Anaphylactic shock: symptoms, causes, treatment, prognosis, diagnosis

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Anaphylactic shock is a dangerous rapidly developing pathological reaction of the body to an allergen. This condition can have very negative consequences. And this article will tell you about the pathogenesis of anaphylactic shock in children and adults, give clinical recommendations and tell you what kind of first aid kit you need if you are overtaken by anaphylactic shock.

Features of the ailment

Anaphylactic shock( anaphylaxis, allergic shock) is an acute, rapidly developing pathological reaction of the organism in response to an attack of allergens, in which all systems and organs experience extremely pronounced painful changes, often incompatible with lifeeach 5 to 10 patients). The speed of all processes, characteristic of banal allergy, is accelerated in the event of a shock effect, and their severity is increased tens of times.

All the organs and respiratory tract, vessels and capillaries are exposed to:

• ;
• brain, heart;
• organs of the gastrointestinal system;
• skin and mucous membranes.

The following video will tell you what an anaphylactic shock is:

Children

A special danger of anaphylaxis is for the child's organism due to the lack of development of many systems and organs, protective function, anatomical and physiological features. For example, the larynx of the larynx in a child - the condition is critical, since the respiratory clearance is extremely small and the swelling of the mucosa at a thickness of only 1 mm will easily block the access of air to the newborn and the baby.

At this age of vaccination, medications often provoke an acute allergic reaction. But if in adults the shock usually occurs with the secondary penetration of allergens into the blood, then in children, anaphylaxis can develop at the first contact with a provocateur of an allergic shock, if the mother used a certain medication for breast-feeding and breastfeeding, and through the placenta or milkblood of the baby. And neither the dose nor the method of administration of a pharmacological agent is of any importance if the child is already sensitized( has an increased sensitivity to a particular substance).

In addition, it is in children that anaphylaxis develops in foods.

Pregnancy

Pregnancy also creates a particular vulnerability to the future mother and fetus. With overloads that the heart and vascular system undergo during anaphylaxis, the probability of miscarriages, early placental abruption, premature birth and intrauterine death is very high. The pregnant woman herself is also endangered by catastrophic bleeding, stroke, respiratory and heart failure.

For the types and forms of anaphylactic shock, read below.

Classification

According to the flow patterns

Classification by the forms of the course of anaphylactic shock( AH) is tied to the key signs of the disorder of specific systems and target organs, to which the main aggression of allergens is directed.

Anaphylaxis is subdivided into the following forms:

1. Typical .It occurs most often, accompanied by impaired functions of blood vessels, respiratory organs and pathways, skin and subcutaneous edema.
2. Hemodynamic .It is accompanied by violations of blood circulation, insufficiency of myocardium functioning, cardiac vessels.
3. Asphyxic , with a predominance of acute respiratory failure, swelling and spasms of the respiratory tract, reaching the degree of asphyxiation( suffocation).
4. Abdominal or gastrointestinal form with symptoms of acute poisoning, "acute abdomen", stomach and intestinal diseases.
5. Cerebral , with characteristic lesions of the central trunks of the nervous system, cerebral vessels developing before the brain edema.
6. The form of AS, triggered by with physical overload .

By severity of

severity The severity of the course of the pathology according to the criteria:

Baseline criterion	Degree of severity
I	II	III	IV
Blood pressure in mm Hg. Art.	below the normal value of 110 - 120/70 - 90 for 30 - 40 units	Systolic( upper) 90 - 60 or lower, diastolic( lower) 40 and lower	Upper 60 - 40, lower - to 0( when measured - not detected)	Not defined
Consciousness	Saved. Severe panic, fear of death	Consciousness confused, a state of constipation, a loss of consciousness	High risk of loss of consciousness	Sudden loss of consciousness
Patient response to anti-shock treatment	Active	Good or satisfactory	Weak	Weak or missing

The severity of shock determines the timethe onset of the first signs. The earlier the symptoms start to appear from the moment of penetration of the allergen into the body, the more severe the manifestations of anaphylaxis.

