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Immunity

Immunity . Trisha Economidis, MS, ARNP Spring, 2014. WAR DECLARED…. We are at war with our environment Troops are prepared to fight from every sector of the body to keep us safe (and healthy) Regiments on the ready include: Antibodies Immunoglobulins White Blood cells

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Immunity

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  1. Immunity Trisha Economidis, MS, ARNP Spring, 2014

  2. WAR DECLARED….. • We are at war with our environment • Troops are prepared to fight from every sector of the body to keep us safe (and healthy) • Regiments on the ready include: • Antibodies • Immunoglobulins • White Blood cells • Immune Response Teams: Antibody-mediated and Cell-Mediated Immunity • And others…….

  3. Immune System Review: Public Enemy Number ONE • Antigen – a protein that stimulates an immune reaction, causing production of antibodies. • Viruses • Bacteria • Fungi • Parasites • Etc…..

  4. Immune System Review • Antibody – a globulin (PRO) produced by B cells as a defense mechanism against foreign materials. Combines in a lock and key style with antigens

  5. Meet the Troops: WBC’s – Name, Rank & Serial Number • Reported in the WBC Differential with a CBC • Granulocytes (basophils, eosinophils, neutrophils – BEN) • Basophils – 0.5 – 1% of total WBC’s. Release histamineand heparin granules • Eosinophils – 1-4% - Destroy helminths, mediate allergic reaction • Neutrophils – 55-70%. First to arrive – Phagocytize! • Bands – Immature neutrophils (5% of total WBCs) • Segmented (Segs) – Mature neutrophils (55% of total WBCs)

  6. WBC’s, continued • Monocytes – 2-3% Phagocytize directly • Lymphocytes – 20-40% • T lymphs – recognize, attack and destroy antigens • B lymphs – produce immunoglobulins to attack and destroy antigens • NK (Natural Killer) cells – kill foreign pathogens

  7. First Line of Defense:Innate Immune Response • Soldiers of the Innate Immune Response: • Neutrophils • Macrophages • NK cells Defenses Provided: • Barrier Protection • Inflammation • Phagocytosis GOAL: Neutralize and Destroy the Invaders

  8. Innate Immune Response:Barrier Protection • Prevents organisms from entering the body • Skin • Respiratory Tree • Tears/Saliva • GI Tract – acidic environment, peristalsis • Bile – antimicrobial • GU tract – mucous membranes

  9. Innate Immune Response: Inflammation • Begins when histamine and other chemical mediators of inflammation are released directly from damaged cells Histamine/chemical release Dilation and increased Permeability of blood vessels flow of phagocytes, antimicrobials, O2, & nutrients to area of damage

  10. Inflammatory Response

  11. Innate Immune Response: Phagocytosis • Phagocytosis • PHAGOCYTES TO THE RESCUE!

  12. Second Line of Defense: Adaptive Immune Response • Body recognizes and destroys pathogens encountered before • Demonstrates self-recognition • Specific – stimulated by and directed toward specific antigens • Generalized, systemic – not limited to site of injury • Has a memory – repeated exposures to antigens produce a more rapid response

  13. Adaptive Immune Response • Cell Soldiers: Lymphocytes – WBCs that mature to either T cells or B cells

  14. Adaptive Immune Response: Military Forces • Antibody-Mediated Immune Response • Cell-Mediated Immune Response

  15. Adaptive Immune Response:Antibody-Mediated Immune Response • B cell Defense: • Activated by contact with an antigen • Proliferate and morph into • 1. Plasma cells (producing immunoglobulinsthat will bind to and destroy antigens) • 2. Memory cells – store the antibody-producing information for future encounters

  16. Immunoglobulins (Ig) – the Special Agents of Antibody-Mediated Immune Response • IgM – Goes after “first time offenders” • IgG – most common one. (AKA: Gamma Globulin) – Active against bacteria and viruses

  17. Immunoglobulins, cont. • IgE – primarily responsible for allergic response and parasitic infections • IgA – secreted by mucous membranes around body openings. Provides more protection for points of entry. • IgD – found of surface of B cells. Trap potential pathogens

  18. Adaptive Immune Response:Cell-Mediated Immune Response • T cell Defense: Acts to destroy body cells that have become infected • Cytotoxic (Killer) T cells • Helper T cells • Suppressor T cells • Memory T cells

