A serious condition that affects the state of the whole body and without proper medical care can cause death. One of its most severe types is anaphylaxis, a severe allergic reaction. MedAboutMe understood why anaphylactic shock occurs and whether the risks of its occurrence can be minimized.

Anaphylaxis is a severe pathological condition that develops as a reaction to a particular allergen. It differs from ordinary allergies in a more massive generalized effect and severe symptoms:

• Hyperemia, feeling of heat.
• Oppression of consciousness, fainting.
• Head and heart pains.
• Drop in blood pressure.
• Seizures.
• Respiratory failure.
• Suffocation.

Anaphylactic shock is caused not only by the activity of antibodies produced as a response to an allergen, but also by the release of certain biologically active substances into the blood, including hormones. Among them are histamine, serotonin, bradykinin. Substances affect the circulatory system, in particular, lead to impaired blood circulation. First of all, the capillaries suffer. The blood ceases to provide the brain with oxygen normally, which is the cause of fainting in anaphylactic shock. Other internal organs also suffer, so shock can lead to their lesions and further pathologies. The condition is dangerous in that it sometimes develops within seconds after the allergen has entered and in a short time causes significant harm to human health.

Anaphylactic shock is a type of true allergy (impaired immune response), which means that it does not depend on the amount of the allergen and can develop even with a small dose. It has also been proven that the way the allergen is administered does not affect the severity of the reaction, but may affect the time it takes to develop.

One of the key allergens that lead to anaphylaxis are drugs. It is various drugs that more often than other substances lead to serious conditions. 10-20% of all cases of such shock are fatal.

It should be noted that sensitization - sensitivity to an allergen - may not develop at the initial stage, but after several years of taking the drug. In some cases, allergies develop gradually. First, after taking the medication, standard reactions occur (itching, swelling, rash), and later, further medication leads to anaphylaxis. However, most often the shock occurs suddenly, without any precursors.

Most often, such a generalized reaction is caused by such drugs:

• Antibiotics, often of the penicillin group - penicillin, ampicillin, bicillin and others.
• Vaccines.
• Anesthetics that are used in surgical procedures - propofol, ketamine, thiopental and others.
• Aspirin and paracetamol (shock rarely occurs).
• Angiotensin-converting enzyme inhibitors (treatment of hypertension) - enalapril, captopril. Anaphylactic shock can occur after several years of regular drug use.

If even a slight allergy to drugs is detected, it is necessary to accurately identify the component that caused the reaction, and further warn doctors about this. For example, if symptoms appear on a specific antibiotic of the penicillin series, in the future, a person should not use any drugs in this group.

Anaphylactic shock is difficult to predict - such a reaction can develop to any component, be primary or occur after minor allergies. Doctors identify a number of allergens, which most often lead to serious conditions:

• Poisons of stinging and biting insects. Often shock develops on the stings of bees and wasps.
• Foods: peanuts, chocolate, oranges, seafood. In children, milk and eggs can cause a similar reaction. It is noticed that severe forms of food allergies are more common for those products that are typical for the region. For example, in coastal areas, shrimp, mussels and other seafood can become allergens. But in Asia, cases of anaphylaxis were recorded after eating chickpeas.

It should be borne in mind that anaphylactic shock can be provoked by the slightest dose of an allergen. This means that people with food allergies need to be extremely careful about the foods they eat. In the case of food, an increase in the intensity of the reaction can also be observed.

Allergies such as hay fever (to plant pollen), reactions to animal hair or bird feathers rarely lead to generalized shock. However, it is these types of allergens that can cause swelling of the larynx, which will lead to suffocation.

It is almost impossible to predict or prevent anaphylactic shock. It can develop at any age and to any potential allergen. According to statistics, the number of cases of anaphylaxis is increasing. So, if in the 80s of the twentieth century 20 such reactions were recorded per 100 thousand people a year, then by the 90s their number had increased to 50 cases of shock. Doctors attribute this increase to an increase in food allergies.

It is believed that women, young people and children are more susceptible to anaphylaxis. In the elderly, anaphylactic shock is less common.

The following categories fall into the risk group for its development:

• Allergy sufferers with any kind of allergy. The fact is that such failures in the immune system rarely occur on one substance, much more often patients are diagnosed with the so-called cross allergy. With it, reactions occur on whole groups of substances, moreover, often from different categories. For example, pollinosis and food allergies, contact dermatitis and drug reactions can be combined. The risk of shock is increased in those who are allergic to latex and contrast agents (given during various examinations).
• People suffering from eczema or mastocytosis. Skin lesions of this kind indicate a tendency to allergic reactions.
• Patients with bronchial asthma. This is one of the most likely risk groups for the development of anaphylactic shock and other severe allergic reactions.
• People taking the same medicine for a long time.

