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Anaphylaxis

Anaphylaxis is a severe and rapid systemic allergic reaction to a trigger substance, called an allergen. Minute amounts of trigger substances may cause a life-threatening anaphylactic reaction. Anaphylaxis may occur after ingestion, inhalation, skin contact or injection of a trigger substance. The most severe type of anaphylaxis - anaphylactic shock - will usually result in death in mere minutes if untreated. more...

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The word is from New Latin (derived from Greek ἀνα-/ana, meaning "up, again, back, against") + φύλαξις/phylaxis, meaning "guarding, protection"—cf. prophylaxis.)

Immediate action

Anaphylactic shock is a life-threatening medical emergency because of rapid constriction of the airway, often within minutes of onset. Calling for help immediately is important, as brain damage occurs rapidly without oxygen. Anaphylactic shock requires advanced medical care immediately; but other first aid measures include rescue breathing (part of CPR) and administration of epinephrine. Rescue breathing may be hindered by the constricted airways but can help if the victim stops breathing on their own. If the patient has previously been diagnosed with anaphylaxis, they may be carrying an EpiPen (or similar device) for immediate administration of epinephrine (adrenaline) by a layperson to help keep open the airway. Repetitive administration can cause tachycardia (rapid heartbeat) and occasionally ventricular tachycardia with heart rates up to 240 beats per minute, but is only dangerous when done in rapid succession. Nevertheless, if epinephrine prevents worsening of the airway constriction, it may still be life-saving.

Symptoms

Symptoms of anaphylaxis are related to the action of immunoglobulin E (IgE) and other anaphylatoxins, which act to release histamine and other mediator substances from mast cells (degranulation). In addition to other effects, histamine induces vasodilation and bronchospasm (constriction of the airways).

Symptoms can include the following:

  • respiratory distress,
  • hypotension (low blood pressure),
  • fainting,
  • unconsciousness,
  • urticaria (hives),
  • flushed appearance,
  • angioedema (swelling of the face, neck and throat),
  • tears (due to angioedema and stress),
  • vomiting,
  • itching, and
  • anxiety, including a sense of impending doom


The time between ingestion of the allergen and anaphylaxis symptoms can vary for some patients depending on the amount of allergen ingested and sensitivity. Symptoms can appear immediately, or can be delayed by half an hour to several hours after ingestion. However, symptoms of anaphylaxis usually appear very quickly once they do begin.

Causes

Common causative agents in humans include:

  • foods (e.g. milk, cheese, nuts, peanuts, soybeans and other legumes, fish and shellfish, wheat and eggs);
  • drugs (e.g. penicillin and other cephalosporins, contrast media, ASA and other NSAIDs such as ibuprofen and diclofenac);
  • latex;
  • Hymenoptera stings from insects such as bees, wasps, yellow jackets, hornets, and some stinging ants; and
  • exercise (see exercise-induced anaphylaxis).

Transfusion of incompatible blood products may lead to extremely similar symptoms, albeit for substantially different biochemical reasons.

Read more at Wikipedia.org


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Anaphylaxis: Q & A
From Alberta RN, 3/1/05

What is anaphylaxis?

While there is no universally accepted definition of anaphylaxis (Anna-fill-axis}, most physicians would agree that it is a life-threatening allergic reaction to a specific trigger (food, insect sting, medication, exercise, and latex) in a person who has become sensitized. There is disagreement, however, about the constellation of symptoms by which it can be recognized.

How common is anaphylaxis?

A conservative estimate is that two percent of the population (approximately 600,000 Canadians) may be affected by potentially life-threatening allergies. The incidence may be higher in children and it has increased dramatically in the last decade.

What is the difference between anaphylactic and anaphylactoid!

Anaphylactic and anaphylactoid reactions are similar in their clinical presentation and treatment. The only difference is the chemical reactions that are taking place. Anaphylactic reactions are mediated by IgE (an immunoglobulin) and anaphylactoid reactions are not.

What is the best treatment for anaphylaxis?

Epinephrine, a hormone produced in the body by the adrenal glands, reverses the negative cardiovascular effects of an anaphylactic reaction and helps to dilate the airways. It is the initial treatment of choice for anaphylaxis and can be used also during a life-threatening asthma attack. For optimal effect, an injection of epinephrine must be administered at the very beginning of a reaction. While life saving, epinephrine only provides supportive emergency treatment and cannot replace thorough assessment and treatment in hospital.

How can I recognize a reaction?

Each allergic individual will react in a specific way (i.e., with specific symptoms). This tends to be consistent from reaction to reaction unless the mode of contact is altered (i.e. ingestion, injection, inhalation). The severity of reaction, however, is less predictable. The quantity of allergen (trigger), asthma, the use of beta-blockers (cardiovascular medication) can affect it and this is why strict avoidance and the immediate use of epinephrine are imperative. Many people watch for hives to develop, but these may not be present.

Mild Symptoms

tingling, numbness, pain in the lips and tongue;

itchy eyes, nose, face;

flushing of the face and body;

Moderate to Severe Symptoms

swelling of the eyes, face, lips, tongue and throat;

difficulty swallowing;

hives;

abdominal cramps, vomiting, diarrhea;

wheezing, coughing, difficulty talking and breathing;

a sense of foreboding, fear and apprehension;

weakness and dizziness;

drop in blood pressure, loss of consciousness, death.

Most serious reactions occur rapidly and respond quickly to epinephrine. Some life-threatening reactions may have a delayed onset or recur several hours after seemingly effective treatment.

To learn more visit www.anaphylaxis.org or contact

Anaphylaxis Canada

416 Moore Avenue, Suite 306

Toronto, ON M4G 1C9

Tel: 416.785.5666

Fax: 416.785.0458

E-mail: info@anaphylaxis.ca

©Anaphylaxis Canada

Reproduced with permission from Anaphylaxis Canada

More resources

In 2002, the Anaphylaxis Working Group of Calgary Health Region Nursing Professional Resources prepared a pamphlet on anaphylaxis. For more information, contact:

Irene Hanrahan

Nursing Professional Resources

Tel: 403.944.1641

E-mail: irene.hanrahan@calgaryhealth.ca

Copyright Alberta Association of Registered Nurses Mar 2005
Provided by ProQuest Information and Learning Company. All rights Reserved

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