This paper will delve into issues concerning autoimmunity, immunity, allergies, and drug resistance, and hypersensitivity reactions in a patient, and the best methods an Advanced Practice Nurse could use to deal with these issues. A conclusion will be made.
1. Allergy can be described as being the body’s immune response to a substance that may not be harmful in itself, but may be harmful because of the effect it has on the body. If one is predisposed to a specific allergy, then it causes symptoms and disease in him, like for example, a runny nose, itchiness, skin rashes and so on. Caused by allergens, an allergic reaction can stem from the pollen in the air, to dust mites, to the fur of a cat or dog, and certain foods like eggs and milk. An individual can be allergic to certain medications as well. (What is Allergy? (n.d) An allergy is different from autoimmunity, in that while an allergy is caused by an external agent, autoimmunity is the body’s automatic response to resisting an onslaught of invading microorganisms of any kind. Autoimmunity constitutes the body misdirecting the immune response, in such a way that it attacks the body itself. It is important to note that autoimmunity is present to a certain level in every human being, since it is an inevitable part of vertebrate life, but looking at it on the negative side, autoimmunity can be the cause of certain diseases of the human body. An autoimmune disease can be described as being a part of the onset of symptoms when progression from benign autoimmunity to pathogenic autoimmunity starts. Idiopathic thrombocytopenic purpura, myasthenia gravis,
and Graves’ disease are a few examples of autoimmune diseases. (What is autoimmunity? 2001) Alloimmunity, on the other hand, is generally described as the condition in the human body, which is in essence immunity to an antigen. Also known as Rh disease, the conditions does not occur in a first pregnancy, but can cause red blood cells from the offspring to enter the maternal blood stream, and if this blood group is different from that of the mother, the mother will produce antibodies to save herself. Therefore, in subsequent pregnancies with the same mate in which an offspring of the same blood type is produced, the child will demonstrate hemolytic anemia, because he would have acquired maternal antibodies in his colostrums. (Alloimmunity 2008)
2. Systemic Lupus Erythematosus is an autoimmune disorder, which is capable of affecting the central nervous system, the peripheral nervous system, and the muscular system of a human body. It is a chronic inflammatory disease that follows a relapsing course in the individual is affects. The pathophysiology of the disease has not been defined completely today, although it is an acknowledged fact that those genes that impact the immune system like for example the human leukocyte antigen, may cause the onset of the symptoms of SLE. When the symptoms of SLE have been triggered, then the body starts its own autoimmune reaction, causing several organs to be affected, because of the fact that immune complexes would be deposited, or cytokines would start their work, or the body may be attacked directly by autoantibodies or by activated leukocytes. SLE can be clinically manifested in several ways, like for example, in organic encephalopathies. (Excerpt from Systemic Lupus Erythematosus 2006) Since SLE can affect any system of the body, it can be a dreadful disease. Some of the more common manifestations are arthritis, non specific fatigue, fever, weight loss or gain, myalgia, athralgia, asymmetrical pain, rashes, lesions and cutaneous manifestations, alopecia, nephritic disease, migraines, headaches, depression, anxiety, psychosis and at time, delirium. The treatments of patients of the SLE would depend upon the severity of the symptoms, and the organs that have been affected. No matter what organs have been affected, successful treatment of the symptoms and manifestations of SLE would depend upon the frequency of follow up treatment and constant investigations into new organ involvement. Adverse reactions of the patient to therapies and medication must be monitored carefully, and in certain cases, preventive care for the onset of symptoms of Systemic Lupus Erythematosus can be as important as the actual treatment for the disease. (Bartels M Christie 2008)
3. Antimicrobial resistance is a major problem that has been under the spotlight recently, because of the fact that it involves the patient developing a resistance to a drug or various drugs. Antimicrobial is the term that is used to describe those substances that either kill or slow down the growth of microbes, wherein microbes are those substances like bacteria, viruses, fungi and parasites, all of which evolve over a period of time, their primary function being that of multiplying, reproducing and spreading as rapidly as possible within the host. All these microbes cause different ailments in a human being, like for example, the influenza virus causes influenza or flu, and fungi cause yeast infections. In general, an antibiotic, a medicine that would eventually kill or at least slow down the growth of these microbes is prescribed by the physician to combat them when they invade the body, and one must remember that an antibiotic can fight a bacterial infection, but it cannot fight a virus infection. When an antimicrobial is