Flashcards in Immunotherapies Deck (25)
What are the main categories/types of immunotherapies?
Immunoglobulin G, hypoerimmune globulins, IgG anti-D antibody, Allergen desensitization, Anti-IgE therapy
What can you treat with IV IgG and how long can the effect last?
Primary and secondary immune deficiency states, autoimmune disorders and inflammatory disorders. The effects can last 2-3 weeks.
What can you find in IV IgG in small amounts and why is this important?
IgA, patients with IgA deficiences can have a auto-imune response (anaphylactic response)
What is the most common path of administration and the side effects of IgG? How can you reduce the SE?
IV, fever, chills, malaise, HA, dyspnea, urticaria, anaphylaxis (IgA def), thrombosis, hemolysis, kidney injury. Pre-treatment-hydrate, otc nsaid, histamine blocker(H!) like benedryl and possibly sterioids. Test for blood borne pathogens and relevant viral infections as well as renal/liver function.
What is hyperimmune globulin and what are some common conditions it is used to treat?
Prepared from the plasma of donors with high titers of antibody against a specific organism or antigen (hep b, rabies, tetanus, varicella-zoster) Provides instant but short lived immunity.
What are some special considerations of using immune globulins?
may decrease efficacy of live vaccines (should hold for 6 months), a vaccine immediately prior may need to be repeated, don't give to patients with IgA antibodies.
What is HBIG and what are it's uses/SE/CI?
Side effects: allergic reaction, back pain, general feeling of discomfort, headache, muscle pain, nausea, pain or bleeding at the injection site
Contraindications: allergy to human immune globulin
Give within 14 days of exposure
Give with Hepatitis B vaccination for long lasting immunity
How can you treat a rabies exposure?
Rabies immune globulin injected around wound and the rest IM in gluteal region. Administer vaccine at the same time.
What is TIG and what are it's indications/SE/CI?
uncertain of their history of tetanus vaccination or if they have not completed their tetanus series
AND has a wound that is unclean or is significant
Administration: IM and with vaccine
Side effects: anaphylaxis, angioedema, pain or tenderness at the injection site, nephritic syndrome
Contraindications: allergy to tetanus toxoid, or if IM injection is contraindicated due to bleeding concerns
Who would you treat with VariZIG?
post exposure prophylaxis for immunocompromised individuals without history of immunity; newborns of mothers with varicella or zoster within 5 days before or 48 hours after delivery
What are some SE of VariZIG and other barriers to use?
Side effects: anaphylaxis, pain at injection site, chills, fatigue, rash, nausea, thrombosis
Limited quantities available, expensive
What is Rh disease and what mother/combinations cause it?
Rh is Rhesus disease and happens when a mother who is Rh- has a child with a Rh+ man and develops antibodies to Rh+. Complications arise during subsequent pregnancies.
How can you treat Rh disease if it's suspected?
You can use Rho(D) immune globulin which suppresses the mothers immune system from attacking the Rh+ cells of the fetus.
What are SE/CI of Rho(D)
: ↑↓ BP, chills, fever, rash, abdominal pain, nausea, vomiting, injection site reaction (discomfort, induration, redness) joint pain, back pain, acute renal failure, anaphylaxis, if given for ITP also cause hemolysis, decreased hemoglobin, increased bilirubin
Contraindications: hypersensitivity to immune globulins or prior sensitization to Rho(D)
When do you treat with Rho(D)?
Given at 28 weeks gestation
Given after trauma to the mother, any procedures during pregnancy, any suspicion of maternal fetal hemorrhage, miscarriage or abortion
Given within 72 hours after delivery if the baby is Rh +
What is the idea behind allergen desensitization (allergy shots)?
Increasing amounts of allergen are administered in an attempt to alter the abnormal immune response to that allergen and relieve symptoms
How does allergen immunotherapy work?
Thought to generate IgG blocking antibodies that cover the antigen and block it from binding with IgE
May stimulate regulatory Tcells to down regulate the response to that antigen
What are the most common allergens in NA that we can treat with immunotherapy?
Pollen, pets, mold, grass, hymenopter (bee stings), ragweed, trees, cockroach, dust mites.
What are indications for immunotherapy use?
Failure of medical and avoidance therapy
Symptoms are secondary to the allergen in question AND skin or serum testing to the allergen is positive
Allergy symptoms interfere with daily life
For children with allergic rhinitis, therapy may decrease the development of asthma (decrease the incidence from 45% down to 25%)
What are some factors to consider when using immunotherapy
CI in sever or labile asthma and patients on BB. Don't initiate during pregnancy. >5yo, reliable patient for f/u
What is the timeline for immunotherapy and some considerations when giving doses?
Build up phase
1-3 injections per week for several weeks
Injections every 2-4 weeks
Duration of therapy
this can be altered if patient is sensitive(slower) or effect is needed sooner(faster)
What can be an adverse reaction to immunotherapy and what should you do to be prepared for this?
Will occur in up to 80% of patients
Occurs at the site of the injection
Redness, pruritus, swelling
Will occur in up to 0.25-3.5% of patients
Occurs away from the injection site
May range from mild rhinitis to fatal cardiovascular collapse
Monitor patient for 30min after injection, no exercise 2hr before and after. Have a crash cart with epi, IV antihistamine, glucocorticoids and airway mgmt supplies.
Measure the size of local reactions in cm for immunologist
How can you determine the extent of a patients reaction to bee stings?
Measure baseline serum tryptase levels
Baseline levels > 11.4 ng/mL may indicate a mast cell disorder (nml < 11.4)
Chronically elevated levels predict more severe reactions to stings in general, more frequent treatment failure and greater risk of relapse after stopping therapy
What is Anti-IgE therapy used for and what is a common medication?
For the treatment of moderate to sever persistent asthma caused by year round allergens and in patients where high dose inhaled steroids fail. Serum IgE levels of 30-700IU/ml. Administered subcut Q 2-4 weeks, $$$$$$