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12/26/23, 10:09 PM NR507 Week 1 Case Study Allergic rhinitis
Week 1 Case Study Template
Case Study Scenario
A 35-year-old woman presents to the primary care office with a history of nasal congestion that
has worsened over time and recurrent sinus infections. She considered herself healthy until
about 12 months ago when she began experiencing rhinorrhea, sneezing, and nasal stuffiness
that "seems to never go away". She noticed that her rhinorrhea greatly improved when she
attended her family reunion on a two-week Caribbean cruise but returned after being home a
few days. She lives with her husband and 5- year-old child. They have two household pets: a
dog that has lived with them for the last 4 years and a cat who joined the family 1 year ago.
Upon exam, the NP observed eyelid redness and swelling, conjunctival swelling and erythema,
allergic shiners (lower lid venous swelling), Allergic crease (lateral crease on the nose) and
inflamed nares.
Pathophysiology & Clinical Findings of the Disease
1. Identify the correct hypersensitivity reaction:
According to the assessment by the nurse practitioner (NP) and the presenting symptoms
this patient’s most likely diagnosis is allergic rhinitis (AR). Allergic rhinitis is a type I
hypersensitivity reaction which is mediated by immunoglobulin E (IgE) antibodies. With this
reaction, mast cells degranulate and histamine and other primary and secondary mediators are
released. In the immediate phase, it is an IgE-mediated immunological response to inhaled
antigens, with a following leukotriene-mediated late phase. The most potent mediator is
histamine which affects many target cells causing epithelial damage, mucus secretion,
leukocyte infiltration, and edema. Sneezing, nasal congestion, clear rhinorrhea, and nasal
pruritis are all symptoms of AR (Akhouri & House, 2023).
Testing for allergic reactions to specific allergens can confirm the diagnosis of allergic rhinitis
and identify specific allergic triggers. The most common methods of determining allergy to a
about:blank 1/8
This study source was downloaded by 100000889304135 from nursinghero.com on 09-08-2024 18:17:07 GMT
###NR507_Week_1_Case_Study_Allergic_rhinitis.pdf
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,###NR507_Week_1_Case_Study_Allergic_rhinitis.pdf
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NR507_Week_1_Case_Study_Allergic_rhinitis.pdf - converted
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12/26/23, 10:09 PM NR507 Week 1 Case Study Allergic rhinitis
Week 1 Case Study Template
specific substance are allergy skin testing (testing for immediate hypersensitivity reactions) and
in vitro diagnostic tests, such as the fluorescence enzyme immunoassay (FEIA), such as
ImmunoCAP, which indirectly measures the quantity of specific IgE to a specific antigen (Jean &
Ziyar, 2023).
2. Explain the pathophysiology associated with the chosen hypersensitivity reaction:
There are 4 types of hypersensitivity reactions: type I (IgE mediated) hypersensitivity
reactions, type II (tissue specific) hypersensitivity reactions, type III (immune complex-
mediated) hypersensitivity reactions, and type IV (cell-mediated) hypersensitivity reactions.
Type I hypersensitivity reaction is usually most involved in allergies such as allergic rhinitis and
most occur against allergens in the environment. It can be divided into early and late phases
(McCance & Huether, 2019).
In the early phase, within 20 minutes of when a person is first exposed to the allergen the
sensitization phase of type I hypersensitivity reaction occurs. The allergen is usually introduced
through the respiratory tract by inhalation, through gastrointestinal tract by ingesting, or through
contact via the skin. The allergen or antigen is then processed by antigen-presenting cells
(APCs) which move to the lymph nodes where they instruct naïve T helper cells that carry the
receptors for the specific antigen. Then the naïve T helper cells differentiate into TH1, TH2, or
TH17 depending on the antigen and cytokine signaling. During initial exposure, for sensitization,
differentiation usually results in TH2 cells. These TH2 cells then release IL4, IL5, IL9, and IL14
cytokines. IL5 is involved in development, recruitment, and activation of eosinophils. IL9 is
involved in mast cell activation. IL4 and IL13 affect B cells to produce antigen specific IgE
antibodies. For B cells to produce these antigen specific IgE antibodies they must first
internalize the antigen. The antigen is processed by the MHC class II molecules that present the
peptide of the antigen on the surface of the B cell so the T cell receptor on the TH2 cell
recognizes the bound antigen peptide and the MHC class II complex. This also involves CD40
about:blank 2/8
This study source was downloaded by 100000889304135 from nursinghero.com on 09-08-2024 18:17:07 GMT
###NR507_Week_1_Case_Study_Allergic_rhinitis.pdf
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12/26/23, 10:09 PM NR507 Week 1 Case Study Allergic rhinitis
Week 1 Case Study Template
Case Study Scenario
A 35-year-old woman presents to the primary care office with a history of nasal congestion that
has worsened over time and recurrent sinus infections. She considered herself healthy until
about 12 months ago when she began experiencing rhinorrhea, sneezing, and nasal stuffiness
that "seems to never go away". She noticed that her rhinorrhea greatly improved when she
attended her family reunion on a two-week Caribbean cruise but returned after being home a
few days. She lives with her husband and 5- year-old child. They have two household pets: a
dog that has lived with them for the last 4 years and a cat who joined the family 1 year ago.
