This document discusses anaphylaxis, a severe allergic reaction that can be life-threatening. It defines anaphylaxis and describes the mechanisms behind allergic and non-allergic types. Symptoms are discussed including effects on the skin, respiratory and cardiovascular systems. Biphasic reactions are mentioned. Triggers include foods, drugs, and venom. Diagnosis involves assessing symptoms and laboratory tests. Prevention strategies are also outlined.
This document discusses anaphylaxis, a severe allergic reaction that can be life-threatening. It defines anaphylaxis and describes the mechanisms behind allergic and non-allergic types. Symptoms are discussed including effects on the skin, respiratory and cardiovascular systems. Biphasic reactions are mentioned. Triggers include foods, drugs, and venom. Diagnosis involves assessing symptoms and laboratory tests. Prevention strategies are also outlined.
This document discusses anaphylaxis, a severe allergic reaction that can be life-threatening. It defines anaphylaxis and describes the mechanisms behind allergic and non-allergic types. Symptoms are discussed including effects on the skin, respiratory and cardiovascular systems. Biphasic reactions are mentioned. Triggers include foods, drugs, and venom. Diagnosis involves assessing symptoms and laboratory tests. Prevention strategies are also outlined.
This document discusses anaphylaxis, a severe allergic reaction that can be life-threatening. It defines anaphylaxis and describes the mechanisms behind allergic and non-allergic types. Symptoms are discussed including effects on the skin, respiratory and cardiovascular systems. Biphasic reactions are mentioned. Triggers include foods, drugs, and venom. Diagnosis involves assessing symptoms and laboratory tests. Prevention strategies are also outlined.
Download as PPTX, PDF, TXT or read online from Scribd
Download as pptx, pdf, or txt
You are on page 1/ 27
ANAPHYLAXIS REACTION
Marshell Tendean, MD, DPCP
Department of Internal Medicine UKRIDA, Jakarta Definition and terms :
Anaphylaxis is a severe, life-threatening,
generalised or systemic hypersensitivity reaction. This is characterised by rapidly developing life-threatening airway and/or breathing and/or circulation problems usually associated with skin and mucosal changes. Revised nomenclature for anaphylaxis Anaphylaxis
Allergic anaphylaxis Non-allergic anaphylaxis
IgE- mediated Immunologic, non-
anaphylaxis IgE-mediated anaphylaxis
Johansson SGO et al JACI 2004,113:832-6
Gell and Coombs classification of hypersensitivity Type I Immediate hypersensitivity Type II Cytotoxic reactions Type III Immune complex reactions Type IV Delayed hypersensitivity
Anaphylaxis can occur through Types I, II and III
immunopathologic mechanisms
Kemp SF and Lockey RF. J Allergy Clin Immunol 2002;110:341-8
Mechanisms of allergic anaphylaxis
a severe, acute, systemic allergic
reaction caused by the rapid, IgE- mediated release of potent mediators such as histamine from tissue mast cells and peripheral blood basophils Acutely released mediators of anaphylaxis
degranulation of mast cells and basophils causes the release of:
Gastrointestinal: nausea, vomiting, bloating, cramping, diarrhea Cardiovascular: tachycardia, hypotension, dizziness, collapse, death Other: feeling of impending doom, metallic taste Comments about anaphylaxis signs and symptoms
skin symptoms occur most commonly ( > 90% of patients)
skin, oral, and throat symptoms are often the first ones noted respiratory symptoms occur in 40% to 70% of patients gastrointestinal symptoms occur in about 30% of patients shock occurs in about 10% of patients signs and symptoms are usually seen within 5 to 30 minutes the more rapid the onset, the more serious the reaction
Lieberman P. In: Middletons Allergy: Principles and Practice, 6th edition, Mosby Inc., St. Louis, MO, 2003 Biphasic and protracted anaphylaxis biphasic anaphylaxis is defined as return of symptoms after resolution of initial symptoms, without subsequent allergen exposure usually, symptoms return within 1 to 8 hours (sometimes longer) up to 20% of anaphylactic reactions are biphasic patients with biphasic anaphylaxis may require more epinephrine to control initial symptoms in protracted anaphylaxis, symptoms may be continuous for 5-32 hrs
Lieberman P. Ann Allergy Asthma Immunol 2005;95:217-26
