CAREOF CLIENTS WITH ALLERGIC - Functions as haptens (incomplete

antigens), binding to tissue or serum

DISORDERS proteins to produce a carrier complex
that initiates an antibody response.
ALLERGIC REACTION
- Manifestation of tissue injury resulting from
interaction between an antigen and antibody
ALLERGY
- Is an inappropriate and often harmful response
of the immune system to normally harmless
substances (allergens). Ex. Dust, weeds, pollen,
and dander
ALLERGY REACTION
- In allergic reactions, the body encounters
allergens -> body’s defenses recognize as foreign
-> destroy them, and remove them from the
body. FUNCTION OF ANTIGENS
FUNCTIONS OF IMMUNOGLOBULINS - When the allergen is absorbed through the
- Can be found in lymph nodes, tonsils, appendix, respiratory tract, GIT or skin, allergen
peyer’s patches, or circulating blood. sensitization occurs.
IgE - Macrophages process the antigen and present it
- Involved in allergic disorders and some parasitic to the appropriate cells
infections - These cells mature into allergen-specific
- IgE – producing cells are in the respiratory and secreting plasma cells that synthesize and
intestinal mucosa. secrete antigen-specific antibodies.
- Two or more IgE mols bind together to an
FUNCTION OF CHEMICAL MEDIATORS
allergen and trigger the mast cells or basophils
Mast cells – located in skin and mucous membrane
to release chemical mediators.
- Major role in IgE-mediated immediate
- ATOPY – refers to IgE-mediated diseases such as
hypersensitivity
allergic rhinitis that have a genetic component.
- Releases powerful chemical mediators:
o Primary mediators –
preformed; found in mast
cells or basophils
o Secondary mediators –
inactive precursors formed or
released in response to
primary mediators.

ROLE OF B CELLS
- Production of plasma cells (site of antibody
production) -> destroy and remove antigens
ROLE OF T CELLS
- Assist B cells; directs flow of cell activity; destroy
and digest antigens
- Does not bind free antigens.
- Macrophage present antigen to T cells PRIMARY CHEMICAL MEDIATORS
- T cell does not bind to free antigens 1. Histamine – 1st chemical mediator in immune
and inflammatory responses.
FUNCTIONS OF ANTIGENS - Effects peak 5 to 10 minutes after
Two groups: antigen contact
1. Complete Protein Antigens - Erythema, localized edema in the form
- Stimulate a complete humoral of wheals; pruritus; contraction of
response bronchial smooth muscle -> wheezing
- Ex. Animal dander, pollen, horse serum and bronchospasm; dilation of small
2. Low molecular weight Substances venules and constriction of large
- Ex. Medications vessels; increased secretion of gastric
and mucosal cells -> diarrhea
 - Stimulates H1 (bronchiolar and HYPERSENSITIVITY
vascular smooth muscle cells) and H2 - Is a reflection of excessive or aberrant immune
receptors (gastric parietal cells). response to any type of stimulus
- Usually does not occur with the first exposure to
an allergen
- Reaction follows a re-exposure after
sensitization, or buildup of antibodies in a
predisposed person.

4 Types of Reactions:
1. Anaphylactic hypersensitivity (Type I)
2. Cytotoxic Hypersensitivity (Type II)
3. Immune Complex Hypersensitivity (type III)
4. Delayed-Type hypersensitivity (Type IV)

- Ex. Medications: Benadryl - 1. Anaphylactic Hypersensitivity (Type I)

antihistamine for H1 receptors, - MOST severe type of hypersensitivity
Cimetidine (Tagamet) and Ranitidine - An immediate reaction beginning
(Zantac) – targets H2 receptors within minutes of exposure to an
2. Eosinophil Chemotactic Factor of Anaphylaxis antigen
- Affects the movement of eosinophils to - Primary chemical mediators are
the site of allergens responsible for the symptoms.
- Preformed in the mast cells and is - Unanticipated severe allergic reaction
released from disrupted mast cells. that is rapid in onset
3. Platelet Activating factor - Characterized by edema in many
- Responsible for initiating platelet tissues, including the larynx
aggregation and leukocyte infiltration - Often accompanied by hypotension,
at sites of immediate hypersensitivity bronchospasm & cardiovascular
reactions collapse
- Also causes bronchoconstriction and - Clinical Symptoms are determined by:
increased vascular permeability. o amount of allergen
- Serotnin – mediator released during o amount of mediator released
platelet aggregation and causes o sensitivity of the target organ
bronchial smooth muscle contraction. o route of allergen entry
4. Prostaglandins - May include both local and systemic
- Produce smooth muscle contraction as anaphylaxis
well as vasodilation and increased - Anaphylactic reaction is characterized
capillary permeability by vasodilation, increased
- Causes fever and pain in allergic permeability, smooth muscle
responses contraction, and eosinophilia
- Systemic reaction: laryngeal stridor,
SECONDARY CHEMICAL MEDIATORS angioedema, hypotension, bronchial GI
1. Leukotrienes uterine spasm
- Initiate the inflammatory response - Local reaction: Hives
- Cause smooth muscle contraction, - Order of Management:
bronchial constriction, mucus secretion o Intubate
in the airways, & typical wheal-and- o Epinephrine
flare reactions of the skin. o Fluids
- 100 to 1,000 times more potent in o Antihistamine
causing bronchospasm compared to o Corticosteroids
histamine.

