ANAPHYLACTIC

REACTIONS
INTRODUCTION
• Anaphylactic reactions are sudden, widespread, potentially severe
and life-threatening allergic reactions. They often begin with a
feeling of uneasiness, followed by tingling sensations and
dizziness.
• These reactions can quickly become life threatening and therefore
require emergency treatment.
• Like other allergic reactions, an anaphylactic reaction does not
usually occur after the first exposure to an allergen (the substance
that triggers an allergic reaction) but may occur after a person is
exposed to the allergen again.
TYPES OF ANAPHYLACTIC
REACTIONS
a) Immediate (type I) - Symptoms appear after a few seconds to
minutes. It's the most severe form of allergic reaction. IgE
antibodies are produced by the immune system in response to
allergens such as pollen, animal dander, insect bites, dust mites,
or certain foods
b) Cytotoxic (type II) - Symptoms appear after minutes to hours.
IgG and IgM antibodies damage cells by activating the
complement system of the immune system
TYPES OF ANAPHYLACTIC
REACTIONS CONT’
a) Immune complex-mediated (type III) - Symptoms set in after
several hours. IgM and IgG antibodies react with allergens to
form immunocomplexes (antigen-antibody complexes)
b) Delayed hypersensitivity (type IV) - Symptoms set in hours to
days later. Often in long-term infectious like TB.
RISK FACTORS
There aren't many known risk factors for anaphylaxis, but some
things that might increase the risk include:
i. Previous anaphylaxis. If you've had anaphylaxis once, your
risk of having this serious reaction increases. Future reactions
might be more severe than the first reaction.
ii. Allergies or asthma.
iii. Certain other conditions - heart disease and an irregular
accumulation of a certain type of white blood cell
(mastocytosis).
CAUSES OF ANAPHYLACTIC
REACTIONS
• Anaphylactic reactions are most commonly caused by the
following:
i. Drugs (such as penicillin)
ii. Insect stings and animal venoms
iii. Certain foods (particularly eggs, seafood, and nuts)
iv. Latex
v. Other biologic agents such as animal serum
ANAPHYLACTOID REACTIONS
• Anaphylactoid reactions resemble anaphylactic reactions.
• However, these reactions, unlike anaphylactic reactions, may
occur after the first exposure to a substance.
• Anaphylactoid reactions are not allergic reactions because
immunoglobulin E (IgE), the class of antibodies involved in
allergic reactions, does not cause them.
• Rather, the reaction is caused directly by the substance.
ANAPHYLACTOID REACTIONS:
COMMON TRIGGERS
• Iodine-containing substances that can be seen on x-rays
(radiopaque contrast agents)
• Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs)
• Opioids
• Monoclonal antibodies (manufactured antibodies that target and
suppress specific parts of the immune system)
• Exercise
SYMPTOMS OF ANAPHYLACTIC
REACTIONS
• Anaphylactic and anaphylactoid reactions typically begin within 15
minutes of exposure to the allergen. Rarely, reactions begin after 1 hour.
Symptoms range from mild to severe, but each person usually has the same
symptoms each time.
• The heart beats quickly. People may feel uneasy and become agitated.
Blood pressure may fall, causing fainting, and may become dangerously
low (shock).
• Dizziness,
• Itchy and flushed skin,
• Coughing,
• A runny nose,
SYMPTOMS OF ANAPHYLACTIC
REACTIONS CONT’
• Sneezing,
• Hives
• Swelling of tissue under the skin (angioedema).
• Difficulty in breathing and wheezing may occur because the throat and/or
airways narrow or become swollen.
• People may have nausea, vomiting, abdominal cramps, and diarrhoea.
• An anaphylactic reaction may progress so rapidly that people collapse, stop
breathing, have seizures, and lose consciousness within 1 to 2 minutes. A
severe reaction may be fatal unless emergency treatment is given
immediately.
DIAGNOSTIC EVALUATION
• A doctor's evaluation
• Sometimes blood tests
• The diagnosis of anaphylactic reactions is usually obvious based on
symptoms such as the following:
1. Symptoms of shock (such as low blood pressure, confusion, cold and
sweaty skin, and a weak and rapid pulse)
2. Respiratory symptoms (such as difficulty breathing, a gasping sound
when breathing in, and wheezing)
3. Two or more other symptoms of possible anaphylaxis such as
angioedema, hives, and nausea or other digestive symptoms
• Because symptoms can quickly become life threatening, treatment is begun
immediately, without waiting for tests to be done.
DIFFERENTIAL DIAGNOSIS
There are several conditions, which may mimic certain
characteristics of anaphylaxis such as:
Acute anxiety, which may present as dyspnoea and near syncope
with hyperventilation.
Anaphylactoid reactions which present the same way as
anaphylactic reaction but are not mediated by Ig E.
TREATMENT OF ANAPHYLACTIC
REACTIONS
• In emergencies, give epinephrine by injection under the skin, into a muscle, or
sometimes into a vein or bone. A second injection of epinephrine may be
needed.
• If breathing is severely impaired, a breathing tube may be inserted into the
trachea through the person’s mouth or nose (intubation) or through a small
incision in the skin over the trachea, and oxygen (if needed) is given through the
breathing tube.
• If the person's blood pressure is very low, epinephrine may be given through the
breathing tube.
• Blood pressure often returns to normal after epinephrine is given. If it does not,
fluids are given intravenously to increase the volume in the blood vessels.
Sometimes people are also given drugs that cause blood vessels vasoconstriction
and thus help increase blood pressure.
TREATMENT OF ANAPHYLACTIC
REACTIONS CONT’
• Antihistamines (such as diphenhydramine) and histamine-2 (H2) blockers
(such as cimetidine) are given intravenously until symptoms disappear.
• If needed, beta-agonists that are inhaled (such as albuterol) are given to
widen the airways, reduce wheezing, and help with breathing.
• A corticosteroid is sometimes given to help prevent symptoms from
recurring several hours later, although whether this treatment is necessary
is unclear.
• Mast cells stabilizers to reduce running nose, itchiness and watery eyes
• Decongestants to reduce stuffiness
PREVENTION OF ANAPHYLACTIC
REACTIONS
Prevention strategies entails:
1. Avoiding exposure to allergens,
2. Screening of allergies before medication,
3. Venom immunotherapy following stings and bites,
4. Desensitization of those allergic to drugs in which there is gradual
release of mediators (controlled anaphylaxis).