Flow type

Classification AS according to flow type:

Flow / type	Features
Acute malignant. More common in a typical form.	sudden progressive onset; sharp drop in blood pressure( lower - systolic falls to 0); confusion, progression of signs of a breathing disorder, spasm of the bronchi. severity of manifestations is increasing, the response to active treatment is weak or absent. there is a development of severe pulmonary edema, persistent depression of pressure, coma. The risk of death of a patient is high.
Acute benign	The main pathological manifestations are severe enough. But when the therapy is carried out, they are not characterized by an increase, they give in to reverse development and subsidence. A favorable prognosis is highly likely in emergency treatment.
Abortive	Pathological symptoms are mild, quickly suppressed, often without the use of drugs. occurs in patients with asthma who take hormones( Prednisolone, Dexamethasone).
Extended	Both types are characterized by: Fast start. Typical clinical manifestations of anaphylaxis. Treatment with a protracted type of leak gives a temporary, partial effect. A recurrent course is characterized by a secondary sharp drop in blood pressure after stabilization and removal of the patient from an acute condition. The remaining symptoms are not as pronounced as in acute types of pathology, but hardly respond to therapy. More often observed with prolonged admission of patients with prolonged drugs( for example - Bicillin).
Recurrent
Lightning-fast	Lightning-fast development of anaphylactic reaction - within 10 to 30 seconds. This occurs more often when the drug is injected into a vein. The outlook is disappointing. Favorable completion is possible only with the same immediate introduction of adrenaline and other anti-shock drugs.

About the causes of anaphylactic shock read further.

Reasons for

Development mechanism

Stage I

Sensitization( abnormal sensitization to a specific allergen).

Primary hit of an allergen is perceived by the immune system as the penetration of a foreign agent on which special protein compounds are produced - immunoglobulins E, G, after which the body is considered sensitized, that is ready for a sharp allergic reaction with the reintroduction of the allergen. Immunoglobulins are fixed on immune( obese) cells.

Stage II

Directly - anaphylactic reaction.

With the secondary ingress of the allergen into the blood, immunoglobulins immediately come into contact with it, after which specific substances regulating allergic and inflammatory reactions are released from the mast cells, the main one of which is histamine. It causes swelling, itching, vasodilation - and, as a consequence, - a drop in pressure, a violation of breathing. With anaphylactic shock, histamine is released simultaneously and in a huge volume, which leads to catastrophic disruption of all organs.

The main causes of

Among the numerous causes of development of ASH, first, the introduction of drugs, including:

• antibiotics( penicillin, aminoglycosides, metronidazole, Trimethoprim, Vancomycin);
• Aspirin, other non-hormonal anti-inflammatory drugs( NSAIDs);
• inhibitors of ACE( agents for hypertension - Enalapril, Fosinopril, Captopril even if the drug has been taken before this for several years);
• sulfonamides, iodinated preparations, vitamins of group B;
• plasma substitutes, iron preparations, nicotinic acid, No-shpa, immunoglobulins.

Other causes of development of ASH:

1. Vaccines against influenza, mumps, rubella, tetanus, measles, whooping cough, whey.
2. Anesthetics( Propofol, Thiopental, Ketamine, inhaled Sevoflurane, Halothane) and muscle relaxants( means for muscle relaxation) before surgical operations.
3. Contrasting substances in fluoroscopy, computed tomography or angiography( 1 case per 10 000 studies).
4. Poison of Hymenoptera insects( bites of wasps, bees, hornets, mosquitoes, especially plural).
5. Food products. Peanuts, walnuts and Brazil nuts, fish and its parasites, for example - Anisakis simplex, mollusks, citrus fruits, chocolate, honey and bee products, smoked products, strawberries, tomatoes, cranberries, cheese, legumes, cherries and raspberries. In childhood - milk of a cow, soy, eggs.
6. Food additives - preservatives, sulfites, nitrates, tartrazine, salicylates.
7. Physical load( rare).
8. Systemic mastocytosis, in which an excessive number of mast cells are formed that are capable of releasing excess histamine.
9. Cosmetic preparations( deodorants, varnishes, perfumes, mascara), household chemicals, industrial chemicals, house dust.
10. Pollen of bushes, flowers, seeds of trees( not often).