2. Bradykinin
- Has the ability to cause increased
vascular permeability, vasodilation,
hypotension & contraction of many
types of smooth muscle
- Stimulates nerve cell fibers and
produces pain.
2. Cytotoxic Hypersensitivity (Type II) 3. Immune Complex hypersensitivity (type III)
- Occurs when the system mistakenly - Involves immune complexes that are
identifies a normal constituent of the formed when the antigens bind to
body as foreign antibodies
- May be the result of cross-reacting - Normally, these immune complexes
antibody, possibly leading to cell and are cleared through phagocytosis
tissue damage. - This type of hypersensitivity, the
- Releases complement cascade – part of immune complexes are deposited in
immune system that enhances tissues or vascular endothelium
complements or the ability of the - 2 factors that contribute to injury:
antibodies and phagocytic cells to clear o Increased amount of
damage cells that promote circulating complexes
inflammation and attack the cell o Presence of vasoactive
membrane amines.
- Result
o Increase vascular permeability
o Tissue injury
- Marked by acute inflammation
resulting from formation and
deposition of immune complexes
- Joints and kidneys are particularly
susceptible

- Associated with disorders:

o Myasthenia gravis – the body
mistakenly generates
antibodies against normal
nerve ending receptors
o Goodpasture syndrome –
generates antibodies against
lung and renal tissue thereby
producing lung damage and - Example: Systemic Lupus
renal failure. erythematosus, serum sickness,
nephritis, and rheumatoid arthritis
 - s/s urticaria, joint pain, fever, rash and
adenopathy (swollen glands)
4. Delayed-type Hypersensitivity (Type IV)
- Aka cellular hypersensitivity; delayed ASSES SMENT OF CLIENTS WITH
type ALLERGIC DISORDERS
- Occurs 24-72 hours after exposure to - Comprehensive allergy history
an allergen - Thorough physical exam
- Mediated by sensitized T cells that - Use of an allergy assessment form
cause cell and tissue damage - Take note of:
- S/s itching, erythema and raised lesions - Degree and difficulty experienced
- SQ injection of antigen - Degree of improvement of symptoms
- Often used as an assay for cell- with or without ttt.
mediated immunity (e.g. purified - Relationship of symptoms to exposure
protein derivative skin test for to possible allergens
immunity to Mycobacterium
tuberculosis) SAMPLE ALLERGY ASSESSMENT FORM
- Ex. Latex, contact dermatitis

HEALTH HISTORY
- Allergies
- Types of allergens
- Symptoms experienced
- Seasonal variations in occurrence or
severity in symptoms
- History of testing and treatments
- Prescribed and OTC meds
o Previously taken
o Currently taking for these
allergies
o Effectiveness of the
treatments
- Continued assessment for potential
allergic reactions in the patient is vital
- All medication and food allergies are
listed on an allergy alert sticker and
placed on the front of the patient’s
health record or chart to alert others.
-
DIAGNOSTIC EVALUATION FOR ALLERGIC DISORDERS
- Blood tests
- Smears of body secretion
- Skin tests
- Serum Specific IgE Test (RAST)
** they are not major criteria for diagnosis of an allergic
disease.
A. CBC with differential Interpretation of Skin Test Results
- Eusinophils (n= 2% - 5%)
- 5% to 10% significant result
- 15%-40% definite allergic disorder

