Anaphylactic Shock (anaphylaxis) - Causes, Symptoms And Treatment Of Anaphylactic Shock

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-17 02:10

Causes, symptoms and treatment of anaphylactic shock

Anaphylactic shock is an acute allergic reaction that can be fatal. It affects various organ systems, but most often they are subject to impact

• respiratory system
• the cardiovascular system
• skin and mucous membranes
• gastrointestinal tract

In this case, the speed of the processes characteristic of ordinary allergies is accelerated tenfold, and their manifestations are much more pronounced.

Content:

• The reasons for the development of anaphylactic shock
• Anaphylactic shock symptoms
• Diagnosis of anaphylaxis
• Treatment of anaphylactic shock
• Medical help for anaphylactic shock
• Consequences of anaphylactic shock
• Prevention of anaphylactic shock

The reasons for the development of anaphylactic shock

Determining the cause of anaphylaxis is often difficult because there are too many allergens to act as a catalyst. Based on statistics, we can say that in most cases the body reacts in a similar way to

• various insect bites
• food products
• taking certain types of medications
• interaction with contrast agents.

Insect bites. There are over a million insects of different species in the world, the bite of which can provoke an anaphylactic reaction. But most often the allergy occurs in victims of bees or wasps, and in 1% of those stung, it can develop into anaphylaxis.

Food gives rise to the development of anaphylaxis in at least one third of people with food allergies. Some of the most dangerous products include

• Nuts: primarily peanuts and their derivatives (oil, etc.), hazelnuts, almonds, walnuts and brazil nuts
• Milk
• Seafood: fish, shellfish, crab meat

Less common is an acute allergic reaction to eggs and fruits or berries (bananas, grapes, strawberries).

Medication leads to anaphylactic reaction in a significant number of cases. In a number of medications that can lead to this result:

• antibiotics (especially penicillin, ampicillin, bicillin and others from the penicillin series)
• anesthetics used during surgical operations: intravenous - Propofol, Thiopental and Ketamine and inhalation forms - Sevovluran, Halothane, etc.)
• nonsteroidal anti-inflammatory drugs, including the common aspirin and paracetamol
• angiotensin-converting enzyme inhibitors (Enalopril, Captopril, etc.) used to treat hypertension

The latter type of drugs (ACE inhibitors) can cause an allergic reaction, leading to anaphylactic shock, even if the drug has been taken by the patient for several years.

Medications of other groups lead to the appearance of anaphylaxis within minutes or hours after the first dose.

However, the risk of allergic reactions to the use of these drugs is very low. It is difficult to compare it with the value of the positive therapeutic effect of these drugs. The likelihood that the body will perceive them as an allergen and give an anaphylactic reaction is

• 1 in 5,000 with penicillin
• 1 in 10,000 when using anesthetics
• 1 in 1,500 with non-steroidal anti-inflammatory drugs
• 1 in 3,000 with angiotensin-converting enzyme inhibitors

Contrast agents are used in the diagnosis of various diseases. Most often, they are administered intravenously during radiological examinations of internal organs: fluoroscopy, computed tomography or angiography. They help to examine in detail the organs in which pathology is suspected. The risk of anaphylaxis in this case is about 1 case in 10,000 studies.

Symptoms of anaphylactic shock severity

Depending on the way the allergen enters the body, the time after which the first symptoms appear changes. So, an insect bite promotes an almost instant reaction, developing from 1-2 minutes to half an hour. Food allergy, on the other hand, manifests itself for a longer time - from 10 minutes to several hours.

Typically, symptoms develop within 5-30 minutes of onset. Depending on the severity of the process, there may be either a slight itching of the skin or an acute reaction that seizes all systems of the body and leads to death. The faster the intensification of the symptoms that appear, the higher the likelihood of death if help is not provided on time.

The following clinical symptoms are most pronounced, which show the involvement of various organs and systems in the process:

• Skin changes characterized by a bright, itchy rash
• Changes in mucous membranes that cause watery eyes and swelling of the eyes, lips, tongue, and nasal passages
• Respiratory disorders due to involvement of the airways in the reaction, their swelling and spasms
• Swelling of the throat leads to a feeling of coma, squeezing of the neck
• Abdominal pain, nausea and vomiting, especially when the allergen enters the esophagus
• False tastes like a metallic taste in the mouth
• Blurred consciousness, panic reactions
• Rapid heartbeat, drop in blood pressure, fainting or dizziness

There are three degrees of severity of the course of anaphylactic shock, each of which is characterized by certain symptoms. All of them are described in detail in the table.