Risk factors

Risk factors:

1. Allergic diseases( hives, atopic dermatitis, allergic rhinitis)
2. Chronic diseases of respiratory organs, including asthma, chronic pneumonia, bronchitis, bronchial obstruction).
3. Diseases of the heart and blood vessels
4. Presence of anaphylactic reactions.
5. Concomitant treatment of the patient with the following drugs:
   • beta-blockers( the airway response to histamine, bradykinin is increased and the effect of epinephrine used to remove the patient from shock is reduced).
   • MAO inhibitors( inhibit the enzyme that cleaves epinephrine, thereby enhancing the side effect of epinephrine).
   • ACE inhibitors( can cause swelling of the larynx, tongue, pharynx with the development of choking, "kapotenovy cough").

Symptoms of anaphylactic shock

Symptoms of

The initial manifestations with the rapid development of anaphylaxis are observed already in the first seconds after the penetration of the allergen into the blood. Usually this happens when the medicine is injected into a vein. A typical increase in signs is in the range of 5 to 40 minutes.

But often there is a two-phase course of anaphylactic shock, when after the subsidence of all the signs on the background of intensive treatment after a day - three can suddenly begin the second wave of anaphylaxis.

The basic symptoms of anaphylactic shock are often combined or manifested in a complex way - in accordance with the forms of AS:

Frequency of manifestations	Symptoms of
In 9 cases of 10	exhaustion, dizziness, fear of death; feeling of heat on the face, redness( redness) of the skin; itching rash, red spots and blisters like urticaria( with rapid development of pathology - changes on the skin occur later than other symptoms); swelling of the larynx, lips, tongue, pharynx, eyelids, genitals, fingers, neck pressure reduction.
In half of	patients, edema of the nasal sinuses, sneezing, mucus from the nose; attacks of dry cough; feeling of a lump in the pharynx, superficial panting, hoarseness; stridor( wheezing and exhaling), wheezing in the lungs; bronchospasm; sharp pallor, blue lips, skin around the nose and mouth, nail plates; eye irritation, itching; loss of consciousness.
In the third part of the	patients, the pain in the head is pressing or pulsing; significant and dramatic decrease in pressure; pain and squeezing sensation behind the sternum, in the near-cardiac region; slowing of the pulse, failure in the rhythm of contractions of the heart.
Each 3 to 4 patients with	have an itching of the oral mucosa; complicated swallowing; attacks of nausea, vomiting, loose stools, cramping pains, spasms in the stomach, intestines.
In 5 - 10% of anaphylaxis:	numbness of the muscles of the face, lips; vision impairment( fuzzy, doubling, nebula); panic attacks, tremor( trembling), convulsions; uncontrolled urination and defecation; edema of the brain.

Next, the diagnosis of anaphylactic shock is considered.

Diagnosis

If episodes of an anaphylactic reaction have never been determined in a patient before, then studies are not able to predict its manifestation in the future, that is - to predict its development. However, the probability of its occurrence in one degree or another can be predicted:

• is absolutely for everyone who suffers from any form of allergy;
• in people whose relatives( especially parents) experienced a similar experience of anaphylaxis.

Because anaphylaxis is a condition in which all manifestations grow very quickly, the diagnosis is most often made during the development of the pathology, based on the rate of development of symptoms, and even more often after treatment or death. Since delay in such a situation leads to the patient's death, a detailed study of each symptom at this moment is impossible and simple - extremely dangerous.

Danger of a false diagnosis

On the other hand, due to lack of time and lack of professionalism, false diagnoses are often made.

• For example, with the development of gastrointestinal( abdominal) anaphylaxis, all the signs are very similar to the symptoms of acute poisoning, appendicitis, pancreatitis, biliary colic.
• In hemodynamic form with its severity of heart pain and manifestations of insufficiency - a person is diagnosed with a "myocardial infarction".
• Spasmodic bronchus, dyspnea and even laryngeal edema are classified as signs of an asthmatic attack, and cerebral and neurological disorders - to strokes, meningitis and other diseases that have nothing to do with anaphylactic shock.

