ALLERGIC REACTION

ALLERGIC REACTION
• Manifestation of tissue injury r/f interaction between an antigen (substance that induces
the production of antibodies) and an antibody (Protein substance developed by body in
response to and interacting with a specific antigen)
• Body overreaction
• Allergy is an inappropriate, often harmful response of immune response of immune
system to normally harmless substances
• Chemical mediators released
• Function and production of immunoglobulins (family closely related proteins capable of
acting as antibodies)

5 CLASSES
• IgG – 75% Total Immunoglobulin
o Appears in serum and tissue (interstitial fluid)
• IgA – 15% Total Immunoglobulin
o Appears in body fluids
 Blood, Saliva, Tears, Breast Milk
 Pulmonary, GI, Prostatic, and Vaginal Secretions
o Protects against Respiratory, GI, and Genitourinary infections
o Prevents absorption of antigens from food
o Passes to neonate in breast milk for protection
• IgM – 10% Total Immunoglobulin
o Appears mostly intravascular serum
o Appears as first immunoglobulin produced in response to bacterial and viral
infections
• IgE – 0.004% Total Immunoglobulin –  levels
o Appears in serum
o Takes part in allergic and some hypersensitivity reactions
o Combats parasitic infections
o Located in respiratory and intestinal mucosa

ROLE OF B CELLS - B-LYMPHOCYTE

• Site of antibody production  outpouring of antibodies for purpose of destroying and
removing antigen
ROLE OF T CELLS - T-LYMPHOCYTE
• Assist B cells in producing antibodies

HYPERSENSITIVITY
• Abnormal, heightened reaction to any type of stimuli
• Usually does NOT occur with 1st exposure to allergen
•  exposure causes more of an  in reaction
 • Reaction follows reexposure after sensitization in predisposed individual
• Sensitization initiates hormonal response or buildup of antibodies
FOUR TYPES OF REACTION
TYPE 1 - ANAPHYLACTIC - HYPERSENSITIVITY
• Immediate reaction beginning within minutes of exposure to an antigen
• Reaction mediated by IgE antibodies
• Requires previous exposure to specific antigen  plasma cells produce IgE antibodies in lymph
nodes (where T cells help with promoting reaction)  bind to membrane receptors and mast cells
found in CT and basophiles.
• May include both local and systemic anaphylaxis

TYPE 4 - DELAYED TYPE - HYPERSENSITIVITY

(CELLULAR HYPERSENSITIVITY)
• Occurs 24-72o after exposure to allergen
• Mediated by sensitized T Cell and Macrophages
• Example: Intradermal injection of tuberculin antigen or purified protein derivative (PDD)
• Example Reaction: Contact dermatitis resulting from exposure to allergens
o Such as: Cosmetics, adhesive tape, top meds, med additives, plant toxins
• Primary exposure results in sensitization
• Symptoms: Itching, Erythema, Raised Lesions

DIAGNOSTIC EVALUATION
• CBC With Differential
o WBC normal except during infective states
o Eosinophils – 5-15% nonspecific but does suggest allergic reaction
 Moderate eosinophilia: 15-40%
• Allergic disorders Patients with malignancy
• Immunodeficiencies Parasitic infections
• Congenital heart disease Peritoneal dialysis

• Total Serum Immunoglobulin E Levels

o High total serum IgE levels support diagnosis of atopic disease
o Normal IgE level does NOT exclude diagnosis of allergic disorder

• Skin Test
o Entails simultaneous intradermal injection or superficial application (epicutaneous) of
several solutions at separate sites
o Several Precautionary Steps Observed Before Skin Testing:
 Testing not performed during periods of bronchospasm
 Epicutaneous tests (scratch or prick tests) performed before other testing methods in an
effort to minimize risk of systemic reaction
 Emergency equipment must be readily available to treat anaphylaxis
 Corticosteroids and Antihistamines (including allergy meds) suppress skin test reactivity
and should be withheld 48-96 hours before test

• RAST Test
o RAST test may be performed if doubt about validity of skin tests
o Measures allergen-specific IgE
o Sample serum exposed variety suspected allergen particle complexes  antibodies
present combine with radiolabeled allergens.
o Indicates quantity of allergen necessary to evoke an allergic reaction  report on scale 0-
5. 2+ or greater: considered significant