Anaphylactic shock is a life-threatening allergic reaction. Severe, acute symptoms develop in patients with hypersensitivity of the body upon repeated contact with the irritant. Anaphylaxis is an immediate type of immune response with characteristic symptoms.

The possibility of saving the patient often depends on the amount of information (symptoms, first aid rules) owned by the patient and his relatives. If a person has at least once manifested an allergy, then a new negative response is possible with the next hit of the irritant or with the accumulation of antigens after a certain time. For this reason, it is important to know how anaphylactic shock develops, how to act correctly, and why failure to provide assistance is dangerous.

Reasons for the development of a dangerous reaction

Anaphylaxis is an acute reaction to an allergen. A dangerous condition develops when the irritant enters the body again. The danger of anaphylaxis is not only in the severe nature of the symptoms, the negative effect of antigens on vital organs and systems, but also in the rapid deterioration of the patient's condition. Anaphylactic shock, unspecified ICD code - 10 - T78.2.

With a high sensitivity of the body, a large amount of the allergen (with a bee sting, taking a high dose of a potent drug), negative symptoms appear in 1-2 or 15-30 minutes. With a high concentration of the allergen in the body, a slice of an orange or a few drops of an inappropriate drug is enough for dangerous signs to appear with lightning speed.

The main causes of anaphylaxis:

• the introduction of sera, foreign proteins, drugs for anesthesia and anesthetics;
• oral medication, injections (intramuscular, intravenous);
• bites of stinging insects;
• the use of a radiopaque substance in the diagnosis;
• oral administration or injections of antibiotics;
• the use of citrus fruits, spices, seafood with hypersensitivity of the body.

Forms of anaphylaxis

The classification is based on identifying the system that has the greatest negative impact:

• cerebral. A dangerous variety, accompanied by cerebral edema. Convulsions appear, nervous regulation is disturbed, a person panics, performs strange actions, fear of non-existent things appears;
• gastrointestinal. The main blow is taken by the digestive organs: nausea appears, bloating develops, acute diarrhea occurs;
• asphyxic. The process involves the larynx, bronchi. Danger - swelling of tissues, risk of suffocation. There are wheezing in the throat, perspiration, loss of voice, bronchospasm;
• anaphylaxis with high physical exertion. Symptoms are similar to manifestations, different parts of the body are affected. Redness, itching appear on the body, the temperature and blood pressure indicators rise.

On a note! When providing competent, timely assistance, doctors eliminate all signs of anaphylaxis. In moderate and severe forms, maintenance therapy will be needed: the duration of treatment depends on the patient's condition. After recovery, a person must strictly follow the recommendations of doctors, exclude contact with the allergen. It is important to know that each subsequent attack of anaphylaxis develops more rapidly, the reaction is more severe than the previous time. For this reason, neglect of one's health and medical advice can have a tragic ending.

First signs and symptoms

Any kind of anaphylactic shock poses a threat to a person, especially in the elderly and childhood. The nature of the reaction depends on the sensitivity of the body, the duration of contact with the irritant, the volume of the allergen accumulated over a certain period.

Initial stage:

• hyperemia of the skin;
• secretion of mucus from the nasal passages;
• sneezing
• severe itching;
• tachycardia;
• drop in blood pressure;
• dizziness;
• sore throat;
• tissue swelling.

Some patients also develop other symptoms of anaphylactic shock:

• feeling of pressure in the chest area;
• pain in the abdomen;
• heat spreads through the body;
• weakness appears;
• consciousness is blurred.

Average degree:

• or ;
• dizziness continues, tinnitus appears, fainting is possible;
• heart problems: a sharp, uneven heartbeat, a decrease in pressure to critical levels;
• sticky sweat appears, limbs become cold;
• the patient panics, trembles, or becomes lethargic.

If help is not provided, new signs are added:

• nausea, vomiting, flatulence;
• bronchospasm, risk of suffocation;
• pain in the abdomen;
• problems with urination.

Severe stage of anaphylaxis:

• pressure practically at zero, thready pulse;
• vascular collapse is observed;
• consciousness is absent, the pupils dilate, the patient does not respond to light;
• the muscles of the rectum and bladder relax, urine and feces are discharged;
• the pulse gradually disappears, the pressure is not recorded;
• cardiac activity stops, breathing stops;
• doctors record clinical death.

Important! A severe form of anaphylactic shock requires an immediate medical response, otherwise the consequences will be disastrous. The danger of this stage is the almost instantaneous appearance of a complex of dangerous signs.

