3. Terminology
• IgE-based antibody
Responses are common physiologically in
parasitic infections.
• Atopic individual
Genetic in an individual which is predisposition
to suffer from allergies. They produce IgE
responses against a number of non-parasitic
antigens that induce either no antibody
response or antibody response of a different
isotype.
4. Terminology
Beta-blockers (beta-adrenergic blocking antagonist)
are drugs that treat several conditions:
• Hypertension
• Angina
• Some abnormal heart rhythms
• Myocardial infarction
• Anxiety
• Migraine
• Glaucoma
6. Anaphylaxis
O Ana (without), phylaxis (protection).
O A serious acute allergic reaction that cause
systemic effects and may cause death. (Type
I Hypersensitivity)
O Allergen must be systemically absorbed
(Ingestion or injection) to cause Anaphylaxis
7. Etiology
Causes of anaphylaxis in a study of 266 patients
(Data from Kemp et al)
Food
2%
7%
Idiopathic
34%
20%
37%
Drugs
Exercise
Latex, hormons,
insect bites
13. Summary
These reaction can affect single tissue or organ
(Eczema, asthma and hay fever)
- Or multiple ones (anaphylaxis) depending on the
re-exposure of allergen.
Note: This process normally mediated by IgG or immune complex
18. Signs & Symptoms
Nose & mouth
Sneezing
runny nose
swelling of the tongue
nasal congestion
metallic taste
19. Signs & Symptoms
Lungs and throat
Difficulty breathing
coughing
chest tightness
wheezing or other
sounds
increased mucus
production
throat swelling or itching
change in voice
or a sensation of choking
20. Signs & Symptoms
Heart and circulation
Dizziness
weakness
rapid, slow, or irregular
heart rate
fainting
low blood pressure
24. Risk factor
• History of anaphylaxis, atopy, or asthma. (Some
not)
• Food allergy
• Repeated latex exposure
• β-blocker use may limit the effectiveness of
epinephrine, resulting in protracted anaphylaxis
and severe hypotension
27. Diagnosis
Diagnosis based on:
• Clinical presentation:
Involvement of any two or more body systems is
observed
• History of exposure to a possible triggers
laboratory tests.
28. Diagnostic test
• ECG to eliminate other causes of chest pain.
• Radiographs for chest and neck considering an alternate
diagnosis of epiglottitis or other acute respiratory condition
29. Diagnostic test
• Serum tryptase released along with histamine can be
measureable.
• Serum electrolytes
• CBC
• Clotting studies
• Prick test
exclude electrolyte
disturbances or bleeding that
is causing hypovolemia
30. Treatment and management
• Aim:
1. Full resolution of all associated symptoms.
2. Saving the patient's life in serious reactions
3. Prevention of further anaphylactic reactions.
31. Treatment and management
First linetherapy
Second-line therapy
counteract
treat hypotension
persistent
bronchospasm
Epinephrine
H1 Diphenhydramine
O2
Trendeleburg
Administration position
Supplemental H2 Cimetidine and
O2
ranitidine
Albuterol
IV adminstration
IV fluids
Methylprednis
olone
Glucagon for patient
taking Beta blockers
Corticosteriods
32. Treatment and management
1- Epinephrine
- ANTAGONIST
increase BP and
Bradycardia to
counter shock
- Inhibit further
mast cell
degranulation
2- Antihistamine 3to reduce
inflammation of
your air passages
and improve
breathing
O2
to help
compensate for
restricted
breathing
4- Albuterol
to relieve breathing
symptoms
33. Treatment and management
Epinephrine
Action speed When is it
used?
Dose
Intramuscular
Has rapid
onset action
Severe,
Anterolateral
of the middle
thigh
6< 0.15 mL
6-12 0.3mL
12< 0,5 mL
Intravenous
Has rapid
onset action
Severe,
should be
carefully
monitored
Slow
intravenous
injection
34. Prevention
• Allergen avoidance is the best preventive measure.
1- Diet
2-Physical activity
3- Carry auto-injector
4-Environment
5-Medication
6-Immunization
*Education is recommended about how to deal with this disease.
35. First aid
• Aim:
1. limiting allergic response.
2. decreasing the severity of the symptoms.
36. First aid
Place patient in
Trendelenburg position.
Establish and maintain
airway.
Give oxygen via nasal
cannula as needed.
Place a tourniquet
above the reaction site.
Epinephrine at the site
of antigen injection.
Start IV to rise BP.
37. Refernces
•
•
•
•
•
•
•
Abbas: Basic immunology
BNF – 2013
Clincalkey.com
Kumar and Clarks Clinical Medicine
MDCONSULT.COM
AUSTRALIAN RESUSCITATION COUNCIL
http://www.resus.org.au/policy/guidelines/section_9/anaphyl
axis_first_aid_management.htm
Hinweis der Redaktion
which histamines are produced following exposure to the allergen
Allergn:type of antigen that produces an abnormally vigorous immune response in which the immune system fights off a perceived threat that would otherwise be harmless to the body.
Downstream activation of phospholipase A2, followed by cyclooxygenases and lipoxygenases, produces arachidonic acid metabolites, including prostaglandins, leukotrienes, and platelet-activating factor.
Rhinitis: irritation and inflammation of the mucous membrane inside the nose. hoarseness:disorders of the voice: an impairment in the ability to produce voice sounds using the vocal organs Stridor:high-pitched musical sound resulting from turbulent air flow in the upper airway. Stridor is a physical sign which is caused by a narrowed or obstructed airway. Angioedema: rapid swellin(edema) of the dermis, subcutaneous tissue,[1] mucosa and submucosal tissues. It is very similar to urticaria, but urticaria, commonly known as hives, occurs in the upper dermis.Hypotension due to vascular dilationAirway obstruction due to laryngeal edema
(e.g., some combination of cutaneous, respiratory, GI, or cardiovascular systems)
- Large volumes of intravenous fluids may be required due to marked peripheral vasodilationAlbuterol: is indicated for bronchospasm refractory to epinephrineDiphenhydramine: Life-threatening instances of anaphylaxis must be managed using other methods (eg, subcutaneous or intravenous epinephrine)H2 antagonists are indicated for persistent anaphylaxisCorticosteroids are indicated for the prevention of prolonged or recurrent symptomsGlucagon is indicated for epinephrine-resistant anaphylaxis in patients taking β-blockers
Diet:Identify food allergies and avoid the causative foodIn case of accidental exposure, seek medical attention immediatelyPhysical activity:In cases of exercise-induced anaphylaxis, stop exercising as soon as symptoms occurAvoid exercise for 4 to 6 hours after eatingSexual behavior:Rare cases of anaphylaxis from semen have been reportedCondoms should be used to avoid contact with semen if this is a cause of anaphylaxis. Patients who are latex-sensitive should avoid condoms made of latexEnvironment:Avoid areas where Hymenoptera species are presentWear protective clothing such as long-sleeved shirts, pants, socks, shoes, and hats when exposure cannot be avoided, and avoid wearing bright colors when going outsideLatex-induced anaphylaxis should be identified, and all contact with latex products should be avoidedMedication history:Patients at risk for anaphylaxis should not take β-blockers, ACE inhibitors, angiotensin II receptor blockers, or tricyclic antidepressants. All of these interfere with drug treatment or the body's ability to respond to anaphylaxisImmunization:Desensitization may be possible with some known allergensOther:Avoid known family allergens; some are known to have a genetic basis, although this is a rare occurrence
