Alteration in Immunity

Alteration in Immunity

Differential diagnoses based on Janet’s subjective and objective data

Allergic Rhinitis: This is the swelling of the inside nose lining, which occurs when an individual inhales a substance that they are allergic to and is known to cause symptoms that are present year-round (McCance & Huether 2018).They may include dust mites exposure, seasonal allergies caused by pollen, but their episodic and severity levels differ. Her watery, red eyes which are slightly swollen are all signs of allergic rhinitis. Janet’s flaking erythematous rash is an objective data present on the flexor surface of both her arms. The fact that her symptoms have been present for the last five weeks, it is more likely that she was exposed to an allergen, which caused all her present symptoms.
Common Cold: Janet’s nasal congestion, cough, and sneezing are symptoms likely caused by a viral infection of the nose and throat (upper respiratory tract). According to the Mayo Clinic (2019), a common cold can last a week or 10 days, but for those with a weakened immune system, it can last longer. In this case, it is essential to rule out the possibility of Janet having an infection.
Chronic Sinusitis: This is because of Janet\’s erythema, facial tenderness, and irritated skin of the pharyngeal and nares erythema, thus, is a likely differential diagnosis. The boggy, nasal polyp and moist mucosa are objective findings supporting this diagnosis. Chronic inflammation results in the nasal polyp, which likely develops in five weeks. Janet is suspected of having a long history of recurrent sinus infections.
Additional History Questions

Further evaluation of Janet\’s case can look into her previous and present environment concerning her hygienic condition, such as the food she eats before her body started to weaken. Janet will also need to ascertain whether or not she has been admitted to the hospital before, and if yes, what drug prescription she was given at that time. Other questions may include:

Do you have asthma?
What is her personal history of allergies?
Does your family have a history of any allergies?
Have you ever experienced hay fever?
Any history of asthma in your family?
Pathophysiological Process of Primary Diagnosis

The primary symptoms of Janet’s condition include her nasal congestion, itchy eyes, a ‘tickling’ cough and episodes of frequent sneezing, which could be associated with allergic rhinitis. The attainment of such conclusions is through observing Janet and the information she provided to the physician.

Types of Hypersensitivity Mechanisms

Hypersensitivity response is classified into four types based on the mechanism of action. Immediate allergic reactions like anaphylaxis, food allergy, and asthma are classified as type I. A mediated cytotoxic response by antibody to a particular tissue is referred as type II, while those mediated by antibody-antigen complex hypersensitivity response which causes numerous kinds of tissue damage within the body is called type III (Basu & Banik2018). A delayed type of sensitivity or type IV hypersensitivity is characterized to describe the stimulation of the structure of the endocrine by immune reactions to some autoimmune infections.

Type I hypersensitivity

The Immediate hypersensitivity caused by the induction of IgE antibody to the exposure to allergens. The allergens may be harmless substances such as pollen, dust, or molds. Other allergens may be considered more hazardous such as insect venom, peanuts or shellfish (systemic anaphylaxis). This type of hypersensitivity response occurs as a by-product of an antigen cross-link to membrane-bound IgE antibody of mast cell or basophil. During an anaphylactic reaction, histamine is released, which leads to possible tissue damage inside the body. Hay fever is an example that portrays this type of hypersensitivity.

Type II hypersensitivity

This response is instigated by the toxic properties of antibody attached with antigens on the exterior of cells. Complement-dependent lysis can be activated by the antibodies leading to tissue injury (Basu & Banik2018). Activation of cell lysis by complement induction occurs during cytotoxic reaction where the antibody responds to the antigen attached to the cell membrane. Rh-incompatibility of a newborn is the best example of a cytotoxic reaction.

Type III hypersensitivity

The creation of antigen-antibody complexes facilitates type III hypersensitivity. IgM and IgG bind antigen, deposit immune complexes which stimulate complement, thus, affecting the PMN chemotaxis and its initiation. PMN then releases enzymes tissues which are harmful to the cells. An example of this type of response is serum sickness in the human body.

Type IV Hypersensitivity

Delay in its period course can progress from12-24 hours and endure for 2-3 days. This is where T-lymphocytes introduces cell-mediated responses and macrophages, eosinophil and T-cells are effects of the cell intermediated responses. Tuberculosis, a prolonged-lasting disease depicts this type of hypersensitivity.


From the symptoms provided, it is clear that Janet has immediate (type 1) hypersensitivity. This is an allergic reaction like anaphylaxis, food allergy and asthma justifiable from her physician, as well as, the use of both objective and subjective data. Allergens which may cause the symptoms exhibited by Janet, they are caused by substances such as pollen, molds and dust


Basu, S., & Banik B.K., (2018). Hypersensitivity: An Overview. Immunol Curr Res 2: 105.

Mayo Clinic, (2019).Common cold. Retrieved from

McCance K., L., & Huether, S., E. (2018).Pathophysiology: The Biologic Basis for Disease in Adults and Children (8th ed.) St Louis, MO: Mosby Inc;



What symptoms would the patient present with for each hypersensitivity reaction?

What would your initial treatment plan include for this patient? What would be specific patient education?

What would you recommend for the patients eczema?

What would you educate the patient about serious complications of her hypersensitivity reaction and when to seek emergency evaluation?

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