Diagnostics

If signs of anaphylaxis are detected, the patient, relatives, colleagues, any person who happens to be nearby should dial the ambulance number. The life of the patient depends on the timely implementation of a set of measures, especially with a moderate and severe degree of reaction.

Doctors need to know which allergen caused anaphylactic shock. Determining the irritant is quite simple: an acute immune response develops a few minutes after the use / administration of drugs, dangerous foods, or an insect bite. If you suspect a dangerous reaction, you should not hesitate: without timely assistance, the risk of death of the patient is high.

The ambulance team and resuscitators analyze the situation and carry out special events. Even with a mild degree of anaphylaxis, the patient must be taken to a hospital for maintenance therapy, observation, and condition control.

First aid rules and further treatment

With the development of dangerous symptoms, antihistamines alone are indispensable: anaphylaxis is a critical condition. To save a person, an integrated approach is needed, the use of potent drugs, and resuscitation measures.

First aid for anaphylactic shock:

• with initial signs of an acute reaction, a noticeable increase in negative symptoms call an ambulance without delay;
• while the doctors are on the way, stop contact with the allergen that provoked a severe immune response: remove pieces of food from the mouth, apply a tourniquet to the limb (with the introduction of a drug or a sting of a wasp, bee);
• in the absence of a heartbeat and breathing - make artificial respiration, conduct an indirect heart massage;
• if consciousness is present, then put the patient on his side, raise his legs with a pillow. Be sure to unbutton the shirt collar, take off the sweater with a tight "throat", get rid of the belt on the trousers;
• open a window to let fresh air into the room. It is important to ensure that a person does not freeze if the temperature outside the window is below zero.

The medical team provides assistance on the spot, then delivers the victim to the hospital. Even after the disappearance of negative reactions, the patient should be monitored for several days. In most cases, with moderate and severe anaphylaxis, negative symptoms do not disappear immediately, complications often develop.

First aid:

• the introduction of adrenaline subcutaneously or intramuscularly in the injection zone;
• the next stage is ice around the place of contact with the allergen (bite, injection) to slow down the penetration of antigens into the blood;
• the introduction of cordiamine, caffeine to stabilize pressure, enhance cardiac activity;
• injections of hydrocortisone or prednisolone are required.

Treatment of anaphylactic shock in a hospital:

• with laryngeal edema, intubation is required to maintain proper breathing, with the development of bronchospasm, the drug Eufillin is effective;
• re-introduction of hormonal drugs and adrenaline;
• one of the tasks is to restore normal blood circulation and stroke volume of the heart, to prevent congestion,
• the introduction of compounds that block the action of drugs, against which anaphylactic shock developed;
• supplement therapy with classical and modern antihistamines;
• a positive effect is given by gluconate and calcium chloride. After injections and oral administration, the activity of the heart muscle is restored, immunity is strengthened, the risk of seizures is reduced, and nervous regulation is normalized;
• after stabilization of pressure, diuretics, bronchodilators are taken;
• after relief of acute symptoms, stabilization of the condition, a complex restoration of the body is carried out. The main focus of treatment is on the specific organs or systems affected during an anaphylaxis attack.

Patients should know that removal from a dangerous state takes from several hours to two or three days, sometimes longer. The task of physicians is not only to suppress a generalized allergic reaction, but also to eliminate negative systemic manifestations in the body.

Find out the instructions for use for the treatment of allergic diseases.

A page is written about how to treat urticaria in adults with medications.

Complications and prognosis

The main danger of anaphylactic shock is a high risk of death if competent, timely medical care is not provided. Even with a favorable outcome, a fairly rapid elimination of dangerous signs, further complications are possible in the activity of organs and systems that suffered the main blow during an attack.

For this reason, the patient should regularly visit a therapist to monitor health, early detection and prevention of dangerous conditions: myocarditis, late allergic reactions, severe renal pathologies. In the presence of chronic diseases, the risk of complications increases: an allergic person who has experienced anaphylactic shock must remember this, he must always follow the instructions of the attending physician.

The consequences of anaphylaxis largely depend on the speed and quality of medical care, competent actions of relatives or colleagues of the victim. Panic is a bad helper in a critical situation. If anaphylactic shock is suspected, only strict adherence to the rules of first aid saves a person's life.

28.07.2017

An allergic reaction gives the patient a lot of inconvenience, and if it leads to anaphylactic shock, then this poses a serious threat to human life.

Allergic shock is a severe manifestation of allergy, which is activated at the time of repeated interaction with the irritant.

The danger of the body's reaction to what is happening lies in the fact that 20% of such cases turn into a fatal outcome.

