Chapter 22 Care of Patients with Immune Function Excess: Hypersensitivity (Allergy) and Autoimmunity - Key points and questions

A client has been ordered norepinephrine (Levophed) for treatment of severe hypotension. The nurse plans to monitor the client for which adverse effect? A. Bradycardia B. Headache C. Infection D. Metabolic alkalosis

A client has been ordered norepinephrine (Levophed) for treatment of severe hypotension. The nurse plans to monitor the client for which adverse effect? A. Bradycardia Incorrect: Tachycardia is an adverse effect of norepinephrine (Levophed). B. Headache {{{{{{{{{Correct}}}}}}}}}}}}} Correct: Norepinephrine (Levophed) is a vasopressor and can cause headache. C. Infection Incorrect: Norepinephrine (Levophed) does not suppress the immune system. D. Metabolic alkalosis Incorrect: Metabolic acidosis is an adverse effect of norepinephrine (Levophed).

A client in the allergy clinic develops all of these clinical manifestations after receiving an intradermal injection of an allergen. Which symptom requires the most immediate action by the nurse? A. Anxiousness B. Urticaria C. Pruritus D. Stridor

A client in the allergy clinic develops all of these clinical manifestations after receiving an intradermal injection of an allergen. Which symptom requires the most immediate action by the nurse? A. Anxiousness Incorrect: Anxiousness may be a symptom of a reaction but is not the nurses's highest priority. B. Urticaria Incorrect: Urticaria is a symptom of a reaction but is not the nurse's highest priority. C. Pruritus Incorrect: Pruritus is a symptom of a reaction but is not the nurse's highest priority. D. Stridor {{{{{{{{Correct}}}}}}}}}} Correct: Stridor indicates airway involvement and warrants immediate intervention such as use of oxygen and administration of epinephrine. Maintaining the client's airway is the high-test priority.

A client is admitted to the hospital with suspected Goodpasture's syndrome. Which findings will the nurse expect to observe? A. Bradycardia B. Hemoptysis C. Increased urine output D. Weight loss

A client is admitted to the hospital with suspected Goodpasture's syndrome. Which findings will the nurse expect to observe? A. Bradycardia Incorrect: Tachycardia is a manifestation of Goodpasture's syndrome. B. Hemoptysis {{{{{{{{{{{Correct}}}}}}}}}}}}}}}}} Correct: Hemoptysis is a manifestation of Goodpasture's syndrome. Goodpasture's syndrome usually is not diagnosed until serious lung and kidney problems are present. C. Increased urine output Incorrect: Decreased urine output is a manifestation of Goodpasture's syndrome. D. Weight loss Incorrect: Weight gain is a manifestation of Goodpasture's syndrome.

A client is prescribed prednisone for treatment of a type I reaction. The nurse plans to monitor the client for which adverse effects? Select all that apply. A. Fluid retention B. Gastric distress C. Hypotension D. Infection E. Osteoporosis

A client is prescribed prednisone for treatment of a type I reaction. The nurse plans to monitor the client for which adverse effects? Select all that apply. A. Fluid retention Correct B. Gastric distress Correct C. Hypotension D. Infection Correct E. Osteoporosis Correct Correct Feedback: Correct: Prednisone is a corticosteroid that may cause fluid and sodium retention. Correct: Prednisone can cause gastric distress and irritation and usually is taken with food or antacid. Correct: Prednisone is a corticosteroid that decreases the immune response, increasing the susceptibility for infection. Correct: Prednisone is a corticosteroid that can cause osteoporosis. Incorrect Feedback: Incorrect: Hypertension is an adverse effect of prednisone.

A client who is receiving an intravenous antibiotic begins to cough and states, "My throat feels like it is swelling." Which action will the nurse take next? A. Infuse normal saline at 200 mL/hr. B. Administer epinephrine (Adrenalin) 1:1000, 0.3 mL subcutaneously. C. Discontinue infusing the antibiotic. D. Give diphenhydramine (Benadryl) 100 mg IV.