  19. Immunity Terms: • Immunocompetent – immune system capable of responding to pathogens and mounting an immune response • Immunocompromised – immune system is incapable of normal reaction to pathogens as result of a disease • Immunosenescence – age-associated decline of the immune system • Immunosuppression – Prevention of an immune response with drugs

  20. Types of Immunity • Active Immunity – occurs when the body produces antibodies or develops immune lymphocytes against specific antigens • Naturally acquired – occurs when we have a disease, the body produces antibodies, and the risk of having the disease again is very low. • Artificially acquired – occurs with vaccination; immune system is stimulated with the killed or attenuated organism, produces antibodies and memory cells, but not the disease

  21. Types of Immunity • Passive Immunity – Provides temporary protection against disease-producing antigens when we receive antibodies produced by other people or animals • Naturally acquired – occurs with maternal transfer of antibodies via the placenta and breast milk • Artificially acquired – occurs with administration of antibodies or antitoxins in immune globulin; i.e. Rabies human immune globulin

  22. Assessment of the Immune system • Chief complaint – subjective data • Review biographic data: age, gender, race, ethnic background, family history • Comprehensive health history • Physical Assessment

  23. Immune System Diagnostics • Allergy testing (will discuss with allergies) • ELISA/Western Blot • HIV rapid antibody test • CD4-T cell counts (Helper T’s) – reflection of immune status (normal: 500-1600 cells/mm3) • HIV Viral Load testing – measures the presence of HIV viral genetic material in the patient’s blood rather than the body’s response to the virus

  24. Immune System Diagnostics • Antibody Testing • ANA (Antinuclear Antibody) • Rheumatoid Factor • Complement Assay • ESR (erythrocyte sedimentation rate) • HLA testing – Human Leukocyte Antigen • Lupus erythematosus cell test • Anti CCP antibody test

  25. Health Promotion and the Immune System – Boosting your Immunity • Diet – Balanced diet • Exercise – Regular, moderate work-outs • Stress relief • Get enough sleep • Use sun exposure protection • Quit smoking or Don’t Start • Avoid excess alcohol • Immunizations up-to-date

  26. Pharmacologic Management of Immune Disorders • Antibiotics (anti-infectives) • Use: treatment/prophylaxis of bacterial infections • Cautions: Can depress bone marrow; Superinfections • Cephalosporins • Penicillins • Fluoroquinolones • Macrolides • Sulfonamides • Tetracyclines

  27. Pharmacological Interventions • Antivirals – Destroy viruses either directly or by inhibiting the ability to replicate • acyclovir (Zovirax); HSV-1, HSV-2, VZV • osetamivir (Tamiflu), zanamivir (Relenza); Influenza Types A & B

  28. Pharmacological Interventions • Antifungals • Kill or stop growth of fungal infections of skin, mucus membranes, & systemic • Topical • Clotrimazole, ketoconazole, miconazole, nystatin • Systemic • Amphotericin B, fluconazole, ketoconazole

  29. Pharmacological Interventions • Anti-inflammatory • Corticosteroids • Used for anti-inflammatory and immunosuppressive properties • Topical, inhaled, intranasal, opthalmic, IV, PO, IM • Long, intermediate, and short-acting

  30. Pharmacological Interventions • Anti-inflammatory • NSAIDS • Used short-term for inflammatory arthritis • Reduce pain and inflammation • Sometimes given with a second drug to decrease GI side effects • Ex. Ibuprofen, naproxen, salicylates (ASA) • CAUTION: GI Bleeding

  31. Pharmacological Interventions • Antihistamines • Relief of symptoms associated with allergies, rhinitis, urticaria • 1st generation-sedating • Chlor-trimeton (chlorpheninamine) • Dramamine (dimenthydrinate) • Benadryl (dephenhydramine) • Atarax, Vistaril (hydroxyzine) • 2nd generation-non-sedating • Allegra (fexofenadine) • Claritin (loratadine) • Zyrtec (cetirizine)

  32. Pharmacological Interventions • Adrenergic sympathomimetic - Epinephrine • Inhibits release of hypersensitivity mediators • Inhibits reaction from mast cells • Produces bronchodilation, vasoconstriction • Epinephrine (Adrenalin) • 0.3mg-0.5 mg subcutaneously or IM (Adults)

  33. Pharmacological Interventions • Immunotherapy • SC injections weekly/biweekly of allergen extracts • Goals of Therapy • Stimulate IgG levels for allergen binding • Decrease IgE levels • ALWAYS EXPECT ADVERSE REACTIONS!!!