And an anaphylactic reaction occurs regardless of the type and dosage of the allergen, as well as the speed of its penetration into the body.

Anaphylactic shock in 20% of cases causes the death of the patient

Features of allergic shock

Anaphylactic shock is an organism to an external or internal stimulus that develops very quickly and poses a huge threat to human health and life.

Anaphylaxis develops very rapidly, within a few hours after contact with the allergen. The reaction can occur both in a few seconds and in a couple of hours, so it is important to provide emergency care quickly, otherwise death occurs.

Allergic shock can occur in any person with allergies, regardless of age and gender. But the first anaphylactic cases were seen not in humans, but in dogs. When this condition occurs, the internal organs and systems of the body undergo negative changes.

Coming into contact with the allergen, antibodies that are responsible for the protective functions of the body contribute to the production of special substances, which disrupts the blood flow and the operation of all systems.

Due to the violation of blood circulation in all internal organs, there is a lack of nutrition, for example, oxygen, which leads to a hunger strike, especially the brain. At the same time, there is a drop in blood pressure, dizziness appears, which leads to loss of consciousness.

The condition that occurs in a patient during an allergic shock means a malfunction of the immune system, therefore, after providing first aid, you need to start restoring and strengthening the immune system.

Causes of anaphylaxis

Allergy occurs as a result of direct contact of the body with protein compounds of a different nature, is a kind of immune response. This immune reaction of the body can be varied: from a small rash on the skin to the onset of a dangerous condition, like an allergic shock.

The main reason for the development of anaphylactic shock is repeated contact with an irritant, which most often acts as a drug.

The most common causes of anaphylactic shock are:

1. Some insect bites. Some people have a severe allergic reaction to the sting of insects such as wasps, bees and hornets. And if several insect bites occur at the same time, this almost always leads to the development of allergic shock. And even if for the first time after an insect bite only a slight swelling and redness of the skin appeared, then during the next contact with the allergen, the symptoms will be more pronounced, even if this contact occurs after several years.
2. Bites of some animals. Allergic shock can be caused by any representative of the animal world, which, when bitten, releases poison into its victim. Such animals include spiders, snakes, some types of frogs;
3. Medications. People prefer self-administration of medications, without consulting a doctor. Self-medication can both cure and cripple. Incorrect medication can lead to severe and unforeseen consequences. Medications that can cause allergic shock include:

• antibiotics: tetracycline and penicillin;
• anesthetics that are used during operations;
• non-steroidal anti-inflammatory drugs;
• inhibitors that are used to treat hypertension;
• hormones;
• vaccines, serums;
• enzymes and muscle relaxants;
• food products. Most people eat fast food and low-quality food products containing a huge amount of GMOs, which causes a lack of vitamins and minerals in the body, which leads to serious disruption of the human body. And besides this, some foods lead to the development of an allergic reaction. These highly allergenic foods include:

1. seafood;
2. dairy products;
3. citrus and some other fruits;
4. nuts;
5. chocolate.

Allergic shock most often occurs due to repeated exposure to the allergen.

There are some more factors that lead to the development of the state of anaphylactic shock:

• introduction of radiopaque substances into the body;
• during a blood transfusion;
• conducting skin tests for allergies;
• reaction to cold
• strong physical activity;
• repeated contact with household allergens: cosmetics, dust, plant pollen, chemicals.

Varieties of allergic shock

Anaphylaxis can be classified as follows:

1. according to the severity of the course: mild, moderate and severe course of the disease;
2. according to the nature of the flow:

• benign;
• protracted;
• acute malignant;
• abortive;
• recurrent;

1. according to the speed of development: fast (up to 3 minutes), acute (no more than 30 minutes), subacute (more than half an hour);
2. according to the shape of the flow:

• typical. The most common form, which is accompanied by a violation of the functioning of organs and blood vessels, is swelling of the skin;
• hemodynamic. The cardiovascular system is affected;
• asphyxic. There is acute respiratory failure, there is a violation of the functions of the respiratory tract;
• abdominal. There are symptoms of an acute form of poisoning, pain in the stomach;
• cerebral. The central nervous system is affected, which leads to cerebral edema.

Anaphylaxis is a serious threat to the life of the patient

The mechanism of development of allergic shock

The occurrence of this pathology begins directly with the contact of the immune system with a certain allergen, as a result of which specific antibodies are produced, which in turn lead to the release of a huge number of inflammatory factors.

And these inflammatory factors further penetrate the tissues and organs, resulting in impaired circulation and blood clotting, which can lead to cardiac arrest.

Usually, anaphylactic shock develops upon repeated contact of the body with an irritant, although in some cases this pathology may also occur during the initial interaction with the allergen.

