What is anaphylaxis?

Anaphylaxis is a severe allergic reaction to an allergen (a substance which causes an allergic reaction); it is life threatening systemic reaction that can affect all ages. The defense system or immune system is over reacting to irritant or allergen. When a person is allergic to something, the body makes antibody against the allergen. This antibody is called (immunoglobulin E) IGE. IGE is a special antibody that coats cell called mast cells. Mast cells line nose, lungs, skin and digestive tract. For example when bee sting injects venom, the venom connects to IGE molecules surrounding the mast cells. The mast cells then rupture, releasing their granules which contain histamine and inflammatory substances. These granules burst open, the histamine and inflammatory substances are released to body tissues. The histamine seeks out antihistamine receptors in the skin, respiratory tract, blood vessels and stomach. Histamine attaches itself to receptors like lock and key, this causes the plasma to leak out of the blood vessels. The tissue around the blood vessels absorbs the plasma causing swelling of the skin tissues, vocal chords and even a drop in blood pressure. This reaction might happen in the nose and eyes causing what we know as hay fever; in the lungs, causing asthma, but when a massive release of histamine occurs and affects multiple parts of the body, that is called anaphylaxis. It is rapid onset of increased secretion from mucous membranes, increased bronchial smooth muscle tone, decreased vascular smooth muscle tone, and increased capillary permeability occur after exposure to an inciting substance.

The word used for protection by immunization is 'prophylaxis'.Charles Robert Richet was the 1913 recipient of the Nobel Prize for physiology or medicine. because they work in a similar way. What the scientists saw in the dogs helped them to understand that the same can happen in humans. The word anaphylaxis was coined when scientists tried to protect dogs against a poison by immunizing them with small doses. his term for the some times deadly reaction in a sensitized individual against a second injection of an antigen. This helped us to understand asthma and other allergies too. . "in recognition of his work on anaphylaxis". Far from being protected. so the scientists coined the word 'anaphylaxis' to mean the opposite of protection. the dogs died suddenly when they got the poison again.

Seven out of one hundred people are known to have food allergy. the number of exposures is so high that foods may be the commonest cause of anaphylaxis. Symptoms usually begin five to thirty minutes after ingestion. occasionally after one to two hours. but full-blown anaphylaxis can occur. Fatalities are rare compared to number of exposures.• Food Allergy Symptoms usually are mild and limited to the GI tract. Commonly implicated foods include nuts (especially peanuts). however. legumes. fish and shellfish. milk. Anaphylaxis due to foods may be an underrecognized cause of sudden death and an unappreciated cause of diagnosed anaphylaxis. and eggs. but rarely any longer. .

.• Latex Allergy It is an increasingly recognized problem in medical settings. Anaphylactic reactions occur and have been reported with seemingly benign procedures (e. intraperitoneal exposure to gloves during surgery). where use of gloves and other latex products is universal.g. . Most reactions are cutaneous or involve the mucous membranes. Foley catheter insertion.

Most severe reactions occur soon after exposure. Anaphylaxis may occur in a patient with no prior history of drug exposure. Reports often assert that ten percent of patients allergic to a penicillin antibiotic are allergic to cephalosporins. The faster a reaction develops. Another type of drugs that cause anaphylaxis are Aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs). the more severe it is likely to be. . While most reactions occur within hours. symptoms may not occur for as long as three to four days after exposure. Penicillin and cephalosporin antibiotics are the most commonly reported medical agents in anaphylaxis. Reactions tend to be more severe and rapid in onset when the antibiotic is administered parenterally.• Drugs Parenteral exposures tend to result in faster and more severe reactions.

and have usually four membranous wings and the abdomen generally borne on a slender pedicel) stings are a common cause of allergic reaction and anaphylaxis.• Hymenoptera stings Hymenoptera (highly specialized insects with complete metamorphosis that include the bees. even if severe. gall wasps. wasps. . accurate reaction rates are difficult to estimate. Generalized urticaria is a risk factor for subsequent anaphylaxis. and related forms. In the United States. sawflies. Local reaction and urticaria without other manifestations of anaphylaxis are much more common than full-blown anaphylaxis. ichneumon flies. but a local reaction. is not a risk factor for anaphylaxis. An uncertain but enormous number of exposures occur. ants. Hymenoptera stings result in fewer than 100 deaths per year. often associate in large colonies with complex social organization.

