Causes, symptoms and treatment of anaphylactic shock

Anaphylactic shock – an acute allergic reaction that can lead to death. It affects various organ systems, but most often

• respiratory system

• the cardiovascular system

• skin and mucous

• gastrointestinal tract

The speed of the processes characteristic of ordinary allergies in this case is accelerated tenfold, and their manifestations are much more pronounced.

Reasons for the development of anaphylactic shock

Determining the cause of anaphylaxis is often difficult because there are too many allergens to act as a catalyst. Based on statistics, we can say that in most cases the body reacts in a similar way to

• bites of various insects

• foods

• taking certain types of medications

• interaction with contrast agents.

Insect bites. In the world there are over a million insects of different species, the bite of which can provoke an anaphylactic reaction. But most often, allergies occur in victims of bees or wasps, and in 1% of those stung, it can develop into anaphylaxis.

Food gives impetus to the development of anaphylaxis in at least a third of people prone to food allergies. Among the most dangerous products are

• Nuts: primarily peanuts and their derivatives (butter, etc.), hazelnuts, almonds, walnuts and Brazil nuts

• Milk

• Seafood: fish, shellfish, crab meat

Less common is an acute allergic reaction to eggs and fruits or berries (bananas, grapes, strawberries).

Medicines lead to an anaphylactic reaction in a significant number of cases. Among the medicines that can lead to this result:

• antibiotics (especially penicillin, ampicillin, bicillin and others from the penicillin series)

• anesthetics used during surgical operations: intravenous – Propofol, Thiopental and Ketamine and inhalation forms – Sevovluran, Halothane, etc.)

• non-steroidal anti-inflammatory drugs, including the common aspirin and paracetamol

• angiotensin-converting enzyme inhibitors (enalopril, captopril, etc.) used to treat hypertension

The last type of drugs (ACE inhibitors) can cause an allergic reaction leading to anaphylactic shock, even if the patient has been taking the drug for several years.

Medicines of other groups lead to the appearance of anaphylaxis within a few minutes or hours after the first dose.

However, the risk of allergic reactions to the use of these drugs is very small. It is difficult to compare it with the value of the positive therapeutic effect of these drugs. The probability that the body perceives them as an allergen and produces an anaphylactic reaction is

• 1 in 5 while taking penicillin

• 1 in 10 when using anesthetics

• 1 in 1 when using non-steroidal anti-inflammatory drugs

• 1 in 3 with angiotensin-converting enzyme inhibitors

Contrast agents used in the diagnosis of various diseases. Most often, they are administered intravenously during radiological studies of internal organs: fluoroscopy, computed tomography or angiography. They help to examine in detail the organs in which pathology is suspected. The risk of anaphylaxis in this case is about 1 in 10 studies.

Symptoms of anaphylactic shock severity

Depending on the way the allergen enters the body, the time after which the first symptoms appear changes. So, an insect bite contributes to an almost instant reaction, developing from 1-2 minutes to half an hour. Food allergy reveals itself for a longer time – from 10 minutes to several hours.

As a rule, the development of symptoms occurs within 5-30 minutes from the moment of onset. Depending on the severity of the process, it can be either a slight skin itch or an acute reaction that captures all body systems and leads to death. The faster the increase in symptoms that appear, the higher the likelihood of death if help is not provided on time.

The following clinical symptoms are most pronounced, which show the involvement of various organs and systems in the process:

• Skin changes characterized by a bright rash with intense itching

• Changes in the mucous membranes, causing tearing and swelling of the eyes, lips, tongue and nasal passages

• Respiratory disorders due to involvement in the reaction of the respiratory tract, their swelling and spasms

• Swelling of the throat leads to a feeling of coma, squeezing the neck

• Abdominal pain, nausea and vomiting, especially if the allergen enters through the esophagus

• False taste sensations like a metallic taste in the mouth

• Clouding of consciousness, panic reactions

• Rapid heartbeat, low blood pressure, fainting or dizziness

There are three degrees of severity of anaphylactic shock, each of which is characterized by certain symptoms. All of them are detailed in the table.