A client who is receiving an intravenous antibiotic begins to cough and states, "My throat feels like it is swelling." Which action will the nurse take next? A. Infuse normal saline at 200 mL/hr. Incorrect: The nurse must first assess the client, and although infusing normal saline may be indicated, it is not the nurse's first action. B. Administer epinephrine (Adrenalin) 1:1000, 0.3 mL subcutaneously. Incorrect: The nurse must first assess the client, and although administering epinephrine may be indicated, it is not the nurse's first action. C. Discontinue infusing the antibiotic. {{{{{{{Correct}}}}}} Correct: Because the antibiotic is the most likely cause of the client's anaphylactic reaction, the nurse's first action should be to discontinue the antibiotic. D. Give diphenhydramine (Benadryl) 100 mg IV. Incorrect: The nurse must first assess the client, and although administering diphenhydramine (Benadryl) may be indicated, it is not the nurse's first action.

angioedema

Angioedema is a swelling that is similar to hives, but the swelling is under the skin instead of on the surface. Hives are often called welts. They are a surface swelling. It is possible to have angioedema without hives. • Hold the dose of any prescribed drug when a patient develops angioedema.

Assessment findings reveal that the client admitted to the hospital has a contact type I hypersensitivity to latex. Which preventive nursing intervention is best in planning care for this client? A. Report the need for desensitization therapy. B. Convey the need for pharmacologic therapy to the health care provider. C. Communicate the need for avoidance therapy to the health care team. D. Discuss symptomatic therapy with the health care provider.

Assessment findings reveal that the client admitted to the hospital has a contact type I hypersensitivity to latex. Which preventive nursing intervention is best in planning care for this client? A. Report the need for desensitization therapy. Incorrect: Desensitization therapy is administered via allergy shots when allergens have been identified and cannot easily be avoided. B. Convey the need for pharmacologic therapy to the health care provider. Incorrect: Medications might be indicated if signs of type I or type IV hypersensitivity exist, but this is not a preventive measure. C. Communicate the need for avoidance therapy to the health care team. Correct Correct: Contact hypersensitivities can occur with latex, pollens, foods, and environmental proteins. Avoidance therapy is the recommended nursing intervention. D. Discuss symptomatic therapy with the health care provider. Incorrect: Symptomatic therapy interventions such as epinephrine pen, antihistamines, and corticosteroids are effective only after the hypersensitivity reaction has already occurred.

Cromolyn sodium (Nasalcrom)

Cromolyn sodium (Nasalcrom) is a mast cell-stabilizing drug; it is used to prevent symptoms of allergic rhinitis but is not useful during an acute episode.

Desloratadine (Clarinex)

Desloratadine (Clarinex) is a non-sedating antihistamine.

Fexofenadine (Allegra)

Fexofenadine (Allegra) is a nonsedating antihistamine and is not a first-line drug to treat anaphylaxis.

Hypersensitivity or allergy

Hypersensitivity or allergy is an increased or excessive response to the presence of an antigen, such as a foreign protein or allergen to which the patient has been previously exposed.

Hypersensitivity or allergy Responses

Responses range from uncomfortable symptoms, such as itchy, watery eyes or sneezing to life-threatening problems.

serum sickness

Serum sickness is a reaction that is similar to an allergy. The immune system reacts to medications that contain injected proteins used to treat immune conditions.

Situation: The client with a history of asthma is admitted to the clinic for allergy testing. During skin testing, the client develops shortness of breath and stridor and becomes hypotensive. What is the most appropriate drug for the nurse to give in this situation? A. Epinephrine (Adrenalin) B. Fexofenadine (Allegra) C. Cromolyn sodium (Nasalcrom) D. Zileuton (Zyflo)

