Disorder of the Immune Response Case Study
The case presented is that of Ahmed, a phlebotomist at the hospital who for the past year has been presenting symptoms that have been classified as allergy (nasal congestion and wheezing) since they are presented every time he is in the hospital. The last allergic reaction that I presented was when putting on the gloves which produced in issues of minutes acute respiratory distress, reason why it was interpreted as an allergic response to the latex exposure. The immune system is an integral part of human protection against diseases, but normally protective immune mechanisms can sometimes cause harmful reactions. Ahmed experiment, a type I reaction (immediate hypersensitivity reactions) involve the release mediated by immunoglobulin E (IgE) of histamine and other mediators of mast cells and basophils. The prevalence of atopic diseases (asthma, allergic rhinitis, food allergy and atopic dermatitis) has increased since 2000. Allergic rhinitis is the most frequent allergic disease affected between 17-22% or more of the population. It is estimated that asthma affects 25.7 million people in the United States in 2010, increasing its prevalence from 7.3% in 2001 to 8.4% in 2010. Atopic dermatitis has increased its prevalence worldwide in the last decade. Anaphylaxis can be as high as 2%, with an increase in younger patients. (Buelow & Routes, 2015)
How can this be determined by his signs and symptoms?
The type 1, IgE-mediated hypersensitivity response (anaphylaxis) is characterized by signs and symptoms that mostly involve several systems of the organism, symptoms develop rapidly reaching its maximum severity within 3 to 30 minutes. Symptoms for systems include: Gastrointestinal (may present, abdominal pain, fecal urgency or incontinence, nausea, vomiting, diarrhea). Respiratory (Obstruction of the upper airway by angioedema of the tongue, oropharynx or larynx, bronchospasm, oppression of the chest, cough, wheezing, rhinitis, sneezing, congestion, rhinorrhea). Oral (pruritus of the lips, tongue and palate, in addition to edema of the lips and tongue). Cutaneous (diffuse erythema, flushing, urticarial, angioedema and pruritus). Cardiovascular (fainting, hypotension, arrhythmias, hypovolemic shock, syncope, chest pain). Genito-urinary (urinary urgency, incontinence), Ocular (periorbital edema, erythema, lacrimation, conjunctival erythema) This inflammatory response can cause death in minutes (Lockey, 2012)
How might another type of latex hypersensitivity reaction present?
The allergic reaction to latex can occur in different ways. It can cause an irritant dermatitis (non-allergic inflammation) located on the skin that causes redness, itching and skin lesions caused by chemical irritation which does not involve the immune system. It can also cause type IV dermatitis that is limited to the skin and is an inflammation by chemical contact causes redness, itching and skin lesions. And the systemic reaction type 1 that constitutes the real reaction of hypersensitivity, its symptoms vary from rhinitis to death. (Vargas, Fonceca & Astorga, 2017)
How do T2H cells, mast cells, and eosinophils function to produce the signs and symptoms typical of a type I hypersensitivity disorder?
For an allergic reaction to occur, it first requires sensitization to a specific allergen and occurs in individuals with genetic predisposition. The allergen is inhaled or swallowed and then processed by an antigen-presenting cell (APC), such as a dendritic cell, a macrophage or a B cell. The (APC) then migrate to the lymph nodes, where naive TH cells predominate. They have receptors for the specific antigen. After antigen priming, the virgin TH cells differentiate into TH1, TH2 or TH17 cells based on the cytokines they produce. In the case of sensitization to allergens, the differentiation of virgin TH cells leans towards TH2. These TH2 cells sensitized with allergens release IL-4, IL-5, IL-9 and IL-13. IL-5 plays a role in the development, recruitment and activation of eosinophils. IL-9 plays a regulatory role in the activation of mast cells. IL-4 and IL-13 act on B cells to promote the production of antigen-specific IgE antibodies. Antigen-specific IgE antibodies can bind to receptors located on the surfaces of mast cells and basophils. Reexposure to the antigen can result in antigen binding and cross-linking of IgE antibodies bound in mast cells and basophils. This causes the release and formation of chemical mediators of these cells. For example, histamine acts on the receptors of histamine 1 (H1) and histamine 2 (H2) producing the contraction of the smooth muscles of the respiratory tract and gastrointestinal tract, increased vasopermeability and vasodilation, increased mucus production, itching, cutaneous vasodilation and gastric acid secretion. (Buelow & Routes, 2015)
How is it that someone who does not come into direct contact with latex can still have a hypersensitivity response to the material?
In addition to direct skin contact with latex products, people may be exposed to latex in other ways. For example, latex antigens carried in the air can be inhaled into the lungs and cause allergic reactions. To prevent sticking, latex gloves were typically manufactured by adding powdered corn starch particles. Allergic latex glove proteins can bind to dust particles, which can become airborne and trigger allergic reactions and pull dusts (especially residents living near a busy road). (Wu, McIntosh & Liu, 2016)
What do food allergies have to do with latex allergies?
It has been reported that latex allergies can be caused by foods contaminated by workers wearing latex gloves. Natural rubber is a widely used material approved by the FDA for food additives and packaging. In addition, there is a cross-reactivity with fruits. Studies have shown that tropical fruits (such as avocado, banana, chestnut and kiwi) contain proteins that have allergenic similarities to latex. Patients with allergies to these fruits have a high risk of cross-reactivity and develop an allergy known as “latex fruit syndrome” when they come into contact with latex products. Approximately 30% -50% of people with latex allergy show a hypersensitivity associated with one or more of these fruits. (Wu, McIntosh & Liu, 2016)
References
Buelow, B., Routes, J.M. (2015) Immediate Hypersensitivity Reactions. Retrieved from https://emedicine.medscape.com/article/136217-overview
Lockey, R.F. (2012). Anaphylaxis: Synopsis. World Allergy Organization. Retrieved from http://www.worldallergy.org/professional/allergic_diseases_center/anaphylaxis/anaphylaxissynopsis.php
Vargas, A., Fonceca, c., & Astorga, P. (2017). Latex allergy: Overview and Recommendations for the Perioperative Management of High-Risk Patients. Journal of Head Neck $ Spine Surgery.1(1). Retrieved from https://juniperpublishers.com/jhnss/pdf/JHNSS.MS.ID.555552.pdf
Wu, M., McIntosh, J., Liu, J. (2016). Current prevalence rate of latex allergy: Why it remains a problem? Journal of Occupational Health. 58(2). doi: 10.1539/joh.15-0275-RA