B. Eosinophil Count
- Blood samples or smear of secretions
(sputum)
C. Total Serum IgE levels
- Increased levels may support dx of
allergic disease
D. Skin Tests – most accurate
- Intradermal injection or superficial
application (epicutaneous) of solutions
at several sites
- Positive (wheal-and-flare) reactions are
clinically significant when correlated
with the history, physical findings, and Interpretation of Results
results of other lab tests. Negative Wheal soft w/ erythema
- Results complement the data obtained 1+ Wheal present (5-8 mm) w/ associated
from history erythema
- Dosage of antigen (allergen) injected is 2+ Wheal (7-10 mm) w/ associated erythema
also important 3+ Wheal (9-15 mm) slight pseudopodia w/
- Esp to most px who are hypersensitive associated erythema
to more than 1 allergen 4+ Wheal (12 mm+) w/ pseudopodia & diffuse
erythema
Precautionary Steps before skin testing:
1. Testing must not be performed during Guidelines for the interpretation of skin test
periods of bronchospasm results:
2. Epicutaneous tests are performed 1. Skin tests are used most frequently with the
before other testing methods diagnosis of allergic rhinitis
3. Emergency equipment must be readily 2. Negative test results are helpful in ruling out
available to treat anaphylaxis food allergy
4. Corticosteroids and antihistamines 3. Positive skin tests correlate highly with food
should be stopped 48 – 96 hours before allergy.
testing.
E. Provocative testing
Type of skin tests - Direct administration of suspected
- Prick skin test allergen to the sensitive tissue
- Scratch tests (conjunctiva, nasal and bronchial
- Intradermal skin test (back is most mucosa or GIT)
suitable part of body for skin testing) - Helpful who have large no. of positive
o 0.02- 0.03ml of ID allergen tests
o Positive reaction (urticarial - Disadvantages:
wheal, localized erythema, o Limitation of 1 antigen per
pseudopodia – irregular session
projection at the end of a o Risk for producing severe
wheal) symptoms (bronchospasm)