Situation: The client with a history of asthma is admitted to the clinic for allergy testing. During skin testing, the client develops shortness of breath and stridor and becomes hypotensive. What is the most appropriate drug for the nurse to give in this situation? A. Epinephrine (Adrenalin) {{{{{{{{{{Correct}}}}}}}}}}} Correct: The client is experiencing an anaphylactic reaction, and epinephrine is a first-line sympathomimetic used to treat anaphylaxis. B. Fexofenadine (Allegra) Incorrect: Fexofenadine (Allegra) is a nonsedating antihistamine and is not a first-line drug to treat anaphylaxis. C. Cromolyn sodium (Nasalcrom) Incorrect: Cromolyn sodium (Nasalcrom) is a mast cell-stabilizing drug; it is used to prevent symptoms of allergic rhinitis but is not useful during an acute episode. D. Zileuton (Zyflo) Incorrect: Zileuton (Zyflo) is a leukotriene antagonist; it is used to prevent symptoms of allergic rhinitis but is not useful during an acute episode.

Situation: The client with a history of asthma is prescribed a leukotriene receptor antagonist to prevent allergic rhinitis. The nurse anticipates that which drug will be prescribed? A. Cromolyn sodium (Nasalcrom) B. Desloratadine (Clarinex) C. Fexofenadine (Allegra) D. Zafirlukast (Accolate)

Situation: The client with a history of asthma is prescribed a leukotriene receptor antagonist to prevent allergic rhinitis. The nurse anticipates that which drug will be prescribed? A. Cromolyn sodium (Nasalcrom) Incorrect: Cromolyn sodium (Nasalcrom) is a mast cell-stabilizing drug. B. Desloratadine (Clarinex) Incorrect: Desloratadine (Clarinex) is a non-sedating antihistamine. C. Fexofenadine (Allegra) Incorrect: Fexofenadine (Allegra) is a non-sedating antihistamine. D. Zafirlukast (Accolate) Correct Correct: Zafirlukast (Accolate) is a leukotriene receptor antagonist; it works by blocking the leukotriene receptor and is used to prevent allergic rhinitis.

The client is being discharged from the hospital after an allergic reaction to environmental airborne allergens. Which instruction is most important for the nurse to include in this client's discharge teaching plan? A. Wash fruits and vegetables with mild soap and water before eating. B. Intermittent exposure to known allergens will produce immunity. C. Remove cloth drapes, carpeting, and upholstered furniture. D. Be cautious when eating unprocessed honey.

The client is being discharged from the hospital after an allergic reaction to environmental airborne allergens. Which instruction is most important for the nurse to include in this client's discharge teaching plan? A. Wash fruits and vegetables with mild soap and water before eating. Incorrect: Washing fruits and vegetables pertains to food allergies. B. Intermittent exposure to known allergens will produce immunity. Incorrect: Clients do not develop immunity to known allergens by direct exposure. Common interventions include avoidance therapy, desensitization therapy, and symptomatic therapy. C. Remove cloth drapes, carpeting, and upholstered furniture. Correct Correct: Removing cloth drapes, carpet, and upholstery will reduce airborne pollen, dust mites, and mold. D. Be cautious when eating unprocessed honey. Incorrect: Honey is said to help with allergies to pollen only. It does not have an impact on airborne allergens.

The client recently admitted to the hospital is to receive an antibiotic intravenously for the first time for a urinary tract infection. Before checking the fiveR's prior to administration, what is the nurse's first action? A. Review the clinical records and ask the client about any known allergies. B. Check with the pharmacy for any known allergies for this client. C. Check the client's identification band for any allergies. D. Ask the nurse who previously cared for the client about any known allergies.

The client recently admitted to the hospital is to receive an antibiotic intravenously for the first time for a urinary tract infection. Before checking the five R's prior to administration, what is the nurse's first action? A. Review the clinical records and ask the client about any known allergies. {{{{{{Correct}}}}}}} Correct: The clinical record should have all known hypersensitivities listed for the client. Also, ask the client about any known allergies. B. Check with the pharmacy for any known allergies for this client. Incorrect: The pharmacy is not responsible for obtaining from the client information on all known allergies. C. Check the client's identification band for any allergies. Incorrect: This is also part of the five R's process at the bedside before the medication is given. D. Ask the nurse who previously cared for the client about any known allergies. Incorrect: Asking the previous nurse is not an appropriate safety measure before medication administration.