Upon exam, the NP observed eyelid redness and swelling, conjunctival swelling and erythema,
allergic shiners (lower lid venous swelling), Allergic crease (lateral crease on the nose) and
inflamed nares.
Pathophysiology & Clinical Findings of the Disease
1. Identify the correct hypersensitivity reaction:
According to the assessment by the nurse practitioner (NP) and the presenting symptoms
this patient’s most likely diagnosis is allergic rhinitis (AR). Allergic rhinitis is a type I
hypersensitivity reaction which is mediated by immunoglobulin E (IgE) antibodies. With this
reaction, mast cells degranulate and histamine and other primary and secondary mediators are
released. In the immediate phase, it is an IgE-mediated immunological response to inhaled
antigens, with a following leukotriene-mediated late phase. The most potent mediator is
histamine which affects many target cells causing epithelial damage, mucus secretion,
leukocyte infiltration, and edema. Sneezing, nasal congestion, clear rhinorrhea, and nasal
pruritis are all symptoms of AR (Akhouri & House, 2023).
Testing for allergic reactions to specific allergens can confirm the diagnosis of allergic rhinitis
and identify specific allergic triggers. The most common methods of determining allergy to a
about:blank 1/8
This study source was downloaded by 100000889304135 from nursinghero.com on 09-08-2024 18:17:07 GMT
###NR507_Week_1_Case_Study_Allergic_rhinitis.pdf
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Page 1 of 8NR507_Week_1_Case_Study_Allergic_rhinitis.pdf - converted (1).pdfNR507_Week_1_Case
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,###NR507_Week_1_Case_Study_Allergic_rhinitis.pdf
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NR507_Week_1_Case_Study_Allergic_rhinitis.pdf - converted
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(1).pdfNR507_Week_1_Case
(1).pdf!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
12/26/23, 10:09 PM NR507 Week 1 Case Study Allergic rhinitis
Week 1 Case Study Template
specific substance are allergy skin testing (testing for immediate hypersensitivity reactions) and
in vitro diagnostic tests, such as the fluorescence enzyme immunoassay (FEIA), such as
ImmunoCAP, which indirectly measures the quantity of specific IgE to a specific antigen (Jean &
Ziyar, 2023).
2. Explain the pathophysiology associated with the chosen hypersensitivity reaction:
There are 4 types of hypersensitivity reactions: type I (IgE mediated) hypersensitivity
reactions, type II (tissue specific) hypersensitivity reactions, type III (immune complex-
mediated) hypersensitivity reactions, and type IV (cell-mediated) hypersensitivity reactions.
Type I hypersensitivity reaction is usually most involved in allergies such as allergic rhinitis and
most occur against allergens in the environment. It can be divided into early and late phases
(McCance & Huether, 2019).
In the early phase, within 20 minutes of when a person is first exposed to the allergen the
sensitization phase of type I hypersensitivity reaction occurs. The allergen is usually introduced
through the respiratory tract by inhalation, through gastrointestinal tract by ingesting, or through
contact via the skin. The allergen or antigen is then processed by antigen-presenting cells
(APCs) which move to the lymph nodes where they instruct naïve T helper cells that carry the
receptors for the specific antigen. Then the naïve T helper cells differentiate into TH1, TH2, or
TH17 depending on the antigen and cytokine signaling. During initial exposure, for sensitization,
differentiation usually results in TH2 cells. These TH2 cells then release IL4, IL5, IL9, and IL14
cytokines. IL5 is involved in development, recruitment, and activation of eosinophils. IL9 is
involved in mast cell activation. IL4 and IL13 affect B cells to produce antigen specific IgE
antibodies. For B cells to produce these antigen specific IgE antibodies they must first
internalize the antigen. The antigen is processed by the MHC class II molecules that present the
peptide of the antigen on the surface of the B cell so the T cell receptor on the TH2 cell
recognizes the bound antigen peptide and the MHC class II complex. This also involves CD40
about:blank 2/8
This study source was downloaded by 100000889304135 from nursinghero.com on 09-08-2024 18:17:07 GMT
###NR507_Week_1_Case_Study_Allergic_rhinitis.pdf
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