Diagnosis of anaphylaxis

Currently, medical research is not able to predict in advance the possibility of an anaphylactic reaction if it has never occurred. The risk group includes all those suffering from allergies. The diagnosis itself is made later: either during the reaction itself according to the symptoms and the rate of their development, or after relief. Due to the great danger of delay leading to death, it is not possible to study in detail each of the characteristic signs of anaphylaxis. The speed with which the state of health is deteriorating requires prompt treatment.

The discovery of the allergen that provoked such a reaction of the body is an important step following the treatment of anaphylaxis. If you have not experienced allergies before, then all the necessary specific studies should be carried out for you, which clarify the diagnosis of allergies in general and the cause of an anaphylactic reaction in particular:

• Skin tests

• Skin or application tests (Patch test)

• Blood sampling for IgE analysis

• Provocative tests

The purpose of laboratory tests is to pinpoint the allergen that is causing the reaction. To ensure safety in case of an excessively strong response of the body, the study should be carried out as carefully as possible.

Rast (radioallergen sorbent test) considered the safest study. This radioimmunological method allows you to most accurately calculate the culprit of anaphylaxis, without interfering with the activity of the patient’s body. For its implementation, the interaction of the victim’s blood with allergens sequentially added to it is analyzed. The release of a significant amount of antibodies after the next introduction indicates the detection of the allergen that caused the reaction.

Anaphylactic shock treatment

The speed of development and the severity of the symptoms that accompany anaphylaxis make it an emergency that requires immediate medical attention. The terminal phase of this condition is called anaphylactic shock.

Every second is precious when anaphylaxis is suspected. Whether you have symptoms yourself or someone close to you, the first thing to do is call an ambulance team. Properly rendered assistance before the arrival of doctors increases the chances of survival.

It is required to immediately eliminate contact with the allergen. If he entered the body through the esophagus, and the victim is conscious, gastric lavage is performed. If after an insect bite a sting remains in the body, then it is removed. You can apply a tourniquet above the site of the bite or injection of the drug to slow its penetration into the body.

Anaphylactic shock is almost guaranteed to manifest itself when the allergen enters the body again. Therefore, if you suspect anaphylaxis, you should always carry an emergency kit, including adrenaline injectors, with you at all times.

These include:

• Epi Pen

• He loves it

• Jext

They are administered intramuscularly with any route of penetration of the allergen. Usually, an injection is made into the dorsum of the lateral surface of the thigh muscle, avoiding penetration into the adipose tissue. Familiarization with the instructions will tell you the correct administration of the drug. Most often, after the injection, the injector is fixed for a few seconds in the position in which the drug was injected. After a few minutes, an improvement in the condition should follow, otherwise a repetition of the dose is acceptable.

If the victim has lost consciousness, it is necessary to give the body a horizontal position, laying the head to one side. Removable dentures are removed from the mouth. The safety of the exit of vomit is controlled, and the possibility of retraction of the tongue.

In the absence of a pulse, artificial respiration and indirect heart massage are performed – if there is a skill in correctly conducting these resuscitation measures.

After the provision of first aid by the visiting doctors, inpatient treatment continues. To do this, use the same drugs as in the treatment of allergies. After 2-3 days, at the latest after 10 days, the patient is discharged.

In order to save your life, you need to remember the importance of preventing anaphylaxis. Avoid substances containing allergens, places where insects or plants can grow that cause allergic reactions. You should always have a set of adrenaline injectors and an allergy passport with you.

Algorithm of actions for anaphylactic shock

It will not be difficult for a doctor to diagnose anaphylactic shock in a patient, since the symptoms of this condition are most often not in doubt. Knowing the rules of first aid to the victim, it is possible with a high degree of probability to help save his life.

So, if it was noticed that a person develops anaphylaxis, then it is necessary first of all to call an ambulance. The victim himself should be laid on a flat and hard surface, turn his head to one side, and raise his limbs. If a person has an episode of vomiting, then he will not choke on it. Be sure to provide access to fresh air by opening windows in the room.