F. Serum- specific IgE Test

- Formerly Radioallergosorbent test
(RAST)
- Radioimmunoassay that measures
allergen-sepcific IgE
- Patient’s serum is exposed to a variety
of suspected allergen particle
complexes
- If antibodies are present, they combine
with the radio labeled antigen
 - Test results are compared with control - Contraindications
values; reported on a scale of 0 to 5 o Intake during the 3rd trimester
(Significant > or equal to 2) o Nursing mothers
Advantages: o Newborns and children
o Decreased risk of systemic reaction o Older patients
o Stability of antigens o Px with asthma, urinary
o Lack of dependence on skin reactivity modified retention, open-angle
by medications glaucoma, HPN and prostatic
Disadvantages: hyperplasia
o Reduced sensitivity compared with intradermal - Second generation H1 receptor
skin tests antagonists – nonsedating (does not
o Lack of immediate results, and higher cost cross Blood brain barrier)
o Loratadine
MEDICAL MANAGEMENT o Cetirizine
Goal: provide relief from symptoms o Fexofenadine
- May be combined with decongestants
Avoidance Therapy to reduce nasal congestion (eg.
Every attempt is made to remove allergens that act as Loratadine/psudoephedrine (Claritin-
precipitating factors D) and Cetirizine/pseudoephedrine
- Ex. Use of air conditioners and air (Zyrtec-D)
cleaners o Decongestants can cause
- Removal of dust-catching furnishings increase in blood pressure.
- Removal of pets from home B. Adrenergic agents
- Use of high-efficiency particulate air - Vasoconstrictor of mucosal muscles
(HEPA) purifiers - Reduces local blood flow, fluid
- Changing clothing when coming in from exudation, mucosal edema
outside - Used for relief of nasal congestion
- Showering to wash allergens from hair - Activate the alpha-adrenergic receptor
and skin sites of the smooth muscle of the nasal
- Using OTC nasal irrigation device or mucosal blood vessels causing
saline nasal spray to reduce allergens in reduction of:
the nasal passages o Local blood flow
o Fluid exudation
Pharmacologic Agents o Mucosal edema
A. Antihistamines (H1 receptor antagonist/ H1 - Used topically in nasal (Afrin) and
blocker) ophthalmic (Alphagan P) formulations
- Bind selectively to H1 receptor, in addition to oral route (Sudafed)
preventing the action of histamine at o Topical preparations have less
these sites side effects
- Major class of medications prescribed o However, should be limited to
for the symptomatic relief of allergic a few days to avoid rebound
rhinitis congestion.
- FOR MILD ALLERGIC DISORDERS - Potential Side effects
- they do not prevent the release of o HPN
histamine from mast cells or basophils o Dysrhythmias
- Oral antihistamines are most effective o Palpitations
when given at the fist occurrence of o CNS stimulation
symptoms o Irritability
o Effectiveness is limited to o Tremor
certain patients with hay o Tachyphylaxis (acceleration of
fever, vasomotor rhinitis, hemodynamic statusz0
urticarial, mild asthma. C. Mast Cell stabilizers
- Major side effect: DROWSINESS AND - Stabilizes the mast cell membrane thus
DRY MOUTH reducing the release of histamine and
o Other side effects: other mediators
o Anxiety - Inhibits macrophages, eosinophils,
o Agitation monocytes, and platelets involved in
o Urinary Retention immune response
o Blurred vision - Used prophylactically to prevent the
o Anorexia onset of symptoms and to treat the
o Nausea and vomiting symptoms once they appear
 - Used therapeutically for chronic o Glucose intolerance
allergic rhinitis o Adrenal suppression
- Eg. Intranasal cromolyn sodium
o Effective as antihistamines E. Leukotriene modifiers
but less effective than nasal - Block the action of leukotriene; prevent
corticosteroids in the ttt, of the s/s of asthma
seasonal allergic rhinitis - For long term use
o Beneficial effects may take a - Should be taken daily
week to manifest. - Examples
- Adverse effects are usually mild: o Zileuton
o Sneezing o Zafirlukast (Accolate)
o Local stinging o Montelukast (Singulair)
o Burning sensations F. Immunotherapy
D. Corticosteroids - Allergen desensitization/ allergen
- Anti-inflammatory action immunotherapy/ hypersensitization/ allergy
- Indicated for more severe cases of vaccine therapy
