Anaphylaxis – causes, symptoms, treatment. First aid for anaphylaxis

Anaphylaxis is a severe allergic reaction to a venom, food or medications. Most cases are caused by a bee sting or eating foods known to cause allergies, such as peanuts. Anaphylaxis causes a number of symptoms including rash, low heart rate, and shock known as anaphylactic shock. Moreover, anaphylaxis can be fatal if not properly acted upon when it occurs.

The immune system reacts to the allergen by producing antibodies that attack the allergen, and this starts a series of reactions from the immune system. Allergies can be mild, moderate or severe, and anaphylaxis is the most severe type of allergic reaction. Anaphylaxis triggers vary from person to person, but are usually insect stings or certain foods such as nuts, shellfish, or eggs. Anaphylaxis does not occur with the first exposure to an allergen, but with subsequent exposures.

People who are at high risk should always carry an anti-shock preparation for self-use (adrenaline in a pre-filled syringe), especially if they are traveling in areas where medical treatment is not readily available. If help is provided quickly enough, the patient recovers in most cases.

Anaphylaxis is believed to be more common in children and adolescents, although adults may also get anaphylactic shock if exposed to an allergen.

See also: How does the immune system work?

Anaphylaxis and anaphylactoid reaction

Anaphylaxis is a life-threatening condition that results from the action of allergens and affects many organs. This anaphylaxis does not occur with the first exposure to the allergen, but with subsequent exposures.

Anaphylactoid reaction (non-immune anaphylaxis) is a condition with similar symptoms to anaphylaxis with the difference that it does not require prior exposure to the allergen (occurs at first exposure). It may appear during medical procedures as a reaction to, for example, local anesthetics or chemotherapy.

Anaphylaxis and an allergic reaction

We talk about allergies when the body mistakenly perceives a given substance, e.g. pollen or animal hair, as a threat. People who are allergic to these substances, i.e. allergy sufferers, usually have mild to moderate symptoms. These symptoms also develop locally, incl. as a skin rash or watery eyes and runny nose.

However, it may very rarely happen that an allergen causes an anaphylactic reaction. This is when the immune system overreacts, leading to a body-wide reaction rather than a local allergic reaction. Anaphylaxis affects the respiratory and / or cardiovascular systems and can be life-threatening.

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Anaphylaxis – symptoms

Anaphylaxis symptoms can appear, progress and become life-threatening very quickly.

The most common early symptoms of anaphylaxis are:

1. itchy skin, sometimes changing to hives
2. general redness of the skin;
3. wheezing, hoarseness and tightness in the chest leading to difficulty breathing;
4. swelling of the lips, tongue and throat known as angioedema;
5. irritation and inflammation of the eyes and nasal passages;
6. swelling of the eyes, hands and feet;
7. dizziness;
8. nausea and vomiting, especially after eating foods to which the patient is allergic.

As anaphylaxis rapidly progresses to the more severe form of anaphylactic shock, other symptoms may include:

1. a sense of hopelessness;
2. fast beating heart;
3. stomach cramps, nausea and vomiting

Advanced symptoms of anaphylaxis include:

1. a high-pitched wheezing noise known as a stridor;
2. fast, shallow breathing, or being completely unable to breathe;
3. bluish skin on the lips and tongue;
4. agitation and anxiety;
5. sudden feeling of weakness or dizziness;
6. loss of consciousness.

Read also: What do swollen lips say?

With anaphylaxis, the body’s allergic reaction is tremendous. The white blood cells, which are usually involved in fighting infection, release chemicals such as histamine that lead to severe inflammatory reactions in the affected parts of the body.

Ultimately, the body only experiences problems, but even loses control of its vital functions, respiratory and / or cardiovascular systems.

The blood vessels dilate, which leads to a drop in blood pressure. The tissues in the airways swell, making it difficult to breathe and can completely block the airways. If air cannot reach the lungs, the blood cannot get the oxygen it needs. Oxygen-rich blood is needed for the proper functioning of all cells and organs, such as the brain and heart. The heart muscle needs oxygen to pump blood throughout the body. When one of the major organ systems begins to weaken, others become tense, which can damage many organs. Organ failure can be life threatening.

See also: Foreign bodies in the respiratory tract

Anaphylaxis – risk factors

The most common allergens causing anaphylaxis or anaphylactic shock include:

1. certain foods, including nuts, shellfish, eggs, and some fruits;
2. insect stings, especially wasp and bee stings;
3. natural latex, also known as rubber, often found in condoms and cleaning gloves;
4. certain medications, including some antibiotics such as penicillin and non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin;
5. contrast agents: special dyes used in some medical research, such as angiography;
6. General anesthesia.

In some cases of anaphylaxis, no specific cause for this severe allergic reaction can be found. This is called idiopathic anaphylaxis.

Some factors that may increase the risk of anaphylaxis include:

1. previous anaphylactic reaction;
2. allergies or asthma;
3. some other conditions including mastocytosis, an abnormal accumulation of mast cells that can release histamine and other substances during allergic reactions.

See also: We have an epidemic of allergic diseases. Many of them have to do with cesarean delivery and sterile living

Anaphylaxis – diagnosis

Since anaphylaxis is an emergency and the person experiencing it needs urgent help, blood tests can be performed to confirm anaphylaxis or rule out other causes of symptoms only after a life-saving operation has been performed. One test measures mast cell tryptase, a chemical released by the immune system during a severe allergic reaction. This blood test should be performed as soon as possible and no later than four hours after symptoms appear.