Such false diagnoses are deadly to the patient, as there is simply no time left for proper treatment.

Actions for

Detection of an

problem The identification of an allergen-aggressor that caused an anaphylactic shock is a very important stage that should be included directly in the treatment of pathology. If the patient does not experience allergic reactions, special studies are carried out. They are able to confirm the diagnosis of allergic organism as a whole, as well as the causative allergen in the specific case of anaphylaxis.

Out of them:

• skin, cutaneous, application tests( Patch-test);
• blood test for the presence of immunoglobulins E( IgE), responsible for allergic reactions;
• provocative tests.

To ensure the safety of the patient's health in the event of a sharp response to an allergy provocation, all studies are conducted with a high degree of caution. The most safe is the radioimmunoassay method for conducting an allergensorbent test( RAST), which with the greatest accuracy determines an anaphylactic allergen without affecting the structure of the body.

Safety is provided by conducting an analysis outside the patient's body. In the blood taken from the patient, various kinds of allergens are alternately added. If after the next interaction of blood with an allergen an abnormal amount of antibodies is allocated, this indicates this allergen as the cause of the anaphylactic reaction.

This video will tell you about first aid for anaphylactic shock:

Treatment of

Inpatient - in intensive care and intensive care unit, the main treatment for anaphylactic shock is performed.

Basic principles of

Basic principles of the treatment of anaphylactic shock:

1. Elimination of serious dysfunctions in the functioning of the heart muscle, blood vessels, respiratory and nervous system.
2. Prevention of sudden pressure drop and coma development.
3. Prevention of pulmonary edema, brain, asphyxia, cardiac arrest.
4. Removal of life-threatening edema of the larynx, trachea, bronchi.
5. Suppression of further releases of histamine, bradykinin, kallikrein and removal of allergen substances from the blood.

On whether adrenaline is administered with anaphylactic shock and what other drugs will be needed, we will tell further.

Activities and Drugs

1. Intramuscular injections of epinephrine( epinephrine) 0.1% after 10 - 15 minutes at 0.2-0.8 ml. When calculating children's doses, the norm is 0.01 mg( 0.01 ml) per kilogram of the baby's weight. If no positive reaction occurs, intravenous injection of 1 ml of epinephrine into 10 ml of NaCl solution is done slowly - 5 minutes to prevent myocardial ischemia. Or 1 ml of medicine in 400 ml of NaCl through a dropper, which is more rational.
2. Infusion of liquids to prevent coma: 1 liter of NaCl solution, then -0.4 liters of Polyglucin. Initially, a jet injection of up to 500 ml in 30-40 minutes, later - through a dropper. It is believed that colloidal solutions actively fill the vascular bed, but crystalloid liquids are safe, since dextrans themselves are able to cause anaphylaxis.
3. Glucocorticoids.
   • Hydrocortisone in the muscle or vein: adults from 0.1 to 1 gram. For children, intravenous injection is 0.01 to 0.1 grams.
   • Dexamethasone: 4 - 32 mg intramuscularly, daily dose for intravenous injection of 3 mg per kilogram. After deducing the patient from an acute condition, Dexamethasone is given in tablets in a daily dose of up to 15 mg. Children's doses are calculated by the weight of children: from 0.02776 to 0.1666 mg per kilogram.
   • Prednisolone: ​​150-300 mg once intramuscularly, infants up to a year per kilogram of weight 2 to 3 mg, from 1 year to 14 years of 1 to 2 mg.
4. Means for restoring respiratory patency and relieving bronchospasm, suppressing histamine emissions.
   • Eufillin 2,4% 5 - 10 ml intravenously. Drip administration provides a dose of 5.6 mg per kilogram( 20 ml of the drug is diluted in 20 ml of 0.9% NaCl and 400 ml of saline).The largest doses per day per kilogram of weight: 10 to 13 mg, children from 6 years - 13 mg( 0.5 ml), from 3 to 6 to 20 - 22 mg( 0.8 - 0.9 ml).Carefully use Euphyllin in the last trimester of pregnancy, because the mother and the fetus may have tachycardia.
   • In addition to Euphyllin, Aminophylline, Albuterol, Metaproterol are used.
5. Medications to activate the heart. Atropine 0.1% subcutaneously 0.25 - 1 mg. Children's single doses are prescribed by weight and age in the range of 0.05-0.5 mg.