The course of anaphylactic shock	Easy	Average	Heavy
Symptoms	In the place where there was contact with the allergen, rashes appear, there is a burning sensation and itching, Quincke's edema may develop. A person is able to point out the symptoms that bother him.	To the described symptoms characteristic of a mild course of shock, suffocation is added. A person gets cold sweat, heart pains, pupils dilate. Sometimes bleeding develops (from the nose, from the uterus, or from the digestive tract). Possible speech impairment, loss of consciousness.	The symptoms build up quickly, within a few seconds the person becomes very ill. He loses consciousness, blood pressure drops sharply, the pulse is not heard, breathing becomes heavy. Convulsions develop, foam comes out from the mouth, the skin turns blue. If help is not provided at the same moment, the person will die.
Blood pressure indicators in mm. rt. Art.	90 to 60	60 to 40	Impossible to define
Harbingers of impending shock	The precursor period lasts for 30 minutes (average values), which allows timely assistance to the victim	The harbingers period lasts no more than 5 minutes	No more than a minute.
Lack of consciousness	Fainting can happen, but the person wakes up very quickly.	The person is unconscious for 30 minutes.	A person loses consciousness quickly and may not return to it.
Treatment features	If first aid is provided on time, then anaphylactic shock will pass without any consequences for human health.	Shock can be difficult to overcome, but adequate medical attention can guarantee a full recovery. In this case, a person will recover for a long time.	It is not always possible to save the victim, even if he was provided with a full range of medical services.

Diagnosis of anaphylaxis

Currently, medical research is not able to predict in advance the possibility of an anaphylactic reaction, if it has never occurred. Everyone with allergies is at risk. The diagnosis itself is made later: either during the reaction itself according to the symptoms and the speed of their development, or after stopping. Due to the enormous danger of delay leading to death, it is not possible to study in detail each of the characteristic signs of anaphylaxis. The speed with which the state of health is deteriorating requires prompt treatment.

Finding the allergen that triggered this reaction is an important step following the treatment of anaphylaxis. If you have not encountered allergies before, then all the necessary specific studies should be carried out for you, which clarify the diagnosis of allergy in general and the cause of the anaphylactic reaction in particular:

• Skin tests
• Skin or application tests (Patch test)
• Blood sampling for IgE analysis
• Provocative tests

The purpose of laboratory tests is to accurately identify the allergen causing a given reaction. To ensure safety in the event of an overly strong response from the body, the study should be carried out with the utmost care.

RAST (radioallergenic adsorbent test) is considered the safest test. This radioimmunological method makes it possible to most accurately calculate the culprit of anaphylaxis without interfering with the activity of the patient's body. For its implementation, the interaction of the victim's blood with the allergens that are successively added to it is analyzed. The release of a significant amount of antibodies after the next injection indicates the detection of the allergen that caused the reaction.

Treatment of anaphylactic shock

The rate of development and severity of symptoms accompanying anaphylaxis, classifies it as a medical emergency requiring immediate medical attention. The terminal phase of this condition is called anaphylactic shock.

Every second counts for suspected anaphylaxis. Whether you are experiencing symptoms or someone near you, the first step is to call an ambulance. Correctly provided care before the arrival of doctors increases the chances of survival.

It is required to immediately eliminate contact with the allergen. If he entered the body through the esophagus, and the victim is conscious, gastric lavage is performed. If a sting remains in the body after an insect bite, then it is removed. A tourniquet can be placed above the bite or drug injection site to slow the entry of the drug into the body.

Anaphylactic shock is almost guaranteed to occur when the allergen re-enters the body. Therefore, if you suspect anaphylaxis, you should always carry an emergency kit with you, including adrenaline injectors.

These include:

• EpiPen
• Anapen
• Jext

They are administered intramuscularly for any route of penetration of the allergen. Usually, the injection is made into the dorsal lateral surface of the thigh muscle, avoiding getting into the adipose tissue. Reading the instructions will tell you the correct administration of the drug. Most often, after injection, the injector is fixed for a few seconds in the position in which the drug was injected. An improvement in the condition should follow after a few minutes, otherwise a repetition of the dose is permissible.

If the victim has lost consciousness, it is necessary to give the body a horizontal position, laying his head on one side. Removable dentures are removed from the mouth. The safety of the release of vomit is controlled, and the possibility of tongue sinking.

In the absence of a pulse, artificial respiration and chest compressions are performed - if you have the skill to properly carry out these resuscitation measures.

Read more: First aid for anaphylactic shock, the right choice of drugs

After the first aid by the arrived doctors, inpatient treatment continues. For this, the same drugs are used as in allergy therapy. After 2-3 days, at the latest - after 10 days, the patient is discharged.

In order to save your life, you need to remember the importance of preventing anaphylaxis. Avoid substances containing allergens, areas where insects or plant growth may cause allergic reactions. You should always have a set of adrenaline injectors and an allergic person's passport.