The middle-aged client, who is alert, is admitted to the emergency department (ED) with wheezing, difficulty breathing, angioedema, blood pressure (BP) of 70/52, and apical pulse of 122 and irregular. The nurse makes an immediate assessment using the ABCs for any client experiencing anaphylaxis. What nursing intervention is the immediate priority? A. Raise the lower extremities. B. Start intravenous (IV) administration of normal saline. C. Reassure the client that appropriate interventions are being instituted. D. Apply oxygen using a high-flow non-rebreather mask at 40% to 60%.

The middle-aged client, who is alert, is admitted to the emergency department (ED) with wheezing, difficulty breathing, angioedema, blood pressure (BP) of 70/52, and apical pulse of 122 and irregular. The nurse makes an immediate assessment using the ABCs for any client experiencing anaphylaxis. What nursing intervention is the immediate priority? A. Raise the lower extremities. Incorrect: Assessing respiratory status is an immediate priority. Raising the lower extremities is not the first priority. B. Start intravenous (IV) administration of normal saline. Incorrect: Starting an intravenous (IV) infusion is not the first priority because the client is in respiratory distress. C. Reassure the client that appropriate interventions are being instituted. Incorrect: Reassuring the client is important, but it is not the priority action by the nurse. D. Apply oxygen using a high-flow non-rebreather mask at 40% to 60%. {{{{{{{{{{{{{{{Correct}}}}}}}}}}}}}}}}}}}} Correct: Oxygen application helps to provide adequate oxygenation for the client who is in respiratory distress.

The nurse is assessing a client with suspected serum sickness. Which symptoms will be consistent with serum sickness? Select all that apply. A. Arthralgia B. Blurred vision C. Lymphadenopathy D. Malaise E. Ptosis

The nurse is assessing a client with suspected serum sickness. Which symptoms will be consistent with serum sickness? Select all that apply. A. Arthralgia {{{{{Correct}}}} B. Blurred vision C. Lymphadenopathy {{{{Correct}}}}} D. Malaise {{{{Correct}}}}} E. Ptosis Correct Feedback: Correct: Arthralgia (achy joints) is a symptom of serum sickness. Correct: Lymphadenopathy (enlarged lymph nodes) is a symptom of serum sickness. Correct: Malaise is a symptom of serum sickness. Incorrect Feedback: Incorrect: Blurred vision is not a symptom of serum sickness. Incorrect: Ptosis is not a symptom of serum sickness.

The nurse is reviewing discharge teaching with the client who suffered an anaphylactic reaction to a bee sting. Which statement by the client indicates the need for further teaching? A. "I must wear a medical alert bracelet stating that I am allergic to bee stings." B. "I need to carry epinephrine with me." C. "My spouse must learn how to give me an injection." D. "I am immune to bee stings now that I have had a reaction."

The nurse is reviewing discharge teaching with the client who suffered an anaphylactic reaction to a bee sting. Which statement by the client indicates the need for further teaching? A. "I must wear a medical alert bracelet stating that I am allergic to bee stings." Incorrect: The client should wear at all times a medical alert bracelet that states all allergies. B. "I need to carry epinephrine with me." Incorrect: The client should carry epinephrine (Epi-Pen) at all times. C. "My spouse must learn how to give me an injection." Incorrect: Someone (spouse, neighbor, or family member) must learn how to give the client an injection in case the client is unable to do so himself or herself. D. "I am immune to bee stings now that I have had a reaction." {{{{{{{{{{{{{Correct}}}}}}}}}}}}} Correct: No immunity develops after an anaphylactic reaction. In fact, the next reaction could be more severe. This statement indicates more teaching is needed

The nurse is reviewing the medical record of a client who is prescribed a decongestant. The nurse plans to contact the client's health care provider if the client has which condition? A. Cataracts B. Crohn's disease C. Diabetes mellitus D. Hypertension

