Understanding Immunology & Allergy Nursing Assessment
The immune system is a coordinated network of cells, tissues and organs that defends the body against pathogens, neutralises foreign antigens and clears damaged or malignant cells. It comprises innate defences (skin, mucosa, neutrophils, monocytes/macrophages, NK cells, complement) and adaptive immunity (B and T lymphocytes with antigen specificity and memory). Central lymphoid organs (bone marrow, thymus) generate immune cells; peripheral lymphoid organs (lymph nodes, spleen, mucosa-associated lymphoid tissue) coordinate responses.
Disorders of immunity are broadly grouped as: hypersensitivity / allergic disease (types I–IV — IgE-mediated anaphylaxis and atopy, cytotoxic, immune-complex and delayed-type reactions); autoimmunity (loss of self-tolerance, e.g. SLE, rheumatoid arthritis, type 1 diabetes, autoimmune thyroiditis); primary or secondary immunodeficiency (e.g. SCID, common variable immunodeficiency, HIV-related immunodeficiency, post-chemotherapy or post-transplant immunosuppression); and lymphoproliferative disorders. Many conditions overlap with rheumatology, infectious disease, dermatology, respiratory and haematology.
Nursing assessment integrates targeted history (atopic, infection, drug, vaccination, family and travel history), allergy triggers, mucocutaneous inspection (urticaria, eczema, angioedema, purpura), lymph-node and spleen palpation, respiratory and cardiovascular review, and recognition of red-flag presentations — particularly anaphylaxis, severe cutaneous adverse reactions (Stevens–Johnson syndrome / toxic epidermal necrolysis), and sepsis in the immunocompromised. Care responsibilities include safe administration of antihistamines, corticosteroids, intramuscular adrenaline (epinephrine), biologics, immunoglobulins and immunosuppressants; allergen avoidance and immunotherapy support; vaccination per local schedules; and structured emergency action plans for high-risk patients.
Core immunology concepts
Hypersensitivity (Gell & Coombs): Type I (IgE-mediated mast cell degranulation) — anaphylaxis, urticaria, allergic rhinitis, asthma; Type II (IgG/IgM cytotoxic) — autoimmune haemolytic anaemia, transfusion reactions; Type III (immune-complex) — serum sickness, lupus nephritis; Type IV (T-cell mediated, delayed) — contact dermatitis, tuberculin reaction, drug rashes. Self-tolerance is maintained centrally (thymus, bone marrow) and peripherally (regulatory T cells); breakdown drives autoimmunity. Primary immunodeficiencies typically present with severe, persistent, unusual or recurrent infections (the SPUR pattern) and may need genetic workup.
🚨 Immunology / Allergy red flags — escalate immediately
- Anaphylaxis — acute onset (minutes to hours) of skin/mucosal symptoms plus airway compromise (stridor, wheeze, hoarseness), hypotension/shock, or persistent GI symptoms after exposure to a likely trigger; give intramuscular adrenaline (epinephrine) without delay (Resuscitation Council UK / WAO / EAACI)
- Angio-oedema with airway involvement — swelling of lips, tongue, pharynx or larynx; consider hereditary/acquired C1-INH deficiency or ACE-inhibitor–induced angio-oedema (different management)
- Severe cutaneous adverse reactions — Stevens–Johnson syndrome / toxic epidermal necrolysis or DRESS: blistering rash, mucosal involvement, skin detachment, fever, organ dysfunction (medical emergency, stop offending drug, transfer to specialist unit)
- Neutropenic / immunocompromised sepsis — fever or hypothermia with HIV, post-chemotherapy, transplant or biologic therapy; give empirical broad-spectrum antibiotics within 1 hour
- Acute graft-versus-host disease — rash, diarrhoea, hyperbilirubinaemia post haematopoietic stem-cell transplantation
- Suspected primary immunodeficiency in a child — severe, persistent, unusual or recurrent infections; failure to thrive; family history of early infant deaths
Rapid Assessment Pathways
Allergic / Anaphylactic Reaction
- Onset minutes to hours after suspected exposure (food, drug, venom, latex)
- Skin/mucosa: urticaria, flushing, angio-oedema, pruritus
- Respiratory: rhinorrhoea, sneezing, wheeze, stridor, dyspnoea
- GI: nausea, vomiting, abdominal pain, diarrhoea
- Cardiovascular: tachycardia, hypotension, syncope (anaphylaxis)
Recurrent / Unusual Infections
- Frequency, severity, opportunistic organisms (PCP, candida, CMV)
- Sites: sinopulmonary, skin, deep-seated, disseminated
- Failure to thrive, poor growth, family history
- FBC and differential, immunoglobulins, lymphocyte subsets, HIV test
- Vaccine response (e.g. specific antibodies post-immunisation)
Suspected Autoimmunity
- Multisystem: joints, skin, kidneys, blood, mucosae
- Systemic: fatigue, fever, weight loss, photosensitivity
- Disease-specific antibodies (ANA, anti-dsDNA, RF, anti-CCP, ANCA)
- Inflammatory markers (ESR, CRP), complement (C3, C4)
- Organ-specific vs systemic (consider rheumatology referral)
Vaccine / Drug Reaction
- Time relationship to vaccine, drug or biologic
- Local: redness, swelling, pain, induration
- Systemic: fever, rash, anaphylaxis, serum sickness
- Rare: GBS, ITP, myocarditis, vaccine-induced thrombosis (signal-dependent)
- Report via local pharmacovigilance (e.g. Yellow Card, VAERS, EudraVigilance)
Immunology / Allergy Symptoms
Common Conditions
Nursing Procedures
Diagnostic Tests
Immunology / Allergy Medications
Related Body Systems
▶ References & Guidelines
- World Health Organization (WHO). Asthma · HIV/AIDS · Immunization, Vaccines and Biologicals.
- World Allergy Organization (WAO). Allergic Diseases Resource Center and Anaphylaxis Guidance.
- European Academy of Allergy and Clinical Immunology (EAACI). Clinical guidelines on anaphylaxis, food allergy, drug allergy, allergen immunotherapy and atopic dermatitis.
- American Academy of Allergy, Asthma & Immunology (AAAAI) / ACAAI / JCAAI. Joint Task Force Practice Parameters.
- ARIA — Allergic Rhinitis and its Impact on Asthma. ARIA guidelines.
- Global Initiative for Asthma (GINA). Global Strategy for Asthma Management and Prevention.
- National Institute for Health and Care Excellence (NICE). Allergies, intolerances and anaphylaxis · Blood and immune system conditions.
- Resuscitation Council UK. Emergency treatment of anaphylaxis — guidelines.
- UNAIDS. Global HIV statistics fact sheet.
- European Society for Immunodeficiencies (ESID) / Jeffrey Modell Foundation. Diagnostic criteria for primary immunodeficiencies.
- Centers for Disease Control and Prevention (CDC). ACIP immunisation recommendations (international reference).
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