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  1. 1. ANAPHYLAXISFatima Al-Awadh
  2. 2. Objectives Define Hypersensitivity Reaction. Mention the Types of Hypersensitivity Reactions. Define Anaphylaxis. Mention the Etiologic Causes. Explain the Pathophysiologic Mechanism. Mention the Signs & Symptoms. Demonstrate the Diagnostic Investigations. Display the Treatment & First Aid.
  3. 3. Hypersensitivity Reaction Injurious, or pathologic, immune reactions are called hypersensitivity reactions. Hypersensitivity reactions may occur in two situations. First, responses to foreign antigens may be dysregulated or uncontrolled, resulting in tissue injury. Second, the immune responses may be directed against self antigens, as a result of the failure of self-tolerance (autoimmunity).
  4. 4. Types of hyper sensitivity reactions Immediate Antibody- immune complex T cell-mediatedhypersensitivity mediated diseases diseases Mast cell Antibodies Antibody- Reactions release directed antigen of T histamine against cell or complex lymphocytes and other tissue deposit in mediators antigens blood vessels
  5. 5. Anaphylaxis Ana (without), phylaxis (protection). Acute multi-systemic allergic reaction involving the skin, airway, vascular system, and GI. Sever immediate (type I) hypersensitivity reaction. True & pseudo-anaphylaxis.
  6. 6. EtiologyCauses of anaphylaxis in a study of 266 patients (Data from Kemp et al) 2% Food 7% Idiopathic 20% 34% Drugs Exercise 37% Latex, hormons, ins ect bites
  7. 7. Etiology Pharmlogic agents • Antibiotics (penicillin) • Nonsteroidal anti-inflammatory drugs (Asprin) • intravenous (IV) contrast agents Stinging insects • Ants, bees, hornets, wasps, and yellow jackets. Food • Peanuts, seafood, and wheat Latex • Rare • No latex-associated deaths
  8. 8. Pathophysiology First exposure Activation of TH2 cell → Stimulate IgE switiching Allergen B Cell TH2 Cell
  9. 9. Pathophysiology First exposure IgE production IgE secreting B cell IgE
  10. 10. Pathophysiology First exposure IgE bind to mast cell Mast cell FcɛRI IgE
  11. 11. Pathophysiology Second exposure Allergen Recognition Mast cell FcɛRI IgE
  12. 12. Pathophysiology Second exposure Activation of mast cell to release histamine and other mediators Allergen Mast cell Mediators FcɛRI IgE
  13. 13. Pathophysiology Mediators Vascoactive aminase & Cytokines lipid Immediate Late phase reaction (6- hypersensitivity reaction 24 hours) (minutes)
  14. 14. Signs & SymptomsSkin Itching flushing hives (urticaria) swelling
  15. 15. Signs & SymptomsEyes Itching tearing swelling around the redness eyes
  16. 16. Signs & SymptomsNose &mouth Sneezing runny nose nasal congestion swelling of the metallic taste tongue
  17. 17. Signs & SymptomsLungs andthroat wheezing or other Difficulty breathing coughing chest tightness sounds increased mucus throat swelling or or a sensation of change in voice production itching choking
  18. 18. Signs & SymptomsHeart and circulation Dizziness weakness fainting rapid, slow, or low blood pressure irregular heart rate
  19. 19. Signs & SymptomsDigestive system Nausea vomiting cramps diarrhea
  20. 20. Signs & symptomsNervous system Anxiety confusion sense of impending doom
  21. 21. Diagnosis The diagnosis of anaphylaxis is based upon symptoms that occur suddenly after being exposed to a potential trigger. Differential diagnosis severe asthma attack heart attack panic attack food poisoning An increased amount of tryptase protein can be measured in a blood sample collected during the first three hours after anaphylaxis symptoms have begun. tryptase levels are seldom elevated in food-induced
  22. 22. First Aid Place patient in Establish and Trendelenburg maintain airway. position. Give oxygen via Place a tourniquet nasal cannula as above the reaction needed. site. Epinephrine at the site of antigen Start IV to rise BP. injection.
  23. 23. Treatment EPINEPHRINE Benadryl (diphenhydramine) - H1 antagonist Tagamet (cimetidine) - H2 antagonist Corticosteroid therapy In severe anaphylaxis, observe for 6 hours or longer
  24. 24. Prevention Avoid the responsible allergen (e.g. food, drug, latex, etc.). Keep an adrenaline kit (e.g. Epipen) and Benadryl on hand at all times. Wear medic Alert bracelets .Venom immunotherapy is highly effective in protecting insect-allergic individuals.
  25. 25. References Abbas & Lichtman, Basic Immunology 3E, Chapter 11 http://www.authorstream.com/Presentation/Moiloa-898248- anaphylaxis/ http://med.mui.ac.ir/clinical/orjanc/Anaphylaxis.ppt http://www.uptodate.com/contents/anaphylaxis-symptoms-and- diagnosis-beyond-the-basics http://www.oregonems.org/Downloads/Anaphylaxis.ppt
  26. 26. Thank YouFatima Al-Awadh