allergic and perennial rhinitis - Administration of gradually increasing quantities
- Examples of specific allergens to the px until a dose is
o Beclomethasone (Beconase, reached that is effective in reducing disease
Qnasl) severity from natural exposure
o Budesonide (Rhinocort) - Used when avoidance of allergen is impossible
o Flunisolide (AeroSpan) - Most common method: serial injection of one or
o Triamcinolone (Nasocort) more antigen
- Given via metered spray devices - Effective for ragweed pollen, grass, tree pollen,
- Full benefit may not be achieved for cat dander & house dust mites
several days to 2 weeks - Begin with very small amount
- Adverse effects - Gradually increased, usually on a weekly
o Drying of the nasal mucosa intervals, until a maximum tolerated dose is
o Burning and itching senstaions achieved
- Systemic effects are more likely with - Maintenance booster injections are
dexamethasone administered at 2-4 week interval
o Use of this medication should Goals:
be limited only up to 30 days o Reduce level of circulating IgE
o Suppresses the host defenses, o Increase level of blocking IgG
must be used with caution in o Reduce mediator cell sensitivity
patients with TB or untreated Evidences of failure:
bacterial infections o No decrease in symptoms within 12 to
o Inhaled corticosteroids DO 24 months
NOT affect the immune o Failure to develop increased tolerance
system to the same degree as to known allergens
systemic corticosteroids. o Failure to decrease the use meds to
- Response to corticosteroids is delayed reduce symptoms.
– they have little or no value in acute Contraindications:
therapy for severe reactions such as - Patients using beta-blocker or ACE inhibitors
anaphylaxis - With significant pulmonary or cardiac disease
- Px with high-dose long-term or organ failure
corticosteroid therapy must be - Inability of the patient to recognize/ report
cautioned to not stop taking the signs of systemic reaction
medication suddenly. Doses are - Non- adherence of the patient
tapered when discontinuing this - Absence of any equipment or adequate
medication to avoid adrenal personnel to respond to allergic rxn
insufficiency. - Pregnancy
- Oral and parenteral corticosteroids are Nursing Responsibilities:
only used when conventional therapy - Monitor px after administration of
has failed and symptoms are severe immunotherapy
and of short duration. - Should not be administered by a lay person/
- Side effects patient
o Fluid retention - Px must remain in the office or clinic for 30
o Weight gain minutes
o HPN - If px develops local swelling, the next dose
o Gastric irritation should not be increased.
 ALLERGIC DISORDERS 2.Systemic Reaction – involve cardiovascular,
respiratory, GI and integumentary organ
Two Types of IgE-mediated Allergic Reactions systems. More common
Atopic Disorder Common Causes
- Extrinsic – triggered by the - Foods
environmental antigens that would o Peanuts, tree nuts (walnuts, pecans,
stimulate IgE mediates responses cashews, almonds), shellfish, fish milk,
Nonatopic disorder eggs, soy wheat
- Intrinsic -triggered by non-immune - Medications
stimuli o Antibiotics, especially penicillin and
sulfa antibiotics, allopurinol
1. Atopic Disorder o Radiocontrast agents, anesthetic
Atopy – genetic predisposition to mount an IgE response agents (lidocaine, procaine), vaccines,
to inhales or ingested innocuous proteins. hormones, aspirin, nonsteroidal anti-
Ex. ASTHMA, ALLERGIC RHINITIS, ATOPIC DERMATITIS inflammatory drugs
- Associated with heightened immune responses - Other Pharmaceutical/Biologic Agents
to common allergies such as inhaled and food o Animal serums (tetanus antitoxin,
allergens. snake venom antitoxin, rabies
- Mediated by IgE antibody and are frequently antitoxin), antigens used in skin testing
present in the same individual. o Insect stings
o Bees, wasps, hornets, yellow jackets,
2. Non – atopic disorder ants
- Less common o Latex
- Lacks genetic component and organ specificity o Medical and non- medical products
Ex. NON ATOPIC ASTHMA – can be triggered by aspirin, with latex
pulmonary infection, cold exercise psychologic stress,
inhaled irritants, NON ATOPIC DERMATITIS

