immunologic and allergic disease
TRANSCRIPT
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IMMUNE SYSTEM Mission: to seek and kill
invaders or foreign bodies
(microorganisms, parasites,
cancer cells, etc.)
Must be able to distinguish
between what is self and
non-self Any substance identified as
non-self, stimulate an
immune response in the body
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Antigenmaybe contained within or on bacteria,viruses, other microorganisms or cancer cells
- They may exist on their own
e.g. food molecules, pollen
A normal immune response
Ag (antigen)activates / mobilizes forces to defend
by attacking it.
Mistake self for non-selfattack own tissues
(autoimmune disorder)
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Immune System is made up of lymphoid tissues inthe body which includes:
- bone marrow
- parts of spleenGIT
- thymus
- tonsils
- proteins and cells in the blood are also part of theimmune system
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TERMINOLOGIES: Antibody (immunoglobulin)a protein produced by
B cells
interacts with antigen
Antigenany substance that the immune system
recognizes and can stimulate an immune response
B Cell (B Lymphocyte / Bursa Cells / Humoral
Immunity)bone marrow derived or bursa
equivalent lymphocyte in a WBC that produces
antibodies specific to the Ag that stimulated their
production
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T Cell (T Lymphocyte / Thymus / CellularImmunity)
- thymus derived, WBC that is involved in specific
immunity and that maybe one of 3 types:
Helper T-Cell
Killer (Cytotoxic) T-Cell
Regulatory T-Cell
BasophilWBC that releases histamine
- produces substances to attract other WBC to a
troubled spot
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Cytokinesproteins secreted by cells that act as theimmune systems messengers and that help regulate
an immune response
EosinophilsWBC that kills bacteria
- Kills other foreign cells too big to ingest
- Help immobilize and kill parasites
- Participates in allergic reactions
- Help destroy cancer cells
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Macrophagelarge cell that develops from aWBC called monocyte
- ingests bacteria and other foreign cells
NeutrophilWBC that ingests and killsbacteria and other foreign cells
PhagocyteA cell that ingests / kills /
destroys invading microorganisms, other
cells and cell fragments
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1. The body generates an immune responseagainst itself (autoimmune disorder)
2. The body cannot generate appropriate
immune responses against invadingmicroorganisms (immunodeficiency
disorder)
3. An excessive immune response to oftenharmless foreign antigens damages normal
tissues (an allergic reaction)
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- immune system mistakenly attacks anddestroys healthy body tissue response is
a hypersensitivity reaction similar to the
response in allergic reaction.ALLERGYreaction to an outside substance
that it would normally ignore
AUTOIMMUNE DISORDERreaction tonormal body tissue that it would normally
ignore
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CAUSE: UNKNOWNTHEORY: some microorganisms
(bacteria & virus) or drugs may trigger
some of these changes, especially in
people who have genes that make
them more likely to get autoimmunedisorders.
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1. An autoimmune disorder mayresult in:
destruction of one or more typesof body tissues
abnormal growth of an organ
changes in organ function
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2. An autoimmune disorder may affect one or moreorgan or tissue types.
a. It can be organ specific:
ENDOCRINE SYSTEMthyroid gland Hashimotos thyroiditis
Graves disease
Type I & II autoimmunepolyglandular syndrome
Insulin dependent DM
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SKIN- pemphigus vulgaris
- dermatitis herpetiformis- epidermolysis bullosa
- autoimmune alopecia
- contact dermatitis
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HEMOTOLOGIC- autoimmune hemolytic anemia
- autoimmune thrombocytopenic purpura
- autoimmune neutropenia
NEURO-MUSCULAR SYSTEM
- myasthenia gravis- multiple sclerosis
- GuillainBarre Syndrome
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HEPATOBILIARY SYSTEM- autoimmune chronic active hepatitis
- primary biliary sclerosis
- sclerosing cholangitis
GIT
- pernicious anemia- inflammatory bowel disease
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b) It can be organ nonspecific CONNECTIVE TISSUE DISEASES
- systemic lupus erythematosus
- rheumatoid arthritis- scleroderma
- sjogrens syndrome
- ankylosing spondylitis- psoriasis
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VASCULITIC SYNDROMES- hypersensitivity vasculitis
- Wegeners Granulomatosis
- Takayasus Arteritis- Kawasakis Disease
- Sarcoidosis
- Graft versus host disease
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symptoms of an autoimmune disease varybased on the disease and location of the
abnormal immune response
symptoms that often occur with autoimmunediseases include
- fatigue
- fever
- body malaise
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depends on the type of disease which willgenerally include:
- ANA (antinuclear antibody tests)
- autoantibody test
- CBC
- C-Reactive Protein (CRP)
- erythrocyte sedimentation rate (ESR)
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GOALS: reduce the symptoms
control the autoimmune process
maintain the bodys ability to fight disease
1. SUPPLEMENTS
- hormonal replacement- vitamins e.g. B12- insulin injections
- thyroid supplements
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2. BLOOD TRANSFUSION3. PHYSICAL THERAPY
4. MEDICINE
- to control or reduce immune systemsresponse (immunosuppressive drugs)
- corticosteroids
- non-steroidal drugs - azathioprine- cyclophosphamide
- sirolimus
- tacrolimus
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- Depends on the disease- Can be controlled by treatment
- Symptoms can come and go
- Flare-up when symptoms worsen
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- Occurs when the bodys immune response isreduced or absent
- Occurs when T or B lymphocytes do not
work as well as they should or when the bodydoes not produce enough antibodies.