prescribed, the microbes would be killed, or on the other hand, survive, and carry ‘resistance genes’. These survivors will replicate, and become predominant, so that they will become antibiotic resistant. Antimicrobial resistance can be caused through either inappropriate usage of antibiotics, or because of insufficient diagnostics, or even because of over usage of antibiotics within a hospital environment, which causes a fertile environment in which the viruses or bacteria can grow and multiply. Treatment for antimicrobial drug resistance must be started with the help of a healthcare provider, and even if the drugs may not cure the individual, they may at the very least help to reduce the chances of him spreading the infection to others. The best method, however, is to prevent the patient developing antimicrobial resistance, and this is where the APN would play an important role. She must be aware of the disease, and avoid misusing or overusing medications. She would also serve as the clear channel of communication between the patient and the physician, and this in itself would help the patient prevent the onset of drug resistance, and even if he has developed it, to overcome it. (Antimicrobial (drug) resistance 2008)
4. Although it may be true that the immune system in a human being is meant to protect him against disease, it is also true that the same immune reactions would cause adverse effects on the host. This is essence is what is meant by a hyper sensitivity reaction. These reactions can be commonly divided into four groups: type 1, type 2, type 3, and type 4. On the other hand, they can also be divided into groups such as immune complex reactions, inactivation or activation antigen reactions, and even allergic reactions. Today, several new types of mediators are available, which would form a part of the treatment for any of the gamut of hypersensitivity reactions: arachidonic acid metabolites, leukotrienes including B4, C4, D4 and E4. (Anand, K Miriam (2007)
Hypersensitivity reactions are perilous and hazardous, and in some cases, can even be fatal in the patient who suffers an attack. Take for example the abacavir hypersensitivity reactions in euroSIDA in euroSIDA HIV-I infected patients. A test was conducted on 3,278 patients, to investigate the incidence of abacavir hypersensitivity reactions and resultant deaths in them. The method used for the purpose was the ‘poisson regression model’, which was used to compare the incidence of the sensitivity reaction and the subsequent discontinuation in accordance with the line of treatment received, the geographical regions in which the patients received the treatment, and other factors. The results of the test indicated that out of the 3,278 patients who were started on abacavir, about 64.1 percent discontinued. Out of these patients, about 5.1 percent discontinued within a period of three months, because they had developed HSR, or hypersensitivity reaction, indicating that the incidence of HSR was higher for those patients who were starting abacavir in the first line regimen, as compared to those in the second line regimen. This was most probably, felt experts, of an increased over diagnosis. However, it must be remembered that the incidence of hyper sensitivity reaction has decreased over the past few years, perhaps due to the fact that today, genetic screening facilities are more widely and freely available than before. Furthermore, there is an increased awareness of specific symptoms in patients today, and this in itself would help prevent hyper sensitivity reactions. (Bannister WP, Moller Friis N, Mocroft A, Viard JP et al n.d) The implications of the new forms of treatment for HSR can be numerous, and today, the Advanced Practice Nurse must be well informed and well aware of the newest and latest diseases and their symptoms and treatment, so that she would be able to serve the patient better.
Bartels M Christie (2008) Systemic Lupus Erythematosus E Medicine Retrieved on September 8, 2008 from http://www.emedicine.com/MED/topic2228.htm
Bannister WP, Moller Friis N, Mocroft A, Viard JP (n.d) Incidence of abacavir hypersensitivity reactions in euroSIDA NCBI Pubmed Retrieved on September 8, 2008 from http://www.ncbi.nlm.nih.gov/sites/entrez/query.fcgi?myncbishare=uwonline&cmd=search&db=PubMed&term=hypersensitivity%20reactions,%20treatment+AND+english+[lang]&dispmax=50&doptcmdl=abstract&orig_db=PubMed&filters=on&pmfilter_EDatLimit=5+Years
Anand, K Miriam (2007) Hypersensitivity reactions, immediate E Medicine Retrieved on September 8, 2008 from http://www.emedicine.com/med/TOPIC1101.HTM
Alloimmunity (2008) The free dictionary by Farlex Retrieved on September 8, 2008 from http://medical-dictionary.thefreedictionary.com/Alloimmunity
Antimicrobial (drug) resistance (2008) National Institute of Allergy and Infectious Diseases Retrieved on September 8, 2008 from http://www3.niaid.nih.gov/topics/antimicrobialResistance/
Excerpt from Systemic Lupus Erythematosus (2006) E Medicine Retrieved on September 8, 2008 from http://www.emedicine.com/neuro/byname/Systemic-Lupus-Erythematosus.htm
What is Allergy? (n.d) Allergy UK Retrieved on September 8, 2008 from http://www.allergyuk.org/allergy_whatis.aspx
What is autoimmunity? (2001) John Hopkins Autoimmune Disease Research center Retrieved on September 8, 2008 from http://autoimmune.pathology.jhmi.edu/whatisautoimmunity.html