ANAPHYLAXIS
- A clinical response to an immediate
immunologic reaction between a specific
antigen and an antibody
- Results from a rapid release of IgE-mediated
chemicals, which can induce severe, life-
threatening allergic reaction.
- Histamine is most common mediator in this
reaction
- Histamine, prostaglandin, and leukotrienes are
potent vasoactive mediators that are implicated
in the vascular permeability changes
- Responsible for flushing, angioedema,
hypotension, bronchoconstriction that
characterizes the anaphylaxis
- Manifestation of smooth muscle bronchospasm,
Diagnosis:
mucosal edema and inflammation and increased
- Prick test
capillary permeability is also present in this kind
of reaction - Intradermal skin test
Clinical Manifestations
- Substances most commonly cause anaphylaxis:
o Foods - The faster the onset, the more severe the
o Medications reaction
o Insect stingslatex Categories
o Mild
- Antibiotics and radiocontrast agents cause the
o Moderate
most serious anaphylactic reactions
o Severe
- Penicillin is the most common cause of
Mild Manifestations
anaphylaxis
- Peripheral tingling
2 types of Anaphylaxis reaction - Sensation of warmth
1. Local reaction – at site of antigen exposure, - Sensation of fullness in the mouth or throat
rarely fatal - Nasal congestion
- Periorbital swelling
- Pruritus
 - Sneezing Who should bring the injector?
- Tearing of eyes o Those sensitive to insect bites or stings
** Onset of symptoms begin in the first 2 hours of o Experienced food or medication
exposure to the antigen reactions
Moderate Manifestations o Experienced idiopathic or exercise-
Symptoms in the mild category plus: induced anaphylactic reactions
- Flushing - Screening of allergies before a medication is
- Warmth prescribed or first administered
- Anxiety o Careful history of any sensitivity must
- Itching be obtained
- Bronchospasm o Ask about previous exposure to
- Edema of airways or larynx with dyspnea, contrast agents, medications, food,
coughing & wheezing insect stings, and latex
**Onset is the same as the mild category o If predisposed, should wear medical
identification (bracelets/necklace)
Severe Manifestations
Symptoms previously describes then progress rapidly Immunotherapy/desensitization
to: - CONTROL MEASURE NOT A CURE
- Bronchospasm - Those whoa re allergic to insect venom
- Laryngeal spasm o Very effective in the reduction of risk of
- Sever dyspnea anaphylaxis
- Cyanosis - Effective also for insulin-allergic patients with
- Hypotension diabetes and those who are allergic to penicillin.
- Dysphagia, abdominal cramping, vomiting, - Based on a Controlled anaphylaxis with a gradual
diarrhea & seizures can also occur release of mediators
- Cardiac arrest and coma may follow - Avoid lapses in therapy
- ANAPHYLACTIC SHOCK –result of manifestations
Medical Management
**Abrupt in onset
- CPR if cardiac arrest is noted
Prevention - Supplemental oxygen
- Strict avoidance of potential allergens o Provided during CPR or if the px is
cyanotic, dyspneic, or wheezing
- Insect stings
o Should avoid areas populated by - Administer epinephrine (Adrenaline)
insects o 1:1,000 dilution; administered SC in the
o Use appropriate clothing upper extremity or in the thigh
o Use of insect repellant o May also be followed through
o Caution to avoid further stings continuous IV infusion (bc. of
hypotension)
- If avoidance of exposure is impossible, an auto-
o Adverse Effects occurs when dose is
injector system for epinephrine should be
excessive or given IV
prescribed.
o CI: older pxs and those with
o EpiPen Auto- Injector
hypertension, arteriopathies or low
o A commercially available first
ischemic heart disease
aid device that delivers
- Antihistamines and corticosteroids
premeasured doses of 0.3mg
or 0.15mg (EpiPen Jr.) of o To prevent recurrence of reaction
epinephrine o Treat urticarial and angioedema
o Requires no preparation - Intravenous fluids, volume expanders and
o Self-administration is not vasopressor agents
complicated o Normally Normal Saline Solution is
given
o To maintain BP and normal
hemodynamic status
- Aminophylline
o To improve airway potency, especially
those with bronchospasm & history of
asthma and COPD.
- Px is transported immediately to the local
emergency dept for observation and monitoring
because of the risk of “rebound” or delayed
reaction 4-8 hours after initial reaction
 - Monitoring should be done for the next 12-14 Tissue edema results from vascular dilation and decrease
hours vascular permeability
- Longer monitoring for px
o Pxs who ingested the allergen Clinical Manfiestations
o Pxs who require more than one dose of - Sneezing
epinephrine - Nasal Congestion
o Hypotension - Clear watery discharge
o Pharyngeal Edema - Nose and throat itching (Post nasal drip)
o Hx of asthma - Dry cough
Nursing Management - Headache
- Assess for S/S of anaphylaxis - Pain over the paranasal sinuses
o Airway, breathing pattern and vital - Epistaxis
signs - Dry cough headache
o Increasing edema - Sinusitis
o Respiratory distress - Pain over the paranasal sinuses
- Prompt notification of the rapid response team
and/or provider Complications
- Rapid initiation of Emergency measures - Allergic asthma
o Intubation - Chronic nasal obstruction
o Admin. Emergency medications - Chronic otitis media with hearing loss
o Insertion of IV lines
- Anosmia (absence of the sense of smell)
o Fluid Administration
- Documentation of interventions done, px vital Assessment and Diagnosis
signs and response to the treatment.
- History and PE
- Explaining to the px what has occurred
- Nasal smears
- Give instructions about avoiding future
- Peripheral blood smears
reactions and about how to administer
- Total serum IgE – increased
emergency medications
- Epicutaneous (on skin) and ID testing
- Make sure the patient has received a
- RAST – presence of IgE
prescription of preloaded syringes of
- Food Elimination and challenge
epinephrine.
- Nasal provocation test
- Instruct and let the px and fam demonstrate the
use of the EpiPen
Medical Management
ALLERGIC RHINITIS - Avoidance therapy
- Most common form of respiratory allergy - Pharmacologic therapy
o Antihistamines
- Presumed to belong to the Type I
o Adrenergic agents
hypersensitivity reaction
o Mast cell stabilizers
- Symptoms caused by Ige
o Corticosteroids
- Occurrence increases as one ages
o Leukotriene modifiers
- Occurs with other conditions
- Immunotherapy
o Allergic conjunctivitis
Nursing Diagnosis
o Sinusitis
- Ineffective breathing pattern r/t allergic rxn
o Asthma
- Deficient knowledge about allergy and the
- Induced by airborne pollens or molds
recommended modifications in lifestyle and self-
o In temperature areas that do not
care practices.
experience freezing temps., molds can
- Ineffective coping with chronicity of condition
persist throughout the year
and need for environmental modifications
o Early Spring - Common tree
Nursing Interventions
pollen
o Early Summer – grass pollen - Assist in modifying the environment
o Early fall – weed pollen, - Reduce exposure to people with respiratory
ragweed infections
Pathophysiology - If with upper respiratory infection, instruct deep
- Begins by inhalation or ingestion of antigen breaths and to cough frequently
- On re-exposure, the nasal mucosa reacts by: - Reinforce adherence to medication schedules
o Slowing of ciliary action and other treatment regimen
o Edema formation - Instruct to seek medical attention if both upper
o Leukocyte (eosinophil) infiltration respiratory infection and allergic rhinitis are
**Histamine is the major mediator of allergic reactions in present.
the nasal mucosa** - Remind about desensitization schedule
 - Explain the difference of each medication - Followed by weeping, crusting, and drying and
- Encourage client to verbalize feelings and peeling of the skin
concerns - In severe responses:
- Hemorrhagic bullae may develop
CONTACT DERMATITIS - Repeated reactions may be
- An acute or chronic skin inflammation that accompanied by thickening of the skin
results from direct skin contact - Secondary infection may develop in
- A delayed-type hypersensitivity reaction skin that is abraded by rubbing or
- Has a sensitization period of 10-14 days scratching.
- 4 basic types
o Allergic
o Irritant
o Phototoxic
o Photoallergic
- 80% of the cases are caused by the excessive
exposure to the additive effects of the irritants
such as soaps, detergents, or organic solvents.
- May be seen after the brief or prolonged periods
of exposure, hours or weeks after sensitized skin
has been exposed.

