ALLERGIES & BIOLOGICS Colleen Cole, DNP, MSN, MBA, FNP, APRN-BC
Objectives • To increase understanding allergens • Understand different types of immunotherapy • Become aware of why patients may benefit from immunotherapy • Be aware of which patients may benefit from immunotherapy • Have a basic understanding of biologics and their use
What is an Allergy? • An allergic reaction begins in the immune system . If you have an allergy, your immune system mistakes an otherwise harmless substance as an invader known as an allergen. The immune system overreacts to the allergen by producing Immunoglobulin E (IgE) antibodies. These antibodies travel to cells starting the reaction that releases histamine and other chemicals , causing an allergic reaction.
Airborne allergy Food allergy Types of Drug allergy Allergy Stinging insect allergy Latex allergy
Estimated 50 million Americans suffer from nasal allergies Antigens stimulate an abnormal response when entering the body by inhalation, Allergy ingestion, or contact Facts Typically develops 80% before age of 20 early in life Genetic background Factors that determine Exposure to allergens susceptibility Exposure to certain toxins (example: air pollution)
Development of allergen hypersensitivity is a two-step process Step 1 Development of Allergies These adhere to Sensitization – circulating basophils or exposure to allergen mast cells located in results à of allergen the mucosal surface of specific Immunoglobulin the skin, GI tract, or (IgE) antibodies. respiratory tract. • The release of mediators from activated mast cells and basophils are responsible for allergic symptoms in sensitive individuals.
Step 2 • Allergic reaction that occurs with additional exposure to the allergen. Allergen reacts with the cell-bound specific IgE, causing chemical mediators such as histamine, leukotrienes, and prostaglandins to be released. Development of Allergies The release of mediators from activated mast cells and basophils are responsible for allergic symptoms in sensitive individuals.
• Clinical response intensified by several factors: What • Length of time exposed to an allergen Intensifies • Exposure to an allergen through the mouth • Exposure to an allergen after ingesting alcohol Allergen • Exposure to an allergen after strenuous activity Reactions? • Exposure to multiple allergens on the same day
GETTING A DIAGNOSIS Clinical history Physical Confirmatory lab examination & skin testing
Testing • Skin test preferred over Radioallergosorbent testing, or RAST testing, • RAST test were formerly the go-to blood test for helping to diagnose an allergy. However, newer allergy blood tests are now available. • ImmunoCAP testing is a more common allergy blood testing specific IgE • Typically wait for full aeroallergy panel skin testing until individual is 6 years of age • Blood work CBC with diff, IgE, IgG, IgA, IgM • Prior to skin testing patient must be off certain medications (if possible) that could potentially lead to false negative results – histamines, steroids, leukotriene inhibitors. • If unable to stop testing proceed with above blood test (RAST/ImmunoCAP) preference.
IgA, IgG, IgM, IgE • IgA. IgA antibodies are found in areas of the body such the nose, breathing passages, digestive tract, ears, eyes, and vagina. IgA antibodies protect body surfaces that are exposed to outside foreign substances. This type of antibody is also found in saliva, tears, and blood. About 10% to 15% of the antibodies present in the body are IgA antibodies. A small number of people do not make IgA antibodies. • IgG. IgG antibodies are found in all body fluids. They are the smallest but most common antibody (75% to 80%) of all the antibodies in the body. IgG antibodies are very important in fighting bacterial and viral infections. IgG antibodies are the only type of antibody that can cross the placenta in a pregnant woman to help protect her baby (fetus). • IgM. IgM antibodies are the largest antibody. They are found in blood and lymph fluid and are the first type of antibody made in response to an infection. They also cause other immune system cells to destroy foreign substances. IgM antibodies are about 5% to 10% of all the antibodies in the body. • IgE. IgE antibodies are found in the lungs, skin, and mucous membranes. They cause the body to react against foreign substances such as pollen, fungus spores, and animal dander. They are involved in allergic reactions to milk, some medicines, and some poisons. IgE antibody levels are often high in people with allergies. • https://www.uofmhealth.org/health-library/hw41342