1. Drugs that prevent pressure loss and increase cardiac output.
   • Dopamine. Applied intravenously after dilution in a solution of glucose 5% or sodium chloride. Adults( per kilogram of weight per minute) from the minimum dosages of 1.5 to 3.5 μg( infusion rate of 100 to 250 μg / min) to 10.5 to 21 μg( 750 to 1500 μg per minute).Children over 12 years of age the highest dose per kilogram of 4 - 8 mcg( per minute).
   • In pregnant women, dopamine is used only in case of a life threat for the mother, teratogenic( disfiguring fetus), the effect of Dopamine is not revealed. Breastfeeding is discontinued.

1. Antihistamines, stopping the release of allergic provocateurs into the blood, eliminate itching, swelling, and flushing. It is rational to prescribe after the recovery of the circulating blood volume, since they can lower the pressure.
   • Intramuscularly: Suprastin( 20 mg) 2 - 4 ml;initial infantile doses: 6-14 years to 1 ml, 1 to 6 years 0.5 ml, from month to year 0.25 ml. The single largest dose per kilogram of weight can not exceed 2 mg.
   • Pipolphen, Tavegil, Dimedrol are also used.

After the passage of an acute period, the patient is prescribed glucocorticosteroids in tablets with a smooth reduction in dosages for 7 to 10 days, and antihistamines.

Therapeutic treatment

• Oxygen therapy .Helps with the growth of oxygen starvation of tissues and bronchospasm.
• Hemosorption is a special extracellular technique for removing allergens from the blood while passing it through sorbents.

All patients who survived anaphylaxis should be observed in the hospital for up to 2 to 3 weeks, because of the possibility of developing repeated anaphylaxis and late complications from the heart, blood vessels, respiratory and urinary system.

Therefore in the hospital several times do:

• blood test; urine;
• study of indicators of urea, creatinine in the blood;
• electrocardiogram or ultrasound of the heart;
• study of feces on Gregersen's reaction.

Next, the prevention of anaphylactic shock is considered.

Prevention of

To reduce the risk of developing asthma in people with a high likelihood of exposure to an allergen:

• must have a set of emergency medicine( we wrote about its standard for anaphylactic shock alone):
  • adrenaline solution;
  • Prednisolone in ampoules;
  • Ventolin, Salbunanol;
  • Suprastin or Tavegil or Dimedrol( in ampoules)
  • harness.
• be able to use an automatic syringe for injecting adrenaline( Epi-pen, Allerjet);
• to avoid insect bites( cover open spaces, do not consume sweets and ripe fruits outside the house), use special deterrents;
• correctly assess the components in the consumed products to avoid the penetration of allergens through the stomach;
• at work, avoid contact with industrial chemicals, inhalation and skin allergens;
• does not use β-blockers at the risk of developing severe anaphylaxis, replacing them with medications of another group;
• when conducting studies using radiocontrast agents in advance to do an injection of Prednisolone
• to make samples for allergy from medicinal and other substances;
• choose medicines in tablets, not in injections;
• always carry a "passport"( card, bracelet, suspension) with information about allergic diseases and drugs that help with ASH.

For possible complications after such an allergic reaction as anaphylactic shock, read on.

Complications of

• Serious complications can be diagnosed:
• Glomerulonephritis
• Intestinal and gastric bleeding
• Cardiac pathologies, including myocarditis
• Bronchospasm and pulmonary edema;
• Edema and cerebral hemorrhages
• coma

If help is delayed, the pulse becomes weak, the person loses consciousness, there is a high risk of death.

Forecast

The prognosis is favorable only in the case of immediate medical care when establishing an accurate diagnosis and emergency hospitalization of the patient.

However, even cupping drugs with acute anaphylaxis does not mean that everything ended well, because there is a high probability of secondary pressure drop and the development of anaphylaxis( usually within 3 days, but there is a longer interval).

About what to do when anaphylactic shock comes, this video will tell: