Anaphylaxis

ANAPHYLAXIS

Acute, potentially life-threatening

reaction caused by :

rapid release of mediators from mast cell & basophiles that follows the interaction with specific, cell-bound IgE (type I)

Clinical Manifestation

Skins : erythema, pruritus, urticaria, angioneurotic oedema

Gastro-intestinal tract : nausea, vomitting, stomache, colic, diarrhoea

Respiration tract : cough, rhinitis, dyspnoe, wheezing/ asthma, larynx edema, cyanose, resp.Insufficiency.

Cardiovasculer system : pale, flushing, palpitating hypotension collapse, shock, cardiac arrest

Foods Causing Allergic Reactions

In children, 6 foods cause almost all food allergy reactions :

Milk

Egg

Peanuts

Wheat

Soy

Tree nuts (walnuts

pecans)

Diagnosis

There is no specific test for anaphylaxis

However, allergy testing can help determine what substances an individual may be allergic to, and provide guidance for the physician as to the severity of the allergy.

Diagnosis is based primarily on :

Medical history, including immediate

past exposure to possible allergens

Physical examination

Response to treatment

Therapy

Fix proximal torniquet on area of injection or insect bite/sting

Injection of aqueous epinephrine 1:1000 0,1 – 0,3 ml IM. Can be repeated after 15-20 min

If the reaction is due to the injection of bee’s sting on an extremity, one half of this above dose may diluted in 2 ml normal saline and infiltrated subcutaneously at the site of the sting to slow absorption

Shock condition are given 1-2 cc epinephrine fluid in aqua 1:10.000 IV even intra cardial

Clear the air way & give O2

Antihistamine = benadryl 2 mg /kg BW/IV

IVFD NaCl 0,9% : 20-40 ml/kg BW in 1-2 hours. If needed : plasma expander fluid 10-20 cc/kg BW in 1-2 hours

Dexamethasone : 0,2-0,3 mg/kg BW/IV

Aminophylline : 4 mg/kg/IV diluted in normal saline

Always kept warm the patient

Airway obstruction may need to inserting the endotracheal tube/tracheostomy

Metabolic acidosis : give bicarbonat, ringer lactat.

Cardiac arrest : external cardial massage

Prognosis

Good when the shocked patient is treated

quickly & effectively

Protection

As with any severe allergy, the primary

method of protection is a two-step process :

Avoiding contact with allergens

Being prepared to treat anaphylactic

emergencies by carrying self-injectable

epinephrine followed by emergency

medical care.

For drug, food & exercise anaphylaxis, the only advice is to avoid the substance or activity known to cause the reaction.

In the case of severe food allergies, it is always a good idea to take that extra step, when in a restaurant, alert the waiter to any food allergies, and when shopping be sure to read labels to identify unsuspected ingredients.

Avoid the food or food protein you are allergic to.

If, for example, you are allergic to milk, avoid milk, yogurt, ice cream and anything that is made with milk.

This sound simple, but food proteins can hide in places you might not expect to find them, most often as ingredient in other food.

Epinephrine

Works directly on the cardiovascular & respiratory systems to counter the potentially fatal effects of anaphylaxis by rapidly :

constricting the blood vessels

relaxing muscles in the airway & lungs to

improve breathing

reversing swelling

stimulating the heartbeat.

Epinephrine provides the patient with

emergency therapy, but immediate follow-up

care by medical professionals will provide the

patient the full treatment necessary to

counter an anaphylactic episode.

The sooner a patient receives epinephrine,

the better that patient’s chance of survival

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