Immunology Epidemiology of Anaphylaxis Working group summarised the findings from a number of important internationally The overall frequency of episodes of anaphylaxis using current data lies between 30 and 950 cases per 100,000 persons per year. Triggers
Anaphylaxis can be triggered by any of a very
broad range of triggers, but those most commonly identified include food, drugs and venom Anaphylaxis from immune causes other than IgE
cytotoxic (Type II)
- transfusion reactions to cellular elements (IgG, IgM) immune aggregates (Type III) - intravenous immunoglobulin - Dextran (possibly)
Kemp SF and Lockey RF, J Allergy Clin Immunol 2002;110:341-8
Anaphylaxis: non-immunologic causes
MULTIMEDIATOR COMPLEMENT ACTIVATION/ACTIVATION
OF CONTACT SYSTEM
radiocontrast media ethylene oxide gas on dialysis tubing (possibly through IgE) protamine (possibly) ACE-inhibitor administered during renal dialysis with sulfonated polyacrylonitrile, cuprophane, or polymethylmethacrylate dialysis membranes
Kemp SF and Lockey RF, J Allergy Clin Immunol 2002;110:341-8
Anaphylaxis: non-immunologic causes
NONSPECIFIC DEGRANULATION OF MAST CELLS
AND BASOPHILS opiates physical factors: - exercise (no food or medication co-trigger) - temperature (cold, heat)
Kemp SF and Lockey RF, J Allergy Clin Immunol 2002;110:341-8
Idiopathic anaphylaxis
common in adults who are referred to allergists for evaluation of anaphylaxis
uncommon in children negative skin tests, negative dietary history, no associated diseases eg. mastocytosis preventive medication: oral corticosteroids, H1 & H2 antihistamines, anti- leukotrienes deaths rare may gradually improve over time
Lieberman PL et al. J Allergy Clin Immunol 2005;115:S483-S523
Severity of anapylaxis reaction Patients can have either an A or B or C problem or any combination. Use the ABCDE approach to recognise these. Airway problems: Airway swelling, e.g., throat and tongue swelling (pharyngeal/laryngeal oedema). The patient has difficulty in breathing and swallowing and feels that the throat is closing up. Hoarse voice. Stridor this is a high-pitched inspiratory noise caused by upper airway obstruction. Breathing problems:
Shortness of breath increased respiratory
rate. Wheeze. Patient becoming tired. Confusion caused by hypoxia. Cyanosis (appears blue) this is usually a late sign. Respiratory arrest. Circulation problems (often referred to as anaphylactic shock) can be caused by direct myocardial depression, vasodilation and capillary leak, and loss of fluid from the circulation. Bradycardia (a slow pulse) is usually a late feature, often preceding cardiac arrest. Cutaneous and mucosal manifestation
They are often the first feature and present in over 80% of anaphylactic reactions. They can be subtle or dramatic. There may be just skin, just mucosal, or both skin and mucosal changes. There may be erythema a patchy, or generalised, red rash. There may be urticaria (also called hives, nettle rash, weals or welts), which can appear anywhere on the body. The weals may be pale, pink or red, and may look like nettle stings. They can be different shapes and sizes, and are often surrounded by a red flare. They are usually itchy. Angioedema is similar to urticaria but involves swelling of deeper tissues, most commonly in the eyelids and lips, and sometimes in the mouth and throat Laboratory tests in the diagnosis of anaphylaxis Plasma histamine Serum tryptase 24-hr Urinary histamine metabolite
0 30 60 90 120 150 180 210 240 270 300 330
Prevention Beta blockers are contraindicated for those at risk especially those sensitive to Hymenoptera venom or those undergoing immunotherapy for respiratory system allergy Always know crossreactivity between drugs A prick or scratch skin test should precede an intradermal skin test (for it might cause anaphylaxis) Desensitization with most antibiotics and other classes of therapeutic agents can proceed by the IV, SQ or oral route Giving graded quantities of drug at regular intervals Development of blocking antibody of the IgG class that interacts with antigen so that less reaches the sensitized tissue mast cells Modification of outdoor activities Wearing informational bracelet and access to unexpired auto-injectable epinephrine kit Factors affecting prognosis
Factor Poor Good
Prognosis Prognosis Onset of symptoms Early Late Initiation of treatment Late Early Route of exposure Injection Oral* -adrenergic blocker use Yes No Presence of underlying disease Yes No
