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Anaphylactic shock is a medical emergency which, if left untreated, leads to death. The main causes of the disease are allergy to drugs, food and insect venoms. The life-saving drug is adrenaline. Although severe anaphylactic reactions are rare, there is no time to waste once they have symptoms.
Until recently, the term “anaphylactic reaction” or “anaphylaxis” was limited to diseases that were allergic in nature. Anaphylactic shock is a sudden, generalized, rapidly progressing, life-threatening reaction that occurs after exposure to a sensitizing agent or substance. According to this definition, an anaphylactic reaction is a certain very severe allergic reaction.
It is known that people who are allergic, when they first come into contact with an allergen (a sensitizing substance), develop IgE antibodies against the substance. Once produced, antibodies are fixed by special receptors on the surface of the immune system cells (basophils and mast cells) circulating in the blood and inhabiting various tissues of the body. When it comes into contact with the allergen again, it is picked up by IgE antibodies against it.
The combination of an allergen with an antibody anchored on the surface of a basophil or mast cell (mast cell) activates the cell, which ejects the accumulated chemical substances (including histamine, tryptase) from its interior, which initiate the entire cascade of events leading to the development of reactions allergic reactions and the appearance of allergic symptoms. These symptoms can be very different and their severity is mild and only local, or – as in an anaphylactic reaction – symptoms can affect the entire body and various vital organs (heart, circulatory system and lungs).
As a result of the ongoing scientific debate, the definition of anaphylactic shock has also been broadened to include reactions that are not mediated by IgE antibodies. It is known that there are also other, not yet fully understood, mechanisms leading to the activation of mast cells.
Some drugs cause the direct release of chemicals in mast cells (such effects may be demonstrated by opioid drugs and anesthesia drugs), others (such as radiological contrast agents) operate through complex mechanisms that have not yet been fully described.
In the “curiosities” category, among other factors that are very rarely the cause of anaphylactic reactions, it is worth mentioning physical exertion, alcohol, horse hair or sperm of a sexual partner.
Also read: Jumping into cold water can cause anaphylactic shock
While it is true that theoretically any foreign substance introduced into the body can cause sensitization, the list of factors causing the most severe, life-threatening anaphylactic reactions seems relatively short.
The first group are drugs that trigger both allergic (immunological) and non-immunological reactions, especially antibiotics (mainly from the group of penicillins and cephalosporins), as well as much less frequently radiological contrast agents and muscle relaxants used in anaesthesiology.
It should also be remembered about the risk of anaphylactic reactions in allergic people who undergo skin tests and undergo immunotherapy (desensitization).
Food is another group of substances with potentially lethal reactions. Here, the most important are cow’s and chicken’s milk proteins, as well as seafood, fish and peanuts (the incidence of food allergy varies geographically and is related to the amount of a given allergen in the diet).
The third important group of potentially dangerous factors are insect venoms. Many scientific publications also point out the risk of anaphylactic shock in people allergic to latex. It should also be remembered that there are comorbidities that worsen the prognosis at the time of a severe anaphylactic reaction.
These types of reactions are more dangerous in young children and the elderly, in people with chronic diseases of the cardiovascular system (with ischemic heart disease, chronic heart failure) and the respiratory system (poorly controlled asthma or chronic obstructive pulmonary disease). It is also known that people who take chronic hypertension treatment drugs from the group of beta- and alpha-blockers of the adrenaline receptor have a lower response to treatment.
If you notice severe allergy symptoms after an insect bite, it is worth performing mail-order insect venom allergy tests available at Medonet Market at an attractive price.
Anaphylactic shock – symptoms
What is the difference between anaphylactic reaction and the symptoms of the so-called common allergy? The difference concerns the severity of symptoms that appear suddenly and dramatically intensify within a few minutes (very rarely hours – in the case of substances that do not go directly into the blood and require absorption, for example, in the digestive tract) from contact with the triggering substance. Symptoms do not affect one, but several different organs.
The most common group of symptoms, occurring up to 90 percent. anaphylactic reactions are skin symptoms in the form of generalized urticaria, itching, reddening of the skin, edema, including swelling localized on the face as well as swelling and redness of the conjunctiva. It should be remembered that some anaphylactic reactions may occur without skin changes. On the other hand, it is also known that both urticaria and angioedema (located on the face or limbs) may be a separate problem and do not always mean a severe anaphylaxis.
The second most frequent group of symptoms are respiratory symptoms in the form of dyspnea, coughing and wheezing, resulting from bronchospasm and / or emerging laryngeal edema. In the latter case, there are often additional symptoms in the form of hoarseness, silence, difficulty swallowing, drooling..
These symptoms pose a direct threat to life and are the main – apart from circulatory disorders – the mechanism in which death occurs in the course of anaphylactic reactions.
