Anaphylaxis

Anaphylaxis is an acute potentially life-threatening IgE-mediated allergic reaction that occurs in previously sensitized individuals when they come again with the triggering antigen in touch. The symptoms can manifest as wheezing, dyspnea, and hypotension. The diagnosis is made clinically. Treatment is with adrenaline. For the treatment of bronchospasm and edema of the upper respiratory tract, inhalation or injection of beta agonists, and sometimes endotracheal intubation may be necessary. Continues, hypotension liquid and sometimes vasopressors be infused intravenously.

Anaphylaxis is an acute potentially life-threatening IgE-mediated allergic reaction that occurs in previously sensitized individuals when they come again with the triggering antigen in touch. The symptoms can manifest as wheezing, dyspnea, and hypotension. The diagnosis is made clinically. Treatment is with adrenaline. For the treatment of bronchospasm and edema of the upper respiratory tract, inhalation or injection of beta agonists, and sometimes endotracheal intubation may be necessary. Continues, hypotension liquid and sometimes vasopressors be infused intravenously. Etiology Anaphylaxis is typically triggered by drugs (eg. As beta-lactam antibiotics, insulin, streptokinase, allergen extracts) foods (such. As nuts, eggs, seafood) proteins (eg. As tetanus antitoxin, blood transfusions) Animal poisons latex peanut and latex allergens can be absorbed through the air. Occasionally, exercise or cold exposure can lead to an anaphylactic reaction or trigger such (with cryoglobulinemia z. B. in patients). A Atopievorgeschichte not increase the anaphylaxis, but may increase the risk of an anaphylactic reaction leads to death. Pathophysiology interactions between antigen and IgE on basophils and mast cells stimulate the release of histamine, leukotrienes and other mediators, which smooth muscle contractions (leading to bronchoconstriction, vomiting or diarrhea leads) and vasodilation with plasma discharge in the tissue (which can lead to urticaria or angioedema can) be caused. Anaphylaxieähnliche you reactions differ clinically indistinguishable from anaphylaxis. With them but no IgE is involved in the reactions and no presensitization required. These reactions occur by direct stimulation of the mast cells or immune complexes activate the complement. The most common triggers of anaphylactic reactions are iodorganische X-ray contrast agents aspirin and other NSAIDs, opioids Ig Exercise symptoms and complaints Symptoms of anaphylaxis begin within 15 minutes after exposure and typically affect the skin, the upper and lower respiratory tract, the cardiovascular system or the gastrointestinal tract. There may be one or more areas to be affected, and symptoms do not progress from mild (eg. As urticaria) to severe (eg. As airway obstruction, irreversible shock) necessarily, even if every patient in a subsequent contact normally the same reactions shows. The symptoms vary from mild to severe. The manifestations may include: redness, itching, urticaria, sneezing, rhinorrhea, nausea, abdominal cramps, diarrhea, choking or shortness of breath, palpitations and dizziness. Among the Sympomen of anaphylaxis include hypotension, tachycardia, urticaria, angioedema, shortness of breath, wheezing, cyanosis and syncope. Within minutes, a shock can develop, the patient may cramp, no more approachable and die. A cardiovascular collapse can occur without respiratory or other ailments. Late phase reactions occur in 4 to 8 hours after exposure or later. The symptoms and manifestations are less severe than they were originally, as a rule, and may be limited to urticaria; However, they may be serious or life threatening. Diagnosis Clinical examination clinically found Sometimes measurement of 24-hour urinary levels of N-methyl-histamine or serum levels of tryptase The diagnosis of anaphylaxis. The suspected anaphylaxis occurs when one of the following reactions can occur suddenly or without any explanation. Shock symptoms (. Eg shortness of breath, wheezing, wheezing) Two or more other manifestations of possible anaphylaxis (eg, angioedema, rhinitis, gastrointestinal symptoms) the risk of a rapid progression of the symptoms to shock does not allow test method, although milder cases in question can be confirmed by a 24-hour test of N-methyl histamine levels in the urine or of tryptase levels in serum. The reason is easy to see normally on the basis of medical history. If health care workers have unexplained anaphylactic symptoms, a latex allergy should be considered. Tips and risks to a latex allergy should be considered when health workers show unexplained anaphylactic symptoms. Therapy Immediate administration of epinephrine infusions Sometimes intubation and sometimes vasopressors for hypotension persists antihistamines Inhaled beta agonists for bronchoconstriction epinephrine epinephrine is the mainstay of treatment of anaphylaxis and should be administered immediately. It can possibly alleviate all the symptoms immediately. The use of epinephrine can be effected subcutaneously or intramuscularly (in adults, the usual dose is 0.3-0.5 ml of a 1: 1000 solution [0.1%], in children, 0.01 ml / kg every 10-30 minutes ). Maximum absorption occurs at an intramuscular administration of the drug side in the thigh. Patients with cardiovascular collapse or severe airway obstruction adrenaline can be given: as an i.v. administered single dose (3-5 ml of a solution 1: 10,000 [0.01%] over 5 minutes) or (1 mg as a continuous infusion in 250 ml of 5% dextrose in water for a concentration of 4 ug / ml, starting with 1 ug / min up to 4 g / min [15 to 60 ml / h]). Adrenaline may also by sublingual injection (0.5 ml of a 1: 1000 solution) or an endotracheal tube (3-5 ml of a 1: 10,000 solution, diluted with a saline solution to 10 ml) are added. Sometimes a second, subcutaneously administered epinephrine injection may be required. Glucagon than 1 mg bolus injection (20-30 ug / kg in children), followed by infusion (1 mg / hour) should be given to patients taking oral beta-blockers, as these are the effects of adrenaline abschwächen.Weitere therapeutic measures in patients with stridor and wheezing, the adrenalin do not respond to O2 treatment is a treatment-indexed with intubation. Early intubation is recommended, as an edema of the upper airways – while awaiting the response to adrenaline – can spread so far that endotracheal intubation is not possible and a Krikothyreotomie is necessary. Hypotension often disappears after the administration of epinephrine. Persistent hypotension can usually i.v. with 1-2 l (20-40 ml / kg in children) Administration of isotonic liquids (eg., 0.9% saline solution) to be treated. Vasopressors (eg. As dopamine 5 ug / kg / min) may be required if the patient is not on fluid replacement still on i.v. appeals adrenaline. Antihistamines – both H1 – (for example 50-100 mg diphenhydramine iv;… Editor’s note .: in Germany is usually clemastine, 2 mg iv [1 ampoule] administered) or H2 blockers (e.g. B. . cimetidine 300 mg IV) – should be administered every 6 h until the symptoms regress. The inhalation of beta agonists useful in the treatment of bronchoconstriction, which persists after treatment with epinephrine; Albuterol, 5-10 mg, as an aerosol can be inhaled continuously (Editor’s note .: in Germany not available;.. Instead continuous inhalation of salbutamol, 2 mg). The value of corticosteroids has not been established, but it could help prevent delayed reactions; are suitable Initial doses of 125 mg i.v. Methylprednisolone. Prevention Primary prevention is to avoid known causative allergens. A desensitization to allergens trigger is performed when a contact can not be reliably avoided (eg., Insect bites). Patients with known reactions to radiographic contrast agents should avoid repeated exposure. However, this is imperative, prednisone is administered p.o. in 3 doses of 50 mg every 6 h given, starting 18 hours prior to the examination, and one hour before the start of study diphenhydramine, 50 mg p.o. (see above). The effectiveness of this approach, however, is not occupied. Patients should wear a bracelet and SOS for immediate self-treatment upon renewed exposure to anaphylactic reactions to insect stings, foods, or other substances known a syringe filled with epinephrine (0.3 mg for adults and 0.15 mg for children) or oral antihistamines with you to lead. Conclusion Typical triggers for anaphylaxis are drugs (eg. As beta-lactam antibiotics, allergenic extracts), food (eg. As nuts, seafood), proteins (eg. As tetanus antitoxin, blood transfusions), venoms and latex. Non-IgE-mediated reactions that show up as anaphylaxis-like manifestations (anaphylactoid reactions), can be caused by iodinated X-ray contrast agents, aspirin, other NSAIDs, opioids, blood transfusion, immunoglobulins and physical stress. The suspected anaphylaxis occurs when patients unexplained hypotension, respiratory symptoms or ? 2 anaphylactic manifestations (eg., Angioedema, rhinitis, gastrointestinal symptoms) have. Adrenalin must be given immediately because anaphylactic symptoms can quickly develop into a Atemwegsokklusion or shock; Adrenalin can relieve all symptoms.

Health Life Media Team

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