The nurse is reviewing the medical record of a client who is prescribed a decongestant. The nurse plans to contact the client's health care provider if the client has which condition? A. Cataracts Incorrect: Decongestants are not contraindicated in clients with cataracts. B. Crohn's disease Incorrect: Decongestants are not contraindicated in clients with Crohn's disease. C. Diabetes mellitus Incorrect: Decongestants are not contraindicated in clients with diabetes mellitus. D. Hypertension {{{{{{{{Correct}}}}}}} Correct: Decongestants have actions similar to adrenergic drugs, causing vasoconstriction, which can increase blood pressure.

The nurse plans to assess the client with type I hypersensitivity for which clinical manifestation? A. Poison ivy B. Autoimmune hemolytic anemia C. Allergic asthma D. Rheumatoid arthritis

The nurse plans to assess the client with type I hypersensitivity for which clinical manifestation? A. Poison ivy Incorrect: Poison ivy is a type IV delayed mechanism of hypersensitivity. B. Autoimmune hemolytic anemia Incorrect: Autoimmune hemolytic anemia is a type II cytotoxic mechanism of hypersensitivity. C. Allergic asthma {{{{{{{{{{{{{{Correct}}}}}}}}}}}}}} Correct: Allergic asthma is a manifestation of type I hypersensitivity. D. Rheumatoid arthritis Incorrect: Rheumatoid arthritis is a type III immune complex-mediated mechanism of hypersensitivity.

The nurse prepares to administer zafirlukast (Accolate) to a client with allergic rhinitis. The nurse understands that zafirlukast works by which mechanism? A. Blocking histamine from binding to receptors B. Preventing synthesis of mediators C. Preventing mast cell membranes from opening D. Blocking the leukotriene receptor

The nurse prepares to administer zafirlukast (Accolate) to a client with allergic rhinitis. The nurse understands that zafirlukast works by which mechanism? A. Blocking histamine from binding to receptors Incorrect: Antihistamines such as diphenhydramine (Benadryl) block histamines from binding to receptors. Zafirlukast is not an antihistamine. B. Preventing synthesis of mediators Incorrect: Corticosteroids prevent synthesis of mediators. Zafirlukast is not a corticosteroid. C. Preventing mast cell membranes from opening Incorrect: Mast cell-stabilizing drugs such as cromolyn sodium (Nasalcrom) prevent mast cell membranes from opening when an allergen binds to IgE. Zafirlukast is not a mast cell-stabilizing drug. D. Blocking the leukotriene receptor Correct Correct: Zafirlukast is a leukotriene antagonist that prevents the occurrence of allergic rhinitis by blocking the leukotriene receptor.

The nursing instructor asks the student nurse to explain a type IV hypersensitivity reaction. Which statement by the student best describes type IV hypersensitivity? A. "It is a reaction of immune globulin (Ig)G with the host cell membrane or antigen." B. "The reaction of sensitized T-cells with antigen and release of lymphokines activate macrophages and induce inflammation." C. "It results in release of mediators, especially histamine, because of the reaction of IgE antibody on mast cells." D. "An immune complex of antigen and antibodies is formed and deposited in the walls of blood vessels."

The nursing instructor asks the student nurse to explain a type IV hypersensitivity reaction. Which statement by the student best describes type IV hypersensitivity? A. "It is a reaction of immune globulin (Ig)G with the host cell membrane or antigen." Incorrect: This describes type II hypersensitivity. B. "The reaction of sensitized T-cells with antigen and release of lymphokines activate macrophages and induce inflammation." {{{{{Correct}}}}}} Correct: This is a delayed hypersensitivity reaction, as is seen with poison ivy (type IV hypersensitivity). C. "It results in release of mediators, especially histamine, because of the reaction of IgE antibody on mast cells." Incorrect: This describes a type I hypersensitivity reaction. D. "An immune complex of antigen and antibodies is formed and deposited in the walls of blood vessels." Incorrect: This describes a type III hypersensitivity reaction.

When preparing the client for allergy testing, the nurse provides the client with which instruction? A. "Avoid taking your loratadine (Claritin) and triamcinolone (Azmacort) inhaler for 5 days before testing." B. "It is okay to use your fluticasone propionate (Flonase) nasal spray before testing." C. "Aspirin in a low dose is allowed to be taken before testing." D. "You can take antihistamine nasal sprays before testing."

When preparing the client for allergy testing, the nurse provides the client with which instruction? A. "Avoid taking your loratadine (Claritin) and triamcinolone (Azmacort) inhaler for 5 days before testing."{{{{{{{{{{{{ Correct}}}}}}}} Correct: Antihistamines and corticosteroid inhalers should be discontinued before skin testing to avoid suppressing an allergic response. B. "It is okay to use your fluticasone propionate (Flonase) nasal spray before testing." Incorrect: Flonase is a steroid inhaler and should be discontinued for 5 days before testing. C. "Aspirin in a low dose is allowed to be taken before testing." Incorrect: Allergists recommend that aspirin be withheld before testing. D. "You can take antihistamine nasal sprays before testing." Incorrect: Nasal sprays that contain antihistamines are not permitted before testing.

Which of these nursing actions is most appropriate for the nurse working in an allergy clinic to delegate to a nursing assistant? A. Plan the schedule for desensitization therapy for a client with allergies. B. Monitor the client who has just received skin testing for signs of anaphylaxis. C. Educate a client with a latex allergy about other substances with cross-sensitivity to latex. D. Remind the client to stay at the clinic for 30 minutes after receiving intradermal allergy testing.

Which of these nursing actions is most appropriate for the nurse working in an allergy clinic to delegate to a nursing assistant? A. Plan the schedule for desensitization therapy for a client with allergies. Incorrect: Planning of care requires broader education and scope of practice and should be done by the registered nurse. B. Monitor the client who has just received skin testing for signs of anaphylaxis. Incorrect: Assessing for complications requires broader education and scope of treatment and should be done by the registered nurse. C. Educate a client with a latex allergy about other substances with cross-sensitivity to latex. Incorrect: Client education is a registered nursing responsibility, which requires broader education and scope of practice. D. Remind the client to stay at the clinic for 30 minutes after receiving intradermal allergy testing. {{{{{{{{{{{{{Correct}}}}}}}}}}}}}} Correct: Reminding a client about safety policies is within the scope of practice of a nursing assistant.

Zafirlukast (Accolate)

Zafirlukast (Accolate) is a leukotriene receptor antagonist; it works by blocking the leukotriene receptor and is used to prevent allergic rhinitis.

Zileuton (Zyflo)

Zileuton (Zyflo) is a leukotriene antagonist; it is used to prevent symptoms of allergic rhinitis but is not useful during an acute episode.

autoantibodies.

• Antibodies directed against self tissues or cells are known as autoantibodies.

Autoimmune disorders include diseases such as

• Autoimmune disorders include diseases such as systemic lupus erythematosus, polyarteritis nodosa, scleroderma, rheumatoid arthritis, and autoimmune hemolytic anemia.

Autoimmune reactions, both antibody- and cell-mediated, are similar to

• Autoimmune reactions, both antibody- and cell-mediated, are similar to normal immune responses against invading organisms, but are directed against normal body cells.

Causes of loss of recognition of self cells are

• Causes of loss of recognition of self cells are not known.

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• Give oxygen to any patient in anaphylaxis.

GOODPASTURE'S SYNDROME

• Goodpasture's syndrome is an autoimmune disorder in which autoantibodies are made against the glomerular basement membrane and neutrophils. • The two organs with the most damage are the lungs and the kidneys. • Spontaneous resolution of Goodpasture's syndrome has occurred but is rare. • Interventions focus on reducing the immune-mediated damage and performing some type of kidney supportive or replacement therapy.

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• Hypersensitivity and autoimmune responses can severely damage cells, tissues, and organs.

what do you do when patients who show any symptom of an allergic reaction.

• Immediately assess the respiratory status and airway of patients who show any symptom of an allergic reaction.

discontinue the IV drug of a patient having an anaphylactic reaction to that drug. Do not discontinue the IV, but change the IV tubing and hang normal saline.

• Immediately discontinue the IV drug of a patient having an anaphylactic reaction to that drug. Do not discontinue the IV, but change the IV tubing and hang normal saline.

...

• Inflammatory and immune responses are helpful in protecting against infection and cancer development and stimulating tissue growth and repair after injury.

patients with known severe allergies or a history of anaphylaxis need to have

• Keep emergency equipment and drugs, such as epinephrine, Benadryl, and cortisol immediately available for patients with known severe allergies or a history of anaphylaxis.

Repeat open application testing (ROAT)

• Repeat open application testing (ROAT) is a form of self-administered patch testing that can help determine which hygiene or beauty products are responsible for a person's contact dermatitis.

SJÖGREN SYNDROME

• Sjögren syndrome (SS) is a group of problems that often appear with other autoimmune disorders. • Problems include dry eyes (sicca syndrome), dry mucous membranes of the nose and mouth (xerostomia), and vaginal dryness. • These problems are caused by autoimmune destruction of the lacrimal, salivary, and vaginal mucus-producing glands. • A monoclonal antibody being investigated for benefit to patients with severe inflammatory manifestations of SS is rituximab.

Autoimmune disorders cure and drugs

• There is no cure. • Anti-inflammatory drugs and immunosuppressive drugs are commonly used along with symptomatic treatment.

Type I RAPID HYPERSENSITIVITY REACTIONS

• Type I, or rapid hypersensitivity, also called atopic allergy, is the most common type of hypersensitivity resulting from increased production of the immunoglobulin E antibody.

TYPE II: CYTOTOXIC REACTIONS

• Type II cytotoxic reactions occur when the body makes special autoantibodies directed against self cells that have some form of foreign protein attached to them. • The autoantibody binds to the self cell and forms an immune complex. • Treatment of type II cytotoxic reactions begins with discontinuation of the offending drug or blood product and symptomatic treatment. • Complications such as hemolytic crisis and renal failure can be life threatening.

TYPE III: IMMUNE COMPLEX REACTIONS

• Type III reactions result from excess antigens causing immune complexes to form in the blood and lodge in small blood vessel walls. • Common sites include the kidneys, skin, joints, and other small blood vessels. • Deposited complexes trigger inflammation, and tissue or vessel damage results. • Many immune complex disorders, mostly connective tissue disorders, are caused by type III reactions, such as rheumatoid arthritis and systemic lupus erythematosus.

TYPE IV: DELAYED HYPERSENSITIVITY REACTIONS

• Type IV reactions involve T-lymphocytes as the reactive cells. • Sensitized T-cells respond to an antigen by releasing chemical mediators and triggering macrophages to destroy the antigen. • Type IV responses typically occurs hours to days after exposure causing edema, induration, ischemia, and tissue damage at the site. • Examples of type IV reactions are positive purified protein derivative tests for tuberculosis, contact dermatitis, poison ivy rashes, insect stings, and tissue transplant rejections.

TYPE V: STIMULATORY REACTIONS

• Type V reactions involve excessive stimulation of a normal cell surface receptor by an autoantibody, resulting in a continuous "turned-on" state for the cell. • An example of Type V reaction is Graves' disease, a form of hyperthyroidism.

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• Urge all patients with severe allergies or those who have a history of anaphylaxis to wear a medical alert bracelet.

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• When inflammation or immune responses are prolonged, excessive, or occur at an inappropriate time, normal tissues are damaged • These prolonged responses are overreactions to invaders and foreign antigens and are known as hypersensitivity or allergic responses.

autoimmune response

• When inflammatory and immune responses fail to recognize and protect self cells, normal body tissues are attacked and harmed. • This type of reaction is known as an autoimmune response.