4 types
1. Allergic Assessment and Diagnostics
- Results from contact skin and allergenic History
substance - Assess date of onset
- Clinical manifestations: - Any identifiable relationship to work
o Vasodilation and perivascular environment and the skin care products used
infiltrates on the dermis
- Location of the lesions
o Intracellular edema
- Distribution of the dermatitis
o Usually seen on the dorsal
- Absence of other etiologies
aspects of the hand
- History of exposure
2. Irritant
Patch test
- Results from contact with substance
- Commonly used: Thin-layer Rapid Use
that chemically or physically damages
Epicutaneous test (TRUE test)
the skin on a nonimmunologic basis
- Occurs first exposure to irritant or
Interpretation of Patch test results
repeated exposure to miler irritants or
repeated exposure to milder irritants
over an extended time
- Clinical manifestations:
o Dryness lasting days to
months
o Vesiculation, fissures, and
cracks
o Most common: hands and
lower arms
3. Phototoxic
- Resembles the irritant type but is
allergic and requires sun and chemical
in combination to damage to epidermis
4. Photoallergic
- Resembles allergic dermatitis but
requires light exposure in addition to
allergen contact to produce
immunologic reactivity.
Clinical manifestations
- Itching
- Burning
- Erythema
- Skin lesions (vesicles)
- Edema
Treatment o Keep skin moisturized with daily baths
o Allergic Type and moisturizers
- Avoidance of offending material Nursing Management
- Aluminum acetate (Burow’s solution or - Provide instructions and counselling abt
Domeboro powder) or cool water strategies to incorporate preventive measures
compress or topical gel – no and treatments into the lifestyle
prescription needed in using this - Teach the signs of secondary infection
- Systemic corticosteroids (Prednisone) - Teach abt the side effects of the medications
for 7-10 days used
- Topical corticosteroids for mild cases
- Oral antihistamines to relieve pruritus DERMATITIS MEDICAMENTOSA
o Irritant - “drug reaction”
- Identification and removal of source of - Term applied to skin rashes associated with
irritation certain medications
- Application of hydrophilic cream or - A type I hypersensitivity reaction
petrolatum - Rashes appear suddenly and have a
- Topical corticosteroids and compresses particularly vivid in color
for weeping lesions o Disappear rapidly after the
- Antibiotics for infection and oral medication is withdrawn
antihistamines for pruritus - On the discovery of a medication allergy,
✓ Treatment of both phototoxic and photoallergic types are o Patients is warned against the
the same as with allergic and irritant types of contact medications and should never be
dermatitis
advised to take it again
ATOPIC DERMATITIS o Advise to let the patient carry
- A type of hypersensitivity disorder characterized information identifying the
by inflammation and hyperreactivity of the skin hypersensitivity with them at all
- Other name: ATOPIC ECZEMA, Atopic times
Dermatitis/Eczema syndrome (ADES)
Clinical Manifestations UTICARIA & ANGIONEUROTIC EDEMA
- Most consistent features: pruritus and Uticaria
hyperirritability of the skin - Each hive remains for a few minutes to several
o Related to large amounts of histamine hours
in the skin - May come, go and return episodically
- Excessive dryness of the skin with resultant o If this sequence continues longer
itching than 6 weeks, the condition is called
- In response to stroking of the skin, redness CHRONIC UTICARIA
appears first Management (Uticaria)
o Pallor follows I 15 – 30 secs and persists - Eliminate causative drug or food
for 1-3 mins - No NSAIDS
o Lesions develop secondary to trauma - Minimizing potential aggravators including
rom scratching; appears in area or heat, stress alcohol and tight clothes
increased sweating and - Antihistamines
hypervascularity - Possibly a short course of Corticosteroids
Chronic (Prednisone)
- Has a tendency to recur with remission from Angioneurotic Edema
adolescence to 20 yes of age - Involves the deep layers of the skin, resulting
Medical Management to a more diffuse swelling
- Topical corticosteroids for inflammation - The skin over the reaction may appear normal
- Antibiotics for infection but often has a reddish hue
- Immunosuppressive agents such as Common Causative Meds:
cyclosporine, tacrolimus, pimecrolimus - ACE inhibitors
- Decrease itching and scratching - Penicillin
o Wear cotton fabric Regions Most Involved:
o Wash with mild detergents - Lips
o Humidify dry heat in winter - Eyelids
o Maintain room tempt @ 20C – 22C - Cheeks
o Use antihistamines such as - Hands
diphenhydramine - Feet
o Avoid animals, dust, sprays and - Genitalia
perfumes - Tongue
Other areas: - For ACU, ice cube provocation test
- Mucous membranes of the larync o Involved the application of an ice cube
- Bronchi to the skin of the forearm for 1-5
- GIT canal minutes
Angioneurotic Edema o Positive – development of uticaria at
- Swelling may appear suddenly, in a few the site