Algorithm of actions for anaphylactic shock

It will not be difficult for a doctor to diagnose anaphylactic shock in a patient, since the symptoms of this condition are most often not in doubt. Knowing the rules for providing first aid to the victim, it is possible with a high degree of probability to help save his life.

So, if it was noticed that a person develops anaphylaxis, then it is necessary first of all to call an ambulance. The victim himself should be laid on a flat and hard surface, his head should be turned to one side, and the limbs should be raised. If a person has an episode of vomiting, then he will not choke on it. It is imperative to provide fresh air access by opening windows in the room.

Then you need to make sure whether the person is breathing or not. If there are no chest movements, then you need to bring a mirror to his mouth. When there is breath, the mirror will fog up. When this does not happen, you need to start implementing the artificial respiration technique.

You also need to feel the pulse. It is best defined on the wrist, on the carotid and femoral arteries. If there is no pulse, then an artificial heart massage is required.

It is imperative to stop the influence of the allergenic factor on the human body. If anaphylactic shock develops as a result of a bee sting, then you need to remove the sting, and apply a tourniquet over the sting site. This will allow the poison to not spread so quickly through the bloodstream. You also need to apply ice to the bite site.

If you follow all the recommendations correctly, this will allow you to gain time and wait for the arrival of an ambulance with minimal losses to the victim's health.

Medical help for anaphylactic shock

Ambulance doctors who diagnosed anaphylactic shock will inject adrenaline into the victim. It is an anti-allergenic agent with an immediate effect. Adrenaline is injected at the site of the bite, and also injected into the limb, which has not been affected by the action of the allergen. If a person's breathing is severely impaired, then the injection is placed under the root of the tongue. The drug is injected slowly and carefully so as not to provoke arrhythmia.

It is possible to stop the laryngeal edema thanks to the injection of adrenaline. If this does not help, then intubation, conicotomy, or tracheostomy is required. All of these procedures involve opening the airways in order to provide the lungs with oxygen.

The work of doctors does not stop there. The patient is indicated for the administration of corticosteroids and antigitsamines. The priority remains such drugs as Suprastin and Diphenhydramine, since they do not lower blood pressure and by themselves are not able to provoke an allergic reaction. Oxygen inhalation is also performed.

If the allergen cannot be identified, then a number of methods are performed in the hospital to determine it.

For this, the following studies are carried out:

• Patch test (application test).
• Blood sampling for the determination of immunoglobulin E.
• Provocative tests.
• Skin tests.

These studies will allow you to isolate the allergen and select the optimal treatment.

Consequences of anaphylactic shock

Despite the fact that timely assistance was provided to a person, anaphylactic shock rarely passes without a trace to health. Certain disorders occur in the body, which make themselves felt for a long time.

The most common consequences of anaphylactic shock include:

• Decrease in blood pressure that remains consistently low.
• The onset of chronic pain in the heart, which develops against the background of ischemia.
• Chronic fatigue, lethargy, lethargy.

After suffering anaphylactic shock, a person often develops neuritis, inflammation of the heart muscle, diffuse damage to the central nervous system. He may also begin to bother with joint pain, sternum pain, abdominal pain, nausea and vomiting.

To stop these consequences, drug therapy is required, but the doctor must prescribe it. In this case, the specialist must be informed that the person has suffered anaphylaxis.

Prevention of anaphylactic shock

As for the prevention of anaphylactic shock, there are simply no specific recommendations. However, there are points to pay attention to.

To a greater extent, anaphylactic shock affects those people who suffer from allergies on an ongoing basis. Therefore, they need to exercise extreme caution when coming into contact with any potential allergens.

The risk group includes asthmatics, patients with eczema, mastocytosis and allergic rhinitis. In such people, anaphylactic shock can develop even with the ingestion of certain foods, or while taking a number of medications. This is not a reason to refuse any treatment. It is imperative to follow medical recommendations, but the doctor must be informed that the person is at risk of developing anaphylactic shock. Also, anaphylaxis in these patients may develop in response to the administration of contrast media for radiological examination.

As for medical professionals, they must know and clearly follow all instructions for the elimination of anaphylactic shock in patients. Medical facilities and ambulances should be provided with anti-shock drugs and emergency devices.

It is imperative to have an adrenaline injector at home. This is a one-time injection of adrenaline and is completely ready to use. Sometimes such a small ampoule can save a person's life. For example, in Western countries, adrenaline can be found in almost every home medicine cabinet.

The average person is advised to acquire knowledge of first aid for anaphylactic shock. First of all, this concerns the technique of performing chest compressions and artificial respiration. It is equally important in any, even in an emergency, to keep a cool mind and not panic.

Article author: Mochalov Pavel Alexandrovich | d. m. n. therapist

Education: Moscow Medical Institute. IM Sechenov, specialty - "General Medicine" in 1991, in 1993 "Occupational Diseases", in 1996 "Therapy".