Aspirin and NSAID have been the most frequently involved medications and seafood. syncope and even death. celery. . ingestion of certain physical activity maybe a predisposing factor for exercise induced anaphylaxis. wheat and cheese have been involved. foods or medications before susceptible persons. This disorder is classically characterized by spectrum of symptoms occurring during physical activity that ranges from mild cutaneous signs to severe systemic manifestations such as In hypotension.• Exercise-induced anaphylaxis It is a distinct form of physical allergy and rare.

insect stings. .• Idiopathic anaphylaxis This term is used when the cause of anaphylaxis is unknown. medications. symptoms in patients with Signs and idiopathic Idiopathic anaphylaxis do not differ from patients with other forms of anaphylaxis. radiographic contrast media. Only after a thorough history. latex. Known causes of anaphylaxis that must be considered in every patient with a possible diagnosis of idiopathic disease include food. anaphylaxis is a diagnosis of exclusion. and exercise. and review of the medical record that this diagnosis is considered. physical.

Only five subjects with possible or probable anaphylaxis were identified. The estimated risk of post vaccination anaphylaxis ranges between 0. only one child had a reaction associated with a single vaccine (MMR-measles. mumps. Out of five. According to the research that was done on over two million individuals from birth to age seventeen vaccinated between 1991 and 1997.26 to 1.• Post Vaccination anaphylaxis Reaction to childhood vaccines is extremely rare. or latex used in vial stopper and syringe plunger. The study pointed out that allergic reactions may be related to vaccine antigen. . and rubella).53 cases per million. animal protein.

it shuts off the air supply and the individual experiences severe respiratory distress • The airways in the lungs can constrict. itching. appearance. If the swelling is very severe. . especially if the allergen is something that was swallowed. shortness of breath and wheezing . Individuals may first notice hoarseness or a lump in the throat.the classic symptoms of asthma • The person may experience nausea. causing chest tightness. mouth and throat. • Anaphylaxis can cause obstruction of the nose. and course. Hives. swelling. vomiting. • The skin frequently shows symptoms first. • The gastrointestinal tract often reacts. redness or a stinging or burning sensation may develop • The loss of fluid from blood vessels causes a drop in blood pressure and the individual may feel light-headed or even lose consciousness. cramping and diarrhea.Signs and symptoms: The clinical manifestations of anaphylaxis can vary in onset.

It is a natural antidote to the chemicals released during severe allergic reactions. Anaphylaxis is an emergency condition requiring immediate professional medical attention. It also relaxes airways. breathing. endotracheal installation is possible if intravenous access is unavailable. Additional medications may be given to counteract the effects Cardio pulmonary resuscitation (CPR) and other . lifesaving measures may be needed. waiting for the paramedics or ER staff to administer epinephrine may greatly increase the risk of death. Other treatments may be given such as oxygen and medications to improve breathing. Intravenous fluids may be necessary to restore adequate blood pressure. it rapidly reverses the effects of a severe allergic reaction by make blood vessels contract. Epinephrine should be administered as soon as practical while assessing and supporting vital functions. Even if the individual responds to the epinephrine. Assessment of the ABC's (airway. Adrenaline (epinephrine) is a natural hormone released by adrenal glands in response to stress. Since there is no way to predict the severity of a reaction. The emergency medical system should be contacted immediately. In clinical setting. It relieves cramping in the gastrointestinal tract and stops itching and hives. and because anaphylaxis can progress so rapidly. In the intubated patient. When injected. helping the individual breathe easier. It is usually given intramuscularly but may be given subcutaneously in mild cases. it is vitally important to go to an emergency room immediately. and circulation from Basic Life Support) should be done in all suspected anaphylactic reactions. opening the airways by reducing throat swelling. intravenous administration is only indicated in severe cases because of the risk of ventricular dysrhythmias.• Women may experience pelvic cramps due to contractions of the uterus. Adrenaline is the recommended first line treatment in anaphylaxis. preventing them from leaking more fluid. Treatment: The backbones of treating anaphylaxis are avoidance of the allergen when possible and emergency administration of adrenaline (epinephrine) when necessary. thus maintaining blood pressure.

The school nurse can also be instrumental in helping the allergic child feel accepted by making other children aware of how it is to have allergies. The parents count on not only the nurse but the rest of the school staff to lessen the possibility of allergic reaction and to deal with reaction if it occurs. The school nurse develops an individualized emergency care plan (IECP) in consultation with the student’s parents and health . When administered as directed.of histamine and to help prevent a delayed allergic reaction. it is important that not only the school nurse be able to recognize the signs and symptoms of this condition and its medical requirements but also the entire school personnel. the risks of not giving adrenaline far outweigh any potential side effects of the medication. its emergent nature and its treatment. School Nurse Role In a school setting. The school nurse is responsible for educating the school staff regarding anaphylaxis.

. The school nurse can also promote the use of medical identification bracelet.care provider.