  34. Pharmacological Interventions • Biologic Response Modifers (BRMs) • Broad class of drugs that alter the body’s response to diseases such as cancer and autoimmune, inflammatory and infectious diseases • 2 broad classes: Hematopoietic drugs Immune Modulators

  35. Pharmacological Interventions • Immune Modulators – either enhance or reduce immune responses (some can do both) • Interferons ex. Alfa 2b • Monoclonal antibodies ex. Rituxan, Remicade, Humira • Interleukins – ex. Kineret • Disease-modifying antirheumaticdrugs or Disease-modifying antirheumatoid arthritis drugs – ex. Methotrexate(Pregnancy category X) Arava, Enbrel, Orencia

  36. Pharmacological Interventions • Immunosuppressant Drugs – Decrease or prevent an immune response • cyclosporine (Sandimmune, Neoral, Gengraf) Used to prevent organ rejection in liver, kidney, and heart transplants; treatment of RA and psoriasis. Off-label use in rejection prevention of pancreas, bone marrow, heart/lung transplants. muromonab-CD3 (Orthoclone OKT3) Only one indicated to treat acute organ rejection in kidney, liver and heart transplant

  37. Pharmacological Interventions • Antimalarial (What’s this doing HERE?) • Plaquenil (hydroxychloroquine) – used to decrease joint and muscle pain in early or mild Rheumatoid Arthritis or Lupus (SLE) • Gold Therapy – Rarely used in the U.S. because of toxicities, but may see in patients from other countries. • Antigout – • Acute: colchicine and an NSAID • Chronic: allopurinol (Zyloprim), probenecid (Benemid)

  38. What is an allergy? • Allergy is an exaggerated immune response to an antigen (foreign or allergen) to which the patient has been previously exposed. • Also called hypersensitivity

  39. Allergy Terminology • Allergen – an antigen that causes an allergic sensitization • Mast cell – a tissue cell that contains granules filled with chemical mediators such as histamine and heparin. Play a major role in allergies as well as immune system function. • Atopic – relating to a hereditary predisposition toward developing certain allergic reactions

  40. Why does an allergic reaction occur? • 1. First time exposure to an allergen, our body responds by making “antigen-specific” IgE • 2. The antigen-specific IgE binds to the surface of mast cells and basophils (both have granules containing chemical mediators including histamine that will be released when stimulated) • 3. Once the IgE is formed, we are sensitized to that allergen

  41. Hypersensitivity (allergic) Reactions • Type I reaction – occurs when the already sensitized person (see previous slide) is re-exposed to the allergen (IgE mediated) • Histamine and other chemicals are released from the cells • Inflammatory response occurs from other proteins released from the cells that draw more WBC’s to the area

  42. Anaphylaxis – Serious Type I Reaction • Immediate life-threatening systemic reaction • Can occur in seconds to minutes • Not common • Life-threatening and can be fatal • What can cause it: allergy shots, insect bites/stings, foods (peanuts, eggs, shellfish, etc.) medications, blood products, contrast media, exercise, skin testing.

  43. Anaphylaxis – What does it look like? • Respiratory – bronchospasm, laryngeal edema, wheezing, cough • Cardiovascular – hypotension, tachycardia, palpitations, syncope • Skin – urticaria, angioedema, pruitus, erythema • GI – N/V/D/, abdominal pain

  44. Angioedema

  45. Emergency Care • Recognize symptoms • A, B, Cs • Administer drugs -Epinephrine 1:1000 0.3-0.5 mL SQ or Epi-pen 0.3 mL IM (adults), 0.15 mL IM (children) -Oxygen -Antihistamines -Bronchodilators

  46. History of Anaphylaxis? • Obtain Medical Alert Bracelet • Carry Epi-pen

  47. Did I inherit my allergies? • Yes, and no…. • The tendency to produce IgE to certain antigen exposure is based on genetic inheritance. • Allergic tendencies are inherited (atopy); specific allergies are NOT inherited

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