Then you need to make sure that the person is breathing or not. If there are no chest movements, then you need to bring a mirror to his mouth. When there is breath, the mirror will fog up. When this does not happen, you need to start implementing artificial respiration techniques.

You also need to feel the pulse. It is best determined on the wrist, on the carotid and femoral arteries. If there is no pulse, then an artificial heart massage is required.

It is imperative to stop the influence of the allergenic factor on the human body. If anaphylactic shock has developed as a result of a bee sting, then it is required to remove the sting, and apply a tourniquet bandage to the bite site. This will allow the poison not to spread so quickly through the bloodstream. You also need to apply ice to the bite site.

If you follow all the recommendations correctly, this will allow you to gain time and wait for the arrival of an ambulance with minimal loss to the health of the victim.

Medical care for anaphylactic shock

Emergency doctors who diagnosed anaphylactic shock will administer adrenaline to the victim. It is an anti-allergic agent with an immediate effect. Adrenaline is used to cut off the bite site, and also inject it into a limb that has not been affected by the action of the allergen. If a person’s breathing is severely impaired, then the injection is placed under the root of the tongue. The drug is administered slowly and carefully so as not to provoke an arrhythmia.

It is possible to stop the swelling of the larynx thanks to an injection of adrenaline. If this does not help, then intubation, conicotomy or tracheostomy is required. All these procedures involve opening the airways in order to provide the lungs with oxygen.

The work of doctors does not stop there. The patient is shown the introduction of corticosteroids and antihitsamines. Such drugs as Suprastin and Diphenhydramine remain in priority, since they do not lower blood pressure and by themselves are unable to provoke an allergic reaction. Oxygen inhalation is also performed.

If the allergen cannot be established, then a number of methods are performed in the hospital to determine it.

For this, the following studies are carried out:

• Patch test (application test).

• Blood sampling for the determination of immunoglobulin E in it.

• provocative tests.

• Skin tests.

These studies will allow you to isolate the allergen and choose the optimal treatment.

Consequences of anaphylactic shock

Despite the fact that timely assistance was provided to a person, anaphylactic shock rarely passes without a trace for health. Certain disorders occur in the body, which make themselves felt for a long time.

The most common consequences of anaphylactic shock include:

• A decrease in blood pressure that remains consistently low.

• The occurrence of chronic pain in the region of the heart, which develop against the background of ischemia.

• Chronic fatigue, lethargy, lethargy.

After suffering anaphylactic shock, a person often develops neuritis, inflammation of the heart muscle, and diffuse damage to the central nervous system. Also, he may begin to be disturbed by joint pain, pain in the sternum, abdominal pain, nausea and vomiting.

To stop these consequences, drug therapy is required, but it must be prescribed by a doctor. In this case, the specialist must be informed that the person has suffered anaphylaxis.

Prevention of anaphylactic shock

With regard to the prevention of anaphylactic shock, there are simply no specific recommendations. However, there are points to which attention should be paid.

To a greater extent, those people who suffer from allergies on an ongoing basis are susceptible to anaphylactic shock. Therefore, they need to exercise extreme caution when in contact with any potential allergens.

The risk group includes asthmatics, patients with eczema, mastocytosis and allergic rhinitis. In such people, anaphylactic shock can develop even when eating certain foods, or when taking a number of medications. This is not a reason to refuse any treatment. It is imperative to follow medical recommendations, but the doctor must be made aware that the person is at risk for developing anaphylactic shock. Also, anaphylaxis in such patients may develop in response to the introduction of a contrast agent to perform a radiological study.

As for medical specialists, they must know and clearly follow all instructions for the elimination of anaphylactic shock in patients. Medical institutions and ambulances should be provided with anti-shock drugs and devices for emergency care.

Be sure to have an adrenaline injector at home. This is a one-time injection of adrenaline, it is completely ready for use. Sometimes such a small ampoule can save a person’s life. For example, in Western countries, adrenaline can be found in almost every home first aid kit.

The average person is advised to acquire knowledge regarding first aid for anaphylactic shock. First of all, this concerns the technique of performing an indirect heart massage and artificial respiration. It is equally important in any situation, even in an emergency, to keep a cool mind and not panic.