Cardiovascular symptoms are observed less frequently – because in about half of the cases of anaphylactic reactions. The most typical and, at the same time, dangerous signal is a drop in blood pressure, which may manifest itself as a feeling of sudden weakness, dizziness, and in extreme cases it causes a sudden loss of consciousness (if the patient does not have skin changes, such sudden loss of consciousness in the course of anaphylaxis may be confused with heart attacks or strokes). The heart rate becomes faster.
The last group of the most common symptoms occurring at a similar frequency as cardiovascular symptoms are gastrointestinal complaints, such as nausea, vomiting, diarrhea and cramping abdominal pain.
In order to diagnose an anaphylactic reaction, it is necessary to develop symptoms from at least two systems (the most urgent are respiratory symptoms and a drop in blood pressure). The most advanced stage of anaphylactic reaction, which results in complete cardiopulmonary failure, is known as anaphylactic shock. Other less serious symptoms include sudden onset of runny nose, sneezing, watery eyes, headache, restlessness or a metallic taste in the mouth.
See also: To have adrenaline and not hesitate to use it
Anaphylactic shock – risk factors
Currently, there are only a few risk factors for anaphylaxis. Here they are:
- previous anaphylaxis – if an anaphylactic shock has already occurred once, the risk of another anaphylactic shock increases. Unfortunately, subsequent reactions may be much more serious,
- allergies or bronchial asthma – people who suffer from any of these conditions are more likely to develop anaphylaxis
- other conditions – these include heart problems and an abnormal build-up of white blood cells (mastocytosis).
If an anaphylactic reaction is suspected, immediate treatment is required. Lack of proper management leads to the development of anaphylactic shock, which is a condition of immediate life-threatening.
Adrenaline should be administered promptly as soon as respiratory symptoms develop or pressure drops.
If you are allergic and have had these reactions in the past, you should always have the pre-filled syringe containing this medicine with you. For people who experience the reaction for the first time, it is necessary to call an ambulance.
Discontinue exposure to a substance that triggers the reaction (discontinue drug administration, remove the insect’s sting) and place the patient in a position with raised legs or, in the event of vomiting, in a safe position and call for help. It should be remembered that antihistamines, inhaled anti-asthma medications or steroids (developing their effects only several hours after administration) are not able to stop the progressive symptoms of an anaphylactic reaction and replace the administration of adrenaline. They are complementary treatments.
After administering adrenaline, the patient must be hospitalized for further observation and treatment. In the event of a full-blown anaphylactic shock, intubation and treatment in an intensive care unit is necessary. In less severe cases, where there is low blood pressure and shortness of breath, large amounts of intravenous fluids and oxygen are administered. Bronchodilators are useful. The observation period depends on the patient’s condition and the speed of symptom relief.
Steroid drugs are also routinely given to prevent symptoms from returning. It is known that in about 10-20 percent. cases of anaphylactic reactions occur so-called the late reaction phase, where symptoms reappear after a few hours to a maximum of three days, despite the lack of re-exposure to the trigger of the reaction.
Patients who have experienced an anaphylactic reaction require allergological diagnosis (if not already known to be allergic) and should be equipped with adrenaline in automatic pre-filled syringes. In Poland, applicators containing adrenaline in a dose of 0,3 mg are available for adults and children over 25 kg and in a dose of 0,15 mg for children weighing over 10 kg.
Read also: Allergy? What’s all the fuss?
Anaphylactic shock – complications
Anaphylactic shock is extremely dangerous to the health and life of each of us. It can block the airways, preventing breathing, and can cause cardiac arrest. This is due to a drop in blood pressure, which prevents the heart from getting enough oxygen. Potential complications can arise from this, such as:
- brain damage
- kidney failure
- cardiogenic shock, which causes the heart to not pump enough blood to the body
- an abnormal heart rhythm that is either too fast or too slow
- heart attacks,
- death.
In some cases, pre-existing medical conditions may worsen. People struggling with respiratory diseases are particularly at risk. For example, if you are struggling with chronic obstructive pulmonary disease, a lack of oxygen can cause irreversible damage to your lungs. Anaphylactic shock can also permanently worsen symptoms in people with multiple sclerosis. The sooner treatment for anaphylactic shock is started, the lower the risk of unforeseen complications.
Also read: There must be adrenaline in schools!
Anaphylactic shock and the statistics
Statistics for Poland are lame, however, it is estimated that the frequency of anaphylactic reactions in the general population oscillates around a few cases per 100 / year, which in our country translates into up to several thousand people annually with life-threatening complications. In about 2-3 percent. cases of anaphylactic shock have a fatal outcome. It is known that atopic people, who have an innate tendency to produce IgE antibodies in response to contact with sensitizing substances (allergens), are at higher risk.