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Respectfully agree or disagree with your colleague’s assessment and explain your reasoning. In your explanation, include why their explanations make physiological sense or why they do not. TWO CITATIONS BY RESPONSE
Response 1
Our bodies react to everything that we encounter in our environment either through contact, injection, ingestion, or inhalation. Many of these factors do not cause a reaction in our bodies but there are times that these factors create an allergic reaction within our bodies that can result in hives, swelling, wheezing, itching, diarrhea, etc. A provider can order testing to determine an individuals allergies so that they can determine the best way to treat symptoms. A common treatment option for allergies is the use of immunotherapy injections to desensitize the bodies response to that particular allergen.
Genetics plays a role into how our bodies will respond to allergens we come into contact with in our daily lives. The term atopy refers to the genetic predisposition to allergic diseases such as asthma, allergic rhinitis, atopic dermatitis, and food allergies (Justiz et al., 2023). In the scenario provided, C.M. is receiving allergy immunotherapy injections to decrease his bodies sensitivity reaction to a determined allergen. Upon receiving his immunotherapy injection C.M. reported feeling weak, nauseous, and having difficulty swallowing, this reaction occurred 30 minutes after the injection. The bodies response to the immunotherapy injection was to release histamine through the H1 receptrs, the histamine causes the bronchial smooth muscles to contract resulting in constriction in the bronchi. Histamine also causes the vascular system to become more permeable which causes blood flow to increase to that area resulting in edema. When the histamine acts through the H2 receptors it causes an increase in gastric acid secretion while decreasing the amount of histamine that is released from mast cells and basophils causing a disruption in degranulation (McCance and Huether, 2019). With a later more prolonged response to the allergen the mast cells could be releasing leukotrines, platelet-activating factor, and prostaglandins at a slower rate, delaying the reaction and possibly making it last longer (McCance and Huether, 2019).
If C.M. were a 13 year old female I would possibly look at the reaction differently due to the increase in likely hood of the female developing asthma. When female hormones change and they start menstruating, using contraceptives, or having children it can cause a change in the reaction of the cells in the body causing an increase in the cell response resulting in the onset of asthma that becomes a chronic issue requiring further medication management and lifestyle changes to manage symptoms (Jensen-Jarolim, 2017).
Response 2
The assigned case study is of a male patient who presents to the clinic to receive allergy immunotherapy “allergy shots”. After receiving the IM medication, he waited 30 minutes before leaving the center. As he was leaving, he began to complain of having difficulty swallowing, nausea, and weakness. His vitals are 100/76, HR 120, Resp 24, O2 sat 95% and the patient has begun tripoding. The patient appears to be experiencing an anaphylactic response to the immunotherapy he received. Anaphylaxis requires immediate intervention in order to prevent mortality. Anaphylaxis is a systemic reaction that is believed to be influenced by mast and basophil cells causing the subsequent release of mediators (Peavy, 2009).
Role of Genetics
Genes play a large role in in the systems of the body, and how they react as allergens is often hereditary. The IgE antigen is responsible for the initiation of the allergic response which occurs in the body. IgE responses have profound effects on genetics affecting the variation and selection (Baud, 2022). The IgE response occurs when the phenotype is affected by the genetic mutations, which is strongly under control by approximately 50-80% of the heritability (Chang et al, 2013).
Why the patient presented with the symptoms to the ED
This 22-year-old male presented to the ED status-post immunotherapy allergy shots. He presents with what appears to be an allergic reaction with tachycardia, tachypnea, and breathing in the tripod position. The patient also reports feeling weakness and nausea. The tripoding position is a common position in which patients enter to help optimize the inspiratory effort, thus allowing the diaphragm to obtain its normal size and shape, subsequently relieving the patient’s shortness of breath (Meegada et al, 2020). All of the noted symptoms allow us to assume the patient is experiencing an anaphylactic response to the allergy shots received before admission.
What was the physiology response and why did the response occur?
When the body detects an allergen, it creates a hypersensitive reaction leading to the activation of mast cells creating an allergic reaction (McCance & Huether, 2019). The most influential mediator in this response is a histamine which acts through the H1 receptors. A great number of histamines and eventually leukotrienes are released increasing the permeability of the allergen thus causing edema, vasodilation, and in turn for this instance, creating trouble breathing or anaphylaxis (McCance & Huether, 2019). This then creates a Type I hypersensitivity reaction, which can be seen during anaphylaxis (Vaillant et al, 2023).
Which cell are involved in this process (Allergic reactions)
Allergic reactions are IgE-mediated. The cells involved in the process include the IgE, mast cells (neutrophils and eosinophils), basophils, and histamines. During the allergic reactions, the IgE antibodies are produced by the immune system which bind to the mast and basophil cells. These cells contain histamines which are released, causing the type 1 hypersensitivity reaction (Vaillant et al, 2023). Histamines are the most potent release in the allergic reaction. The cell binds to the H1 creating a proinflammatory response, thus affecting the airway in the allergic response (McCance & Huether, 2019). The H1 receptor is present within the smooth muscle on cells, and very pertinent within the bronchi, thus causing muscles to contract and causing bronchoconstriction. Neutrophils are the predominant leukocytes that work during the beginning stages of the inflammatory response (McCance & Huether, 2019).
How another characteristic (e.g., gender, genetics) would change your response.
Genetic factors heavily contribute to the result of the disease process subsequently causing individuals to react differently to disease processes. Another characteristic to consider is gender. Sexual hormones and gender have been shown to affect the individual’s response to the allergen. Our immune cells express hormonal receptors which can be influenced by individual hormones. Estrogen has been shown to aggravate the inflammatory response compared to testosterone in men, which promotes protective measures (Jarolim, 2017). There have also been studies that have shown that the intake of oral contraception increases IgE levels showing a direct coloration with hormone levels and allergic reactions (Jarolim & Untersmayr, 2008).