seconds or in minutes or slowly, in 1-2 hours Medical Management
- In the latter case, often preceded by itching or - Avoidance of cold stimuli
burning sensation - Bed rest
- Lesion usually last 24 hours - Warmth
o On rare occasions, swelling may recur - Corticosteroids
at intervals of 3-4 weeks - Instruct client to bring EpiPen for emergency
use
HEREDITARY ANGIOEDEMA o Could possibly develop to
- Rare, potentially life threatening, autosomal anaphylaxis
dominant disorder FOOD ALLERGY
- Has resemblance to allergic angioedema - May be a IgE-mediated or non-IgE-mediated
- Caused by edema of skin, respiratory tract or type of allergy
digestive tract - Thought to occur to people with genetic
- May be precipitated by trauma predisposition combined with exposure to
Clinical Manifestations allergens early in life thru GIT, respiratory tract
- Swelling (no itch) and nasal mucosa
- Abdominal pain (severe) - Most common food offenders:
- Respiratory obstruction o Seafood) lobster, shrimp, crabs,
- Asphyxiation clam, fish)
Medical Management o Legumes (Peanuts, peas, beans,
- Usually subside within 2-4 days licorice)
o Observe for sins of laryngeal o Seeds (sesame, mustard, sunflower)
obstruction (Tracheostomy as life o Tree nuts
saving measure) o Berries
- Epinephrine, antihistamines and o Egg white
corticosteroids – limited success o Buckwheat
o Milk
COLD UTICARIA o Chocolate
- Cold stimulus caused the activation of mast Clinical Manifestations
cells and subsequent release of inflammatory Classic allergic symptoms
mediators - Uticaria
Types - Dermatitis
A. Familial Atypical Cold Uticaria (FACU) - Wheezing
- Autosomal dominant condition; symptoms - Cough
seen at birth within 6 months of life - Laryngeal edema
B. Acquired Cold Uticaria - Angioedema
- Affects young adults aged from 18-25 yrs GI Symptoms
C. Idiopathic - Itching and swelling of lips, tongue and plate
- Abdominal Pain
Clinical Manifestations - Nausea
- Client develops hives when exposed to cold - Cramps
o Cold weather - Vomiting and diarrhea
o Cold water Assessment and Diagnostic Findings
o Cold Objects - Detailed allergy hx
- Lesions occur within a few hours and usually - PE
subside in 2 days - Skin prick Testing
- Fever, chills, conjunctiva infection, sweating, Medical Management
headache and arthralgia - Elimination of food responsible for the
- May develop leukocytosis, an increase in the hypersensitivity
erythrocyte sedimentation rate (ESR) and - Medication therapy
raised C-reactive protein levels o H1 blockers, adrenergic agents,
Diagnostics corticosteroids and cromolyn sodium
- For FACU, symptoms bay be precipitated just - Prescribed EpiPen
by entering a 4C room
 - Education od patient and fam abt how to o Angioedema
recognize and manage early staged of an o Hypotension
acute anaphylaxis o Cardiac arrest
Nursing Management Assessment and Diagnosis
- Focus on preventing re-exposure - History
- - Skin patch test
o Develop strategies that to prevent its - RAST/Serum-specific IgE
recurrence - ELISA (enzyme-linked immunosorbent assay)
- Food allergies must be noted on the client’s test
medical records - Presence of Hevae lates-specific IgE antibody in
✓ Pregnant and BF mothers who are aware of a fam hx of allergy serum
should avoid peanut-containing foods during pregnancy as a
precaution
Medical Management
LATEX ALERGIES - Avoidance of latex-based products
- An allergic reaction to natural rubber proteins - Instruct to wear medical identification
o Though, the various chemicals that - Antihistamines
are used in manufacturing process - Emergency kit containing epinephrine
are thought also to be the source of - Provide a list of alternative products
o the allergic reaction
- Allergic reactions are more likely with Products containing latex Latex-Free Alternatives
parenteral or mucous membrane exposure Gloves Derma Prene, vinyl gloves
Penrose drains Jackson – Pratt, Zimmer
- Most frequent source of exposure: cutaneous
hemovac
o Usually involving wearing of natural
Syringes Terumo, Abbot
latex gloves Tapes Micropore
People at risk Condoms Durex Avanti, polyurethane
- Health Care workers Diapers Huggies
- Those with atopic allergies Female Hygiene pads Kimberly-Clark Products
- Those who have undergone multiple allergies
- People who work in factories that Nursing Management
manufacture latex products - Ask about latex allergy
- Females - Always assume the possibility of latex
- Patients with spina bifida allergy
- Notify health care provider
Route of exposure to latex products - Let client wear medical identification
- Cutaneous - Provide list of alternative latex-free
- Percutaneous products
- Mucosal - Teach proper self-injection of
- Parenteral epinephrine
- Aerosol

Clinical Manifestations
- Irritant contact dermatitis
o Erythema and pruritus
- Local (Delayed-type)
o Vesicular skin lesions
o Papules
o Pruritis
o Edema
o Erythema
o Crusting and thickening of the skin
- For type I Hypersensitivity
o Rhinitis
o Conjunctivitis
o Asthma
o Anaphylaxis
o Uticaria
o Wheezing and dyspnea
o Laryngeal edema
o Bronchospasm
o Tachycardia