- Can be congenital, spontaneously acquired or
iatrogenic- Unusual susceptibility to infection and
frequently to autoimmune diseases and
lymphoreticular malignancies.
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- Ataxia telangiectasia- Chediak-Higashi Syndrome
- Combined immunodeficiency disease
- Complement deficiencies- Di George Syndrome
- Hypogammaglobulinemia
- Panhypogammaglobulinemia- Selective deficiency of IgA
- Wiscott-Aldrich Syndrome
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- Acquired Immuno Deficiency Syndrome(AIDS)
- Iatrogenic
- Idiopathic CD4 and T lymphocytopenia
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depend on the disorderTELL-TALE SIGNS: chronic infection severe infection from bacteria or other
forms that do not usually cause severeinfection poor response to treatment
delayed or incomplete recovery from illness certain types of cancers (Kaposis sarcomaor non-Hodgkins lymphoma certain infections
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Complement levels in blood HIV Test
Blood immunoglobulin levels
CHON electrophoresis
T lymphocyte count
WBC Count
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GOALto prevent infections and treat anydisease and infections that do develop.
1. Avoid contact with persons who have
infections or contagious disorders2. Avoid people who have been vaccinated
with live virus vaccine within the past 2
weeks3. Aggressive Treatmentlong term use of
Abtx. or antifungal
- Prophylactic Tx
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4. Interferontx viral infection andsome types of cancer
- immunostimulant drug
5. Bone Marrow Transplant
6. Passive Immunity
7. Immunoglobulin Infusions
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4 Types of Hypersensitivity Reactions:
TYPE I: immediate Ig-E mediated
which causes rapid degranulation of
mast cells
- IgE binds to the mast cells via a highaffinity Fc receptor.
- Early Phase: within minutes
- Late Phase: hours after initial response
e.g. allergic rhinitis, food allergy,
allergic or atopic asthma.
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TYPE II: Antibody mediated- Ab binds to cells and causes
damage or impairment of
functionse.g. transfusion reactions,
hemolytic anemias, graft
rejection, myasthenia gravis,
good pastures syndrome
TYPE III: imm ne comple
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TYPE III: immune complex
mediated
- Occurs when IgG or IgM binds
with Ag and the complexes are
deposited in tissues
e.g. serum sickness,
glomerulonephritis, arthritis
TYPE IV: T-Cell mediated
(delayed hypersensitivity)
- First exposure: T-cell is
sensitized subsequent exposure:
allergen is recognized anddetected, thereby these cells are
lysed by T Cells.
e.g. contact dermatitis,
granulomatous diseases
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ALLERGYexaggeratedimmunologic response to an
otherwise innocuous agent, which
causes harm to the host
ALLERGENinciting agent
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PATHOPHYSIOLOGY:
IgE binds to surface of mast cells and
basophils
Cross linking ofIgE by Ag causes cellular
activation release of mediators histamines
prostaglandins
leukotrienesSRS-A (slow-
reacting substance of
anaphylaxis
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- Anaphylaxis
- Serum Sickness
- Generalized Drug Reactions
- Food Allergy
- Insect Venom- Mastocytosis
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- Allergic rhinitis- Asthma
- Hypersensitivity
pneumonitis
- Urticaria- Angioedema
- Eczema
- Atopic dermatitis
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Allergic conjunctivitis- Atopic keratoconjunctivitis
- Giant papillary conjunctivitis
- Contact allergy
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DEFINITION: the life threateninganaphylactic response of a sensitized
human appears within minutes after
administration of specific Ag and ismanifested by respiratory distress, often
followed by vascular collapse or by
shock without antecedent respiratory
difficulty.
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Hallmark of anaphylactic reaction: onset of
S/S within seconds to minutes after
introduction of the Ag
S/S: laryngeal edemalump in throat,
hoarseness or stridor
bronchial obstructiontightness in the chest
or wheezing
cutaneous whealserythematous, raised,
serpiginous borders and blanched centers;
pruritic
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Early recognition- Mild symptoms (pruritis and urticaria)
0.2 ml to 0.5 ml of 1:1000
epinephrine SQ- Hypotensionvolume expanders
vasopressor agents
(dopamine)
- O2
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URTICARIAinvolves the superficial
portion of the dermis-well-circumscribed wheals
ANGIOEDEMAwell demarcated localizededema involving the deeper areas / layers of
the skin, including the subQ tissues
ACUTErecurrent episodes of lessthan 6 weeks
CHRONICattacks persisting
beyond 6 weeks
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- Urticarial eruptions are pruritic, appear in
crops of 2472o duration
- Most common sites: extremities, external
genitalia, face
- History
- Skin testing
- Laboratory exam: complement levels,
ESR
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Avoidance of offending agents- H1 and H2 antihistamines
ranitidine 150 mg p.o. BID
diphenhydramine 25-50 mg p.o. QID hydroxyzine 25-50 mg p.o QID
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- Inflammatory condition of the
nose characterized by sneezing,
rhinorrhea and obstruction of
nasal passages
PATHOPHYSIOLOGY:
impingement of allergens on nasal mucosa Ig-E
dependent triggering of mast cells release ofmediators hyperemia, swelling, fluid
transudation
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- Accurate history
- physical examination: boggy nasal mucosa- nasal smearlarge # of eosinophils
- Antihistamines
- Oral Sympathomimetics: pseudoephedrine 30-
60mg p.o. QID
- topical nasal steroids: beclomethasone 2 spraysin each nostril BIDTID
- topical nasal cromolyn sodium 1-2 sprays in
each nostril QID.
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GOOD DAY!!!