Also check: Receptors that inhibit the allergic reaction have been discovered

Anaphylaxis – treatment

A person who has had anaphylaxis needs immediate help. If it is suspected that a person is experiencing anaphylaxis, call an ambulance immediately and transport the person to the nearest emergency department. At this point, it should be emphasized that such a person needs medical consultation even if the symptoms subside. This is because anaphylaxis can be biphasic, meaning that symptoms may disappear as soon as it appears, but then return and worsen again after an hour or more.

Anaphylaxis – first aid

In the case of anaphylactic shock, before medical aid reaches the victim, first aid should be provided, that is:

An adrenaline rush for anaphylaxis

People who realize they are at risk of developing anaphylaxis usually carry a so-called EpiPen, i.e. an automatic disposable adrenaline injector. It looks a bit like a pen and is very easy to use. Sometimes you can also find an adrenaline pre-filled syringe, which is a combination of a syringe and a drug ampoule, ready for immediate injection.

Adrenaline is ordered to be injected in the center of the outer thigh. It can even be done through clothing. If the injection was made elsewhere on your body, get medical help. If adrenaline is given to a child, the leg should be immobilized during the injection to limit its movement and thus reduce the chance of a mistake. Adrenaline works very quickly when administered and wears off fairly quickly.

Correct position of the victim during anaphylaxis

The person in anaphylactic shock should be placed in a comfortable position. Depending on the symptoms experienced, different positions will be recommended.

1. People with low blood pressure should lie flat with elevated legs. Sitting or standing can cause additional heart problems.
2. People with respiratory and respiratory problems can sit up and breathe better.
3. Unconscious but still breathing persons should be placed on their side in the recovery position.
4. Pregnant women should lie on the left side to avoid aorto-venous syndrome, which is a decrease in circulation in the abdominal aorta and inferior vena cava due to pressure exerted by the fetus.

Removal of the allergen

It is very important in helping people who have suffered from anaphylaxis to remove the causative agent of anaphylactic shock. It is not always feasible, but may include, for example, pulling the sting of a bee out of the victim’s body or rinsing the mouth to remove traces of food allergen. In the latter case, it is not recommended to induce vomiting as this may lead to more serious complications.

Cardiopulmonary resuscitation (CPR) for anaphylaxis

If the victim is unconscious and not breathing, the person should be treated with cardiopulmonary resuscitation (CPR) until emergency services arrive. CPR involves placing your hand in the center of the victim’s chest, extending the arms, and performing rhythmic chest compressions and rescue breaths. in the ratio of 30 compressions to 2 rescue breaths.

If it is difficult to find the pulse in the injured person, you can go straight to CPR (if the victim is unresponsive and not breathing). Importantly, CPR can be performed with compressions alone if we are not comfortable with mouth-to-mouth resuscitation and there is no person with us to help.

CPR may not make the victim’s heart beat again if it has stopped, but this method will pump blood around the body to supply oxygen to organs, including the vital brain.

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Hospital treatment of anaphylaxis

In hospital, people suspected of having anaphylaxis are treated on a case-by-case basis. Treatments for anaphylaxis include:

1. adrenaline – injected into the thigh muscle, sometimes given multiple times or, more rarely, through an intravenous drip.
2. intravenous fluids – to raise blood pressure
3. oxygen and bronchodilators – used in severe cases, they are designed to help relax the muscles in the lungs to allow increased airflow to the lungs.
4. steroids and antihistamines.

In very severe cases, a respirator is used, which supports the breathing of the victim until the immune reaction subsides.

Anaphylaxis – complications

Complications if anaphylaxis are not treated may lead to respiratory arrest or airway obstruction due to inflammation of the airways. It can even lead to a heart attack, which in turn can be fatal for the patient.

Anaphylaxis – prophylaxis

If a person has had anaphylactic shock, then if they are exposed to the same allergen again, they will have another anaphylactic reaction. Moreover, subsequent anaphylactic shocks may only get worse. Fortunately, this can be prevented.

Anaphylaxis prevention – avoiding allergens

One of the most important elements in the prevention of anaphylaxis is to avoid allergens that cause anaphylactic shock. People who have already had an episode of anaphylactic reaction have already consulted their allergy doctors to identify the triggers of allergy and assess and advise on how to avoid them in the future.

Anaphylaxis prevention – preparing for future situations

It is equally important to be prepared for situations in which the patient will be exposed to allergens that may cause anaphylactic shock. Such persons should always carry an EpiPen or the adrenaline pre-filled syringe. These types of preparations are prescribed by a doctor and contain a single or double dose of an anaphylactic drug, which is injected into the thigh during an anaphylactic emergency. The doctor will also inform the patient how to use them properly. It is also worth informing the family members and relatives about it. Thanks to this, they will be able to help a sick person in a crisis situation.

Schools and workplaces should also be prepared for situations where anaphylaxis may occur in one of the students or staff.

There are also emergency kits for anaphylaxis. It is recommended that they include:

1. adrenaline rush. It is designed to reverse many of the serious symptoms caused by anaphylactic shock, most importantly: low blood pressure, fast or abnormal heart rate, swelling, and asthma.
2. H1 antihistamines. 1st generation antihistamines are effective in treating skin symptoms and reducing swelling as adrenaline adjuvants.
3. H2 antihistamines. 2nd generation antihistamines also help with cardiovascular symptoms and reduce stomach discomfort by reducing stomach acid, which is produced in large amounts in response to excess histamine in the body.

Anaphylaxis prophylaxis – allergen immunotherapy

In the case of some allergy sufferers, allergen immunotherapy (desensitization) is also used. This method consists in slowly exposing the patient’s organism to the factor responsible for its allergy, lasting months or years. This allows the immune system to slowly get used to the allergen, helping to reduce the severity of the allergic reaction in the future.

See also: Desensitization is an effective method of treating allergies