xxx,

In addition to your points, Streptococcus pyogenes, the Group A Streptococcus (GAS), is the most common cause of bacterial pharyngitis in children and adults. Innate and adaptive host immune responses are fundamental for defense against streptococcal pharyngitis and are central to the clinical manifestation of disease. Host immune responses also contribute to the severe poststreptococcal immune diseases that constitute the major disease burden for this organism (nih.gov).

Cell-to-cell adhesions are formed on plasma membranes, thereby allowing the formation of tissues and organs. Cells are held together by three different means: (a) the extracellular membrane, (b) cell adhesion molecules in the cell’s plasma membrane, and (c) specialized cell junctions (McCance & Huether, 2019) Alterations in Cellular Processes NURS 6501 week 1 Discussion.

McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). Mosby/Elsevier.

Group A streptococcal pharyngitis: Immune responses involved in bacterial clearance and GAS-associated immunopathologies. Retrieved March 4, 2022, from https://pubmed.ncbi.nlm.nih.gov/28951419/

      Hi xx. Great post! I was able to locate some information regarding genetics and allergy risks, although I agree with you that the data is limited. Kanchan et al. report on the correlation between food allergies and genetics (2021). Alterations in Cellular Processes NURS 6501 week 1 Discussion Additionally, Kanchan et al. describe the lack of information and limitations for researchers examining the topic (2021). It has been described that the risk of food allergy increases in the offspring when parental allergies are present (Kanchan et al., 2021). Furthermore, specific genes have been identified in food allergy roles (Kanchan et al., 2021). With the advances of science and genetic research, I am confident that a genetic cause of medication allergies may be identified one day. The case study presented describes an immediate, Type 1 allergic reaction to Amoxicillin. A Type 1 or anaphylactic reaction results from overactive IgE, leading to a histamine response creating the symptoms described in the case study (Justiz-Vaillant & Zito, 2019). Typical signs of anaphylaxis can include swelling of the face, tongue, and airway, low blood pressure, unconsciousness, among others (Justiz-Vaillant & Zito, 2019). Anaphylaxis is considered a medical emergency that can lead to shock and ultimately mortality if left untreated (Justiz-Vaillant & Zito, 2019). Luckily, the patient in the case study recovered without further complication. As a nurse, have you had any personal experiences with a patient having a hypersensitivity? I spent many years treating patients with chemotherapy and blood products, and it was not uncommon for a patient to have an allergic reaction during an infusion.

References

Justiz-Vaillant, A. A., & Zito, P. M. (2019). Immediate hypersensitivity reactions. In StatPearls. Treasure Island, FL: StatPearls Publishing.

Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK513315/

Kanchan, K., Clay, S., Irizar, H., Bunyavanich, S., & Mathias, R. A. (2021). Current insights into the genetics of food allergy. The Journal of     

     Allergy and Clinical Immunology, 147(1), 15–28. https://doi.org/10.1016/j.jaci.2020.10.039

Hixxx,

Thank you for the response. As a nurse, I have had a lot of experiences with Anaphylaxis, unfortunately. I have worked in the emergency department for about 11 years now and have cared for multiple patients in Anaphylaxis and have actually received Epinephrine myself for a throat swelling after ingesting Walnuts (my known allergy) Alterations in Cellular Processes NURS 6501 week 1 Discussion.

Good work on your discussion. The immune system is an integral part of protection against disease. However, some normally protective immune mechanisms can sometimes cause detrimental reaction. These hyper sensitivity reactions can be divided into 4 types:

Type I reaction: immediate hypersensitivity reaction involves immunoglobulin (IgE)-mediated release of histamine and other mediators from mast cells and basophils. Examples include anaphylaxis and allergic rhinoconjunctivitis.

Type II reaction: cytotoxic hypersensitivity reactions involve immunoglobulin G or M antibodies bound to cell surface antigens, with subsequent complement fixation. An example is drug induced hemolytic anemia.

Type III reactions: immune-complex reactions involve circulating antigen-antibody immune complexes that deposit in postcapillary venules, with subsequent complement fixation. An example of this type of reaction is serum sickness.

Type IV reactions: delayed hypersensitivity reactions, cell-mediated immunity are mediated by T cells rather than by antibodies. An example is contact dermatitis from poison ivy or nickel allergy.

Understanding the different types of reactions is important for the provider so an accurate diagnosis and treatment plan can be established Alterations in Cellular Processes NURS 6501 week 1 Discussion.

Dr.

Thanks for your comment and input that simplified the four types of hyperactivity reactions.

Alterations in Cellular Processes NURS 6501 week 1 Discussion Great! Thank you for your educational post. Having an allergic reaction to medications can be mild or severe. The 16 years old’s signs and symptoms show that he was having an anaphylactic reaction. It is life-threatening characterized by airway problems, difficulty breathing, and circulatory problems, and is associated with skin and mucosal changes (Reber et al, 2017). Eosinophils, mast cells, and Basophils are all involved in the pathogenesis of allergic disease, and their pathological roles are linked with the presence of immunoglobulin E (IgE) antibodies (Metcalfe et al., 2016).

Reference:

Metcalfe, Dean D., Ruby Pawankar, Steven J. Ackerman, Cem Akin, Frederic Clayton, Franco H. Falcone, Gerald J. Gleich, et al. “Biomarkers of the Involvement of Mast Cells, Basophils and Eosinophils in Asthma and Allergic Diseases.” World Allergy Organization Journal 9 (2016): 7. https://doi.org/10.1186/s40413-016-0094-3.

Reber, Laurent L., Joseph D. Hernandez, and Stephen J. Galli. “The Pathophysiology of Anaphylaxis.” Journal of Allergy and Clinical Immunology 140, no. 2 (August 2017): 335–48. https://doi.org/10.1016/j.jaci.2017.06.003.

I really enjoyed reading your discussion post this week, you brought up a lot of good points. Alterations in Cellular Processes NURS 6501 week 1 Discussion The fact that the child did not have any known family history of Strep throat is important because some research has been found that Strep throat can be genetic. It has been found that some children develop strep throat and tonsil infections because they have a gene that prevents them from developing immunity. Researchers have found that strep throat did run in some families (Citroner, 2019).  Also, research has found that people with an allergy to Penicillin have a genetic variation in their immune system (Erdmann, 2020).

The physiological response that the child had with the swelling of the lips and tongue and wheezing was in inflammatory response to his allergy to Penicillin. Drugs may cause allergic reactions by any mechanism of hypersensitivity. Allergic inflammation includes several inflammatory cells including mast cells, basophils, lymphocytes, dendritic cells, eosinophils, and sometimes neutrophils (Barnes, 2011).

References

Barnes, P., (2011).  Pathophysiology of allergic inflammation. National Library of Medicine. Https://pubmed.ncbi.nlm.nih.gov/21682737.

Citroner, G. (2019). Here’s why certain kids repeatedly get strep throat. Healthline. https://www.healthline.com/health-news/why-your-kid-keeps-getting-strep-throat

Erdmann, J. (2020). Penicillin allergies may be linked to one immune system gene. Science News. https://www.sciencenews,org

Hello XX, you have highlighted very important points. Alterations in Cellular Processes NURS 6501 week 1 Discussion Through your post I have had time to read more about streptococcal Pharyngitis and how family history contributes to the likelihood of an individual developing the allergy. In this scenario, Genetics play a significant role in drug allergy reactions.  Drug allergy occurs as a simultaneous reaction between the drug and the immune system. HLA alleles are the risk factors that aid the development of severe allergic reaction after drug administration (Finberg & Guharoy, 2012). Identifying people showing severe allergic reactions that could be fatal helps in improving patient care. The boy presented the specific described symptoms due to being hypersensitive to amoxicillin drugs. When the boy was exposed to amoxicillin, which is the specific allergen in this scenario, his body produces specific antibodies. The produces antibodies are Basophils found in the blood streams (Pourpak et al.,2008). The allergen introduced in the body joined together with the basophils bringing about an antibody-antigen reaction. This resulted to the breakage of the basophils which instigated the occurrence of swelling of the tongue and lips, difficulty in breathing and audible whizzing. Health providers ought to normalize carrying out antibiotic tests before administering and prescribing drugs. This will help arrest severe allergic drug reaction which could turn out to be fatal.

References

Finberg, R. W., & Guharoy, R. (2012). Understanding Drug Allergies and Drug Toxicities. In

Clinical Use of Anti-infective Agents (pp. 85-96). Springer, New York, NY.

Pourpak, Z., Fazlollahi, M. R., & Fattahi, F. (2008). Understanding adverse drug reactions and

drug allergies: principles, diagnosis and treatment aspects. Recent patents on

            inflammation & allergy drug discovery, 2(1), 24-46.

The physiologic response can further be broken down. The release of histamine and will cause vasodilation and increase in vascular permeability. Increase in vascular permeability causes extravasation of neutrophils and other inflammatory cells to leak out of the blood vessels. This is what causes redness, swelling, low blood pressures, syncope, and things like that in the early phase of Hypersensitivity Type 1 (He et al., 2013) Alterations in Cellular Processes NURS 6501 week 1 Discussion.

According to Weiss (2002), there has been a correlation between childhood exposure to germs and a decrease prevalence of hay fever, allergic asthma, and allergic sensitization. This article talks about how children that were raised on farms were shown to have a lower prevalence of these illnesses than children who were not. Although there are many theories about this data, there is no clearcut evidence that I found on the genetic level to show any changes.

References

He, S., Zhang, H., Zeng, X., Chen, D., & Yang, P. (2013). Mast cells and basophils are essential for allergies: Mechanisms of allergic inflammation and a proposed procedure for diagnosis. Acta Pharmacologica Sinica, 34(10), 1270–1283. https://doi.org/10.1038/aps.2013.88

Weiss, S. T. (2002). Eat dirt — the hygiene hypothesis and allergic diseases. New England Journal of Medicine, 347(12), 930–931. https://doi.org/10.1056/nejme020092

Hello xxx, i agree with your assessment of the child having both a sore throat (strep) and also having a allergic reaction to Amoxicillin his MD prescribed for him. Anaphylaxis is a serious emergency that can lead to life threatening failure, it is caused as you mentioned by a IgE-mediated cell response that causes a sudden release of histamine. According to Vaillant & Zito.,2019  anaphylactic responses are mediated by iGE that then produces a immune response to environmental proteins, it then binds to mast cells and basophils which contains the histamine which causes the reaction, as evidenced with the child having a swollen lip that progressed to difficulty breathing.

Reference:

Vaillant,J & Zito,p (2019). Immediate Hypersensitivity Reaction( NCBI) Statspearl Publishing. Retrieved March 8th, 2022 from https://content.waldenu.edu/content/dam/laureate/laureate-academics/wal/ms-nurs/nurs-6501/week-01/Justiz-Vaillant_Immediate%20Hypersensitivity%20Reactions.pdf  Alterations in Cellular Processes NURS 6501 week 1 Discussion