Thymus derived cells that have receptors that are activated by binding with foreign antigens

Secrete mediators that influence the response of other cell types involved in the recognition and destruction of foreign substances 

Differentiate into specific plasma cells that synthesize antibodies

aka bursa derived cells 

"GAMED"

IgG

IgA

IgM

IgE

IgD

Cause the release of histamine and other chemicals that cause allergic reactions

Main player in anaphylaxis 

Monocytes and Macrophages

Neutrophils (aka polymorphic leukocytes)

Eosinophils

Mast Cells (histamine releasing)

Inflammatory cell activators synthesized by macrophages to act as secondary messengers and activate endothelial cells and WBCs 

Interleukin causes histamine release and bronchospasm

System of 20 differnt proteins that bind to activated antibodies, cell membranes, and other complement proteins

Primary humoral response 

DEPRESSES nonspecific host resistance 

Affected by anesthetic drugs, other effects of drugs used in surgery, surgery itself, coincident infections, and blood products 

Anaphylactic or Immediate reaction (minutes to an hour post exposure) 

Caused by antigen bining to IgE antibodies (mast cells released mediators-histamine)

Need to have PREVIOUS exposure to antigen 

Symptoms can last up to 36 hrs 

Anaphylaxis

Extrinsic Asthma

Urticaria (hives)

Allergic Rhinitis

Angioedema (especially laryngeal)

HOTN

Wheezing/Bronchospasm

Arryhtmias 

Non-IgE-mediated reaction caused by histamine release from basophils and mast cells

symptoms usually less severe

"Cytotoxic"

Antibody-dependent cell-mediated cytotoxic hypersensitivity 

IgG and IgM

Cell damage: direct lysis, increased phagocytosis, killer-T cells produce cytotoxic effects

Ex. ABO incompatible tranfusions reactions, drug induced hemolytic anemia, HIT 

" Immune Complex"

Antigen/Antibody complexes deposit in microvasculature

Complement is activated and neutrophils are localized to site of complement deposition which produces tissue damage

Ex. serum sickness, snake antisera, protamine mediated pulmonary vasoconstriction 

"Delayed"

Results from interactions of sensitized lymphocytes with specific antigens= delayed hypersensitivity

Manifests 18-24 hrs and disapppears 72-96 hrs later

Ex. Contact dermatitis, tissue rejection, GVHD 

Coughing

Wheezing

Laryngeal edema

Decreased pulmonary compliance

Pulmonary Edema

Respiratory Failure 

Disorientation

Diaphoresis

LOC changes

HOTN

Tachycardia

Dysrhythmias

Decreased SVR

CV arrest

Pulmonary HTN

Urticaria (hives)

Flushing

Periorbital edema

Perioral edema 

Releases endothelium derived releasing factors- NO

Increases capillary permeability

Constricts airway and vascular smooth muscle 

Causes gastric secretion

Inhibits mast cell activation

Contributes to vasodilation 

Peptide Mediators

Arachidonic Metabolities

Kinins

Platlet Aggregating Factors 

Synthesized in mast cells and basophils to produce vasodilation, increased capillary permeability, and bronchoconstriction

Can stimulate vascular endothelium to release prostacyclin and NO 

Complement Activation- release biologicall active complement fragments of C3 and C5

C3 and C5 release histmaine from mast cells and basophils, contract smooth muscle, increase capillary permeability, and cause interleukin synthesis (bronchoconstriction) 

It is a non-immunologic release of histamine 

Drug competes with histamine at receptor sites

Do NOT prevent the release...just keep it from binding

H1 and H2 need to block both 

Antibiotics (vanc)

Basic Compounds

Muscle Relaxants (NMB)

Opioids (Morphine and Demerol)

Thioibarbiturates 

Leukocytes Histamine Release 

Radioallergosorbent Test (RAST)

Enzyme-Linked Immunosorbent Assay (ELISA)

Intradermal Testing (Skin Testing) 

NMBs

Latex

Antibiotics

Other (contrast, protamine, etc.)

Colloids

Opioids

Hypnotics

LA 

Contain perservatives, accelerators, antioxidants

Healthcare workers, spina bifida, GU abnormalities

Bananas, Avocado, Kiwi

Airway Maintenance 

100% O2

IV Volume Expansion

Epinephrine 

Stops all anesthetic drugs- treat hypoxia and hypotension

40% loss due to 3rd spacing

2-4 L LR (adults)

25-50 ml/kg cyrstalloids- additional benefit 

CV Unstable: 5-10 mcg IV bolus, 0.1-1 mg infusion with CV collapse

CV Stable: 0.1-0.5 mg  SC/IM

0.05 mcg/kg

Helps SVR 

B-agonists

Albuterol, Terbutaline, Ipratropium 

Hydrocortisone

(Solucortef)

Methylprednisone 

(Solumedrol) 

0.5-1 mEq/kg 

May repeat q 5 min

Acidosis reduces effect of epi