Hypersensitivity

BY
Mahbob Elahi & Imtiaz Ahmad
 0bjectives
• At the end of this lecture the Learners well be able
to :
• Define hypersensitivity.
• Explain types of hypersensitivity.
• Discuss causes of hypersensitivity
• Differentiate sign and symptoms of hypersensitivity
• Evaluate nursing diagnosis and interventions
 Hypersensitivity
• It is defined as state of exaggerated or
inappropriate immune response to an antigen.

OR
• Over reaction of the immune system to
harmless environmental antigens.
 Types of hypersensitivity
• There are four types of hypersensitivity.
• Type 1
• Type 2 mediated by humoral mechanism.
• Type 3
• Type 4 mediated by T lymphocytes.
 TYPE 1
• It is also called anaphylactic reaction and is
rapidly occurring.
• It is mediated by Ig E antibodies.
• Prior sensitization is needed.
• Active chemical mediators release such as
histamine , serotonin and bradykinine.
 Mechanism
• First exposure causes production of Ig E
antibodies.
• Subsequent antigen + antibody (bound to
mast cell and basophils)
•
• degranulation of mast cells and basophils.
• hypersensitivity reaction within seconds to
minutes.
Mechanism
 Conti…
• The initial response is immediate reaction and
mediated by histamine.
• Histamine is the most important mediator
causing.
 vasodilation
 bronchospasm
 increased secretion of stomach , nose
and lacrimal gland.
 Example of local anaphylactic
reaction
• Skin:
• The antigen may come in contact with skin
directly or by injection (insect bite) or it may
be ingested (food).
• Contact with allergen causes immediate
reddening , swelling and itching (urticaria)
 Cont...
• Lungs
• Inhalation of allergens (e.g.pollen, dust leads
to contraction of bronchial smooth muscle
resulting in acute airway obstruction and
wheezing (allergic bronchial asthma.
• Nose (hay fever or allergic rhinitis)
• Intestine (Allergic gastroenteritis)
 Systemic anaphylactic reactions

Release of mediators causes vasodilatation and

increase vascular permeability that leads to
circulatory shock , allergic edema which
particularly affects larynx and may cause fatal
asphyxia(choking,).
 Type 2 reaction
• Also called cytotoxic reaction .
• In type 2 antibodies are formed against the cell
surface or tissue that contain the antigen
• IgG and IgM antibodies are produce against
antigen .
 Conti…
• Examples
• Blood transfusion reaction
• Hemolytic diseases of new born
• Auto immune hemolytic anemia.
 Type 3 reaction
• It is called immune complex reaction.
• This type of hypersentivity is mediated by
antigen antibodies-complexes .
• Initiate an acute inflammatory reaction in
tissue by activation of complements and
accumulation of polymorphs
• Exogenous antigens e.g.bacterial,virus,drug
• Endogenous antigen of DNA
 Cont…
• Examples
• Acute serum sickness develop in three
phases.
• Phase 1. formation of antigen antibody
complexes in the circulation
• Phase 2. deposition of immune complexes in
various tissue.
• Phase 3. development of inflammatory reactions
in various sites through out the body.
 Conti…
• Rheumatoid arthritis.
• Polyarthritis nodosa.
• Pneumonitis.
 Type 4 reaction
• Cell mediated hypersensitivity ,
• this type of reaction in mediated by T cell
rather than antibodies.
• Occurs typically 24 – 72 hours after exposure
of a sensitized individual to the antigen .
• Also called Delayed –type hypersensitivity.
• Because sensitized T cells respond to an
antigen with the help of macrophages
 Cont…
• First exposure to antigen recognition and
phagocytosis by macrophages present T
forming memory T cells .
• Later memory T cells interact with antigen and
secret biologically active factors called
lymphokines.
Sign /symptoms of hypersentivity
• Flu
• Fever, chills, cough
• Joint pain
• Headaches
• Anorexia
• Weight loss
• clubbing
 Nursing diagnosis
• Impaired skin integrity related to sensitive
reactions.
• Respiratory distress related to bronchospasm
secondary to hypersensitivity.
• Anorexia related to GI disturbance secondary
to allergic reactions.
• Lethargy related to rheumatoid arthritis
secondary to diseases processes.
 Nursing interventions
• Assess and support the patient’s (ABCs) .
• Check the patient’s vital signs and
oxygenation.
• Administer emergency prescribed drugs for
allergic reaction.
• Administer supplemental oxygen.
• Document the clinical status of patient’s.