Alterations in Cellular Processes NURS 6501 week 1 Discussion
Alterations in Cellular Processes
Scenario: A 16-year-old boy comes to clinic with chief complaint of sore throat for 3 days. Denies fever or chills. PMH negative for recurrent colds, influenza, ear infections or pneumonias. NKDA or food allergies. Physical exam reveals temp of 99.6 F, pulse 78 and regular with respirations of 18. HEENT normal with exception of reddened posterior pharynx with white exudate on tonsils that are enlarged to 3+. Positive anterior and posterior cervical adenopathy Alterations in Cellular Processes NURS 6501 week 1 Discussion. Rapid strep test performed in office was positive. His HCP wrote a prescription for amoxicillin 500 mg po q 12 hours x 10 days disp #20. He took the first capsule when he got home and immediately complained of swelling of his tongue and lips, difficulty breathing with audible wheezing. 911 was called and he was taken to the hospital, where he received emergency treatment for his allergic reaction.
In the case study, the boy is showing signs of an Anaphylaxis reaction or hypersensitivity type one reaction to Amoxicillin. Anaphylaxis is a systemic response to an antigen that can potentially lead to death (Peavy & Metcalfe, 2008). Anaphylaxis can vary in severity, triggers, and symptoms. Triggers for anaphylaxis can include medications, foods, and stinging insects. Anaphylaxis occurs in at least 1 in 50 adults in the United States, showing an increase in prevalence (Wood et al., 2014). In this particular case study, the trigger, or antigen is Amoxicillin.
Genetics may play a role in hypersensitivity reactions. According to Khoury and Lyons (2019), there may be a link between people with elevated basal serum tryptase and an increase risk in hypersensitivity reactions, although research is still being done. According to Abbas and Moussa (2021), there may be a genetic predisposition to allergic reactions. There was not a lot of data available about the role of genetics in allergic reactions Alterations in Cellular Processes NURS 6501 week 1 Discussion. I do not think there is very clear-cut evidence showing the link between the two at this time. Gender does not seem to play a role in allergic reactions either.
Physiologic Response and Cell Activity
When the boy in the case study ingested the Amoxicillin, this triggered a hypersensitivity response in his body. It appears that the boy has been exposed to Amoxicillin before and his body has been sensitized to it. Sensitization is when there is enough T cells built up where the reaction is noticeable and what triggers the allergic reaction (McCance & Huether, 2019). If he was not sensitized, he would not have had the reaction. During the sensitization process, the antigen is ingested into the body. In this case, the antigen is the Amoxicillin. Once the Amoxicillin is ingested, the antigen- presenting cell comes along and takes in some of the Amoxicillin, breaks it down and puts it on its surface receptors. The antigen-presenting cell travels to the lymph nodes where it meets the T-Helper cells. The antigen-presenting cell presents the antigen to the T-helper cell. The T-helper cells then notify the B-cells that there is a new antigen. The T-helper cells communicate with the B-cells using cytokines. The B-cell is activated into a IgE plasma cell. The IgE cell then binds onto the FC receptors of mast cells and basophils. The body is sensitized at this point. (Peavy & Metcalfe, 2008)
The scenario discussed in the case study happened after sensitization occurred. The mast cells were just floating around in his body waiting to encounter Amoxicillin again. When the boy in the case study ingested Amoxicillin this time, the Amoxicillin is cross linked on the IgE on the mast cells and basophils and it activates the degranulation process. This releases large amounts of histamine and other mediators into the body which causes peripheral vasodilation, increase in vascular permeability, smooth muscle contraction, and bronchospasms (He et al., 2013) Alterations in Cellular Processes NURS 6501 week 1 Discussion. All of these internal changes cause external symptoms. Increasing vascular permeability and vasodilation causes edema and redness to tissues. With the increase in vascular permeability, neutrophils and other cells are able to escape from blood vessels and cause inflammation. Smooth muscle constriction and bronchospasms cause shortness of breath and wheezing. The release of mediators from the mast cells attracts Eosinophils to tissues causing things like itching, eczema, hay fever, angioedema, and asthma (Abbas & Moussa, 2021).
Abbas, M., & Moussa, M. (2021). Type I Hypersensitivity Reaction. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK560561/
He, S., Zhang, H., Zeng, X., Chen, D., & Yang, P. (2013). Mast cells and basophils are essential for allergies: Mechanisms of allergic inflammation and a proposed procedure for diagnosis. Acta Pharmacologica Sinica, 34(10), 1270–1283. https://doi.org/10.1038/aps.2013.88
Khoury, P., & Lyons, J. J. (2019). Mast cell activation in the context of elevated basal serum tryptase: Genetics and presentations. Current Allergy and Asthma Reports, 19(12). https://doi.org/10.1007/s11882-019-0887-x
McCance, K. L., & Huether, S. E. (2019). Pathophysiology – e-book: The biologic basis for disease in adults and children (8th ed.). Mosby. Alterations in Cellular Processes NURS 6501 week 1 Discussion
Peavy, R. D., & Metcalfe, D. D. (2008). Understanding the mechanisms of anaphylaxis. Current Opinion in Allergy & Clinical Immunology, 8(4), 310–315. https://doi.org/10.1097/aci.0b013e3283036a90
Wood, R. A., Camargo, C. A., Lieberman, P., Sampson, H. A., Schwartz, L. B., Zitt, M., Collins, C., Tringale, M., Wilkinson, M., Boyle, J., & Simons, F. R. (2014). Anaphylaxis in america: The prevalence and characteristics of anaphylaxis in the united states. Journal of Allergy and Clinical Immunology, 133(2), 461–467. https://doi.org/10.1016/j.jaci.2013.08.016