Allergic rhinoconjunctivitis Urticaria Diagnosis Angioedema IgE Asthma Mediated Gastrointestinal allergies –Eosinophilic esophagitis Disorders Atopic dermatitis Oral allergy syndrome Anaphylaxis
• Atopic dermatitis is an eczematous eruption associated with asthma and allergic rhinitis • Occurs in 10% to 20% of children and 1% to 3% of adults Atopic • Est. 50% and 80% of children who have atopic Dermatitis dermatitis later develop asthma and/or allergic rhinitis as a progression known as the atopic march • Immunotherapy has proven to be beneficial in these patients
• Several features suggests classification as an atopic disorder including the following: • Family history of allergic rhinitis and asthma Atopic • Elevated levels of serum IgE Dermatitis • Eosinophilia • Frequent hypersensitivity to environmental allergens
Airborne Allergy • Indoor Allergens • House Dust mites • Cockroaches • Molds • Rodents • Animal Dander • Outdoor Allergens • Pollens • Molds
Food Allergy Tree nuts spices Peanuts Vegetables Wheat Fruit Soy Fish, Eggs shellfish
Food Allergy vs. Food Intolerance • Food allergy is NOT the same as food intolerance. • Food allergy occurs in susceptible person who was previously sensitive to a particular food allergen. Symptoms may include pruritis, urticaria, angioedema, wheezing, airway obstruction, nauseas, vomiting, abdominal cramping, diarrhea, nasal congestion, and in severe cases anaphylaxis. • Food intolerance may be an adverse response to food that is NOT based on immunologic mechanisms. For example milk “allergy” or intolerance can exist because of immunologic reaction to a protein in milk where the person lacks an enzyme that digest lactose. • Non-allergic food-induced disorders such as celiac disease and lactose intolerance have significantly different pathophysiology mechanisms
Symptoms include difficulty swallowing Symptoms of the comment and/or an mouth and throat itchy or burning sensation of the Oral Allergy tongue or throat Syndrome Persons who are Example individual allergic to certain may be allergic to pollens may Birch and experience experience this symptoms when they syndrome when eat apples from their they consume cherries, celery, certain raw fruits or peaches, pears, or vegetables hazelnuts
Oral Pollen Allergy Syndrome
Occur between 8 – 15 per 100 hospital admissions annually Drug Allergy Antibiotics & anti-inflammatory drugs most common
Vespids (yellow jacket, hornet, wasp) Apids (honeybee, bumblebee) Stinging Insect Formicidae (fire ant) Allergy Affects 0.3% to 3% of people in US Causes 40 deaths per year
Symptoms from minor dermatitis to anaphylaxis Latex Demonstration of IgE sensitivity confirms dx BUT lack of IgE does Allergy NOT rule it out Symptoms may occur on skin, resp, eyes, GI & GU.
Latex Allergy Cross- Reactivity
Avoidance Pharmacotherapy Allergy Treatment Allergy immunotherapy
Immunotherapy History • Various forms of allergy treatments have been tried over last century from oral drops, nasal inhalations, powders, tablets, to injections • Early 20 th century – allergy drops • 1911 Leonard Noon and John Freeman discovered hypodermic inoculations • Second ½ of 20 th century SCIT became widely utilized in the world • 1970 Hymenoptera venom therapy proven safe & effective • 2014 SLIT – Difficult to obtain insurance coverage at this time
• Raises the patient's tolerance to specific allergens • Vials are made specific to the allergens that the patient tests positive • Immunotherapy is typically given over 3-5 years • Goal is to halt or minimize allergic disease What About symptoms • Patient receives 1 st dose from each new vial Immunotherapy? in the allergist office. May receive following doses from that vial at PCP IF PCP agrees and is prepared to administer care for potential anaphylaxis post injection and follows administration protocols for potential injection site reactions
Summary of Safety SCIT vs SLIT • SCIT • Rare systemic reactions (3/1000 injections) • Rare fatalities (1/2.5M injections- declining) • Frequent local reactions • Erythema/pruritus/swelling- injection site • SLIT • Rare systemic reactions • Specific administration on taking medication sublingal • No known fatalities • Frequent local reactions • Erythema/Pruritus/edema- mouth, lips, tongue, upper airway
Recommend
More recommend
