i t iv i ty reac t ions

Produces b roncho cons t r ic t ion Inc reased vasc ular perm eabi l i ty

A ct iva tes Hagem an fac tor w hich s t im ula tes

the p rod uc t ion o f Bradykin ins


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Pros taglandins

produces small muscle contractions

VasodilationVascular permeability

II. Seco n d ary Med iators

Leukot r ines These are released by the mucosal mast cells .They are collectively known as the Slow

React ing Subs tanc e of A naph ylaxis .initiates the inflammatory responsesmooth muscle contraction

bronchial constriction


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causes wheals and flare reactions noted in theskinMucus secretions in the airwaysExtremely potent in causing vasospasm

Bradyk in ins

A polypeptide wit the ability to cause :Increased vasopermeability Vasodilation

HypotensionContraction of the bronchial muscle leading tospasms and dyspnea.

Stimulates nerve endings that causes pain


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ANAPHYLACTIC SHOCK The result of awidespread hypersensitivity reaction. The symptomsmaybe seen as vasodilation, pooling of blood in theperiphery and hypovolemia and with altered cellular metabolism.

Occurs as a response when an allergen reactsstrongly with the antibodyDoes not occur in the first exposureWith the first exposure, the body manufactures

antibody specifically, IgE antibodies begins and progresses rapidly and is potentially

lethal


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Bronchospasm, mucosal edema, inflammationAnd capillary permeability. These symptoms are producedwithin seconds of initial contact

Other symptoms that may soon follow are: laryngeal

stridor, hypotension, laryngeal, GI and uterine spasm.

CLINICAL MANIFESTATIONS CATEGORIESmildmoderate

severe


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Allergic reactions can beprovoked by :

a.skin contact with poisonplants, chemicals, animalscratches, insect stings.b. Ingesting or inhalingsubstances like pollen,animal dander, molds andmildew, dust, nuts andshellfishc. Medications such aspenicillin and other antibiotics

Any m ed icat ion has the po tent ial to caus e an a llergic react ion .


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A. MILD REACTIONS:1. REDNESS, PRURITUS, URTICARIA AND SWELLING

MODERATE REACTIONS:1. MILD REACTIONS2. SLIGHT DIFFICULTY IN BREATHING, SOME USE OF

ACCESSORY MUSCLES3. INTENSE ITCH, REDNESS AND MORE EDEMA4. FLARING OF THE ALAE NASAE5. FATIGUE AND WEAKNESS

SEVERE REACTIONS:1. MODERATE REACTIONS2. RESPIRATORY ACIDOSIS, DYSPNEA, STRIDOR,

PULMONARY EDEMA, DECREASED BREATH SOUNDS, X-RAY SHOWS SEVERE PULMONARY CONGESTION


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B. Cardiovascular pallor, clammy skin Tachyarrythmias Hypotension Decreased oxygen saturation hypoxemia and hypercapnea Warm to touch if febrile

C. Neurologic anxiety, restlessness, inability to

obey commands Decreasing level of consciousness,coma and unresponsiveness


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D. Renal

decreased urine output less than 30cc/hr.

E. Integumentary - maybe febrile redness,,presence of wheals edematous (lips, mouth and tongue,periorbital, scalp and genitals


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MANAGEMENTDRUGS

SYMPATHOMIMETICS

AMINOPHYLLINES / THEOPHYLLINES a. check B/p & heart rateb. respiratory assessment

EPINEPHRINE / ADRENALINE check B/p &heart rate

ANTIHISTAMINES blocks histamine receptorsa. do not allow the pt. to driveb. monitor b/p

diphenhydramineatarax claritin


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Oral cor t ico s tero ids anti-inflammatories andregulate immune response. Monitor blood sugar levels

DecadronHydrocortisones (solucortef)Medrol and solumedrol

Diuret ics Lasix and Mannitol - determine blood pressure,

do not give for b/p below 100 systolic. Monitor intake

and outputNa Bicarbonate monitor ABGs and electrolytesAlbumin infusions and Isotonic Infusions to allow

fluids to remain within the vessels and increase cardiacoutput & b/p


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NURSING INTERVENTIONS:Administer epinephrine. Monitor blood pressure a

heart rate. Must be connected to cardiac monitor. Odetermine arrythmias. Maybe given subcu or IV orintratracheal. Increases b/p, cardiac output, heartcontraction and rate.

Aminophylline promotes bronchodilatation andrelaxation of the bronchial muscles. Given throughinhalation or IV. Increases oxygenation


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TREATMENT Anaphylaxis is always an emergency. It requires

an immediate injection of epinephrine.In the early stage of anaphylaxis, when the

patient still has normal blood pressure and isconscious, give epinephrine I.M. or subcutaneouslyS.C. Massage the injection site to help the drug moveinto circulation faster.

With severe reactions, when the patient lostconsciousness and is hypotensive, administer epinephrine I.V.


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After the initial emergency, give other medication as ordered: epinephrine solutionor suspension S.C., corticosteroid, anddiphenhydramine I.V. for long-termmanagement, and aminophylline I.V. over 10to 20 minutes for bronchospasm.Evaluate the patient. On recovery, his bloodpressure should be within normal limits and

his respirations should be regular andunlabored.


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Teaching tips for Anaphylaxis

To prevent anaphylaxis, teach the patient to avoidexposure to known allergens. If he has a food or drugallergy, tell him to avoid the offending food or drugs inall its forms. If he has allergic to insect bites or sting,tell him to avoid open fields, and wooded areasduring the insect season and to carry an anaphylaxiskit (containing epinephrine, antihistamine, andtourniquet) when outdoors.

Advise the patient to wear medical identification jewelry identifying his allergy.

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Anaphylaxis Reactions