The first stage in the development of allergic shock is sensitization, that is, the increased sensitivity of the body to a particular allergen.

And already the second stage of this mechanism for the development of anaphylaxis is the anaphylactic reaction itself, which consists in a protective reaction of the immune system to the re-penetration of the allergen into the body.

The development of anaphylaxis is directly related to the reduced immunity of the body.

After the secondary entry of the irritant into the blood, specific substances are released, especially histamine, which is responsible for allergic reactions.

Such protective reactions of the body lead to the development of edema, vasodilation, which in turn provokes respiratory failure.

Allergic shock leads to the release of a huge amount of histamine, which disrupts the work of all systems and organs of the human body.

That is, we can say that the development of anaphylactic shock occurs in 3 successive stages:

• immunological stage;
• pathochemical stage;
• pathophysiological stage.

Primary symptoms with the rapid development of anaphylactic shock appear from the first seconds of penetration into the blood of the allergen. This lightning-fast development of symptoms especially occurs after the administration of the drug intravenously.

Signs of anaphylactic shock can occur from a couple of seconds to 40 minutes. Quite often, anaphylaxis occurs in 2 phases, when after intensive treatment of the first attack, after 2-3 days, the second wave of symptoms of allergic shock occurs.

When anaphylaxis develops very quickly, most people experience the following symptoms:

• a sharp drop in blood pressure to a critical point;
• loss of consciousness, fainting;
• blanching, and sometimes blueing of the skin;
• the patient has sticky cold sweating;
• palpitations, weak pulsation;
• disturbed breathing process, convulsions, foam near the mouth;
• spontaneous defecation.

Symptoms of anaphylactic shock can be observed from the first seconds of the body's interaction with the allergen.

In the acute form of the development of anaphylactic shock, the following symptoms are observed:

• allergic manifestation in the form of a skin rash, redness of some parts of the body,;
• there is swelling of the lips, ears and eyelids;
• disturbed respiratory process, shortness of breath, voice change;
• dry paroxysmal cough;
• painful sensations of various kinds. They depend on the age of the patient. So, in children, anaphylaxis is expressed in abdominal cramps, and in adults - in a severe throbbing headache;
• the general condition of the patient worsens, which consists in a depressed mood, anxiety and fear of death;
• then there are lightning-fast signs of shock.

The subacute form of allergic shock is characterized by the same symptoms as other forms of pathology, only their manifestation is much slower, so the sick person has time to seek medical help on his own.

In addition to the above signs, during an attack of anaphylaxis, some more symptoms may be observed:

• sensation of heat all over the body;
• sharp pain in the chest;
• nausea, vomiting;
• ear congestion;
• severe itching of reddened skin;
• dilated pupils;
• increased tactile sensitivity;
• blue fingers;
• loss of taste.

It is important to follow the algorithm of actions in the event of an attack, because in such a situation every second is important

First aid for anaphylaxis

With the onset of anaphylactic shock, especially lightning-fast, it is necessary to provide emergency medical care to the victim as soon as possible.

And the most important thing in this business is not to waste a single minute, otherwise the lost time, even the smallest one, will lead to death. Therefore, it is very important to be able to provide first aid to the victim of anaphylactic shock.

The algorithm of actions for anaphylaxis is quite simple and contains the following steps:

• if the irritant that caused this condition is identified, then contact of the patient with the allergen must be immediately excluded;
• the patient must be carefully placed in a horizontal position, on his back with raised legs;
• you need to constantly check the pressure and if it has dropped or risen sharply, then you need to take action and give a suitable medicine;
• the victim must be provided with an unhindered supply of fresh air. To do this, you need to unfasten and loosen the pressure of clothing on the body;
• it is necessary to calm the patient, since excitement will only intensify the pathological process;
• then you need to ensure the patency of the airways. To do this, slightly raise the head of the victim and slightly turn it to the side. If vomiting has begun, then you need to put the person on his side so that the vomit flows out;
• ask the victim if he has any allergy medication with him. And if possible, give the patient medicine;
• if anaphylaxis occurred as a result of an insect or animal bite, then ice or something cold should be applied to the affected area, and also drag this place with a tourniquet;
• call an ambulance, although it would be better to do this at the very beginning.

• leave the victim alone;
• give the patient water or food;
• put something under the head;
• if anaphylaxis occurred due to intravenous administration of the drug, then the drug should be stopped from entering the body, and in no case should the needle be removed.

Diagnosis of allergic shock

After the first attack of anaphylactic shock has occurred, it is necessary to identify the substance that provoked this attack as soon as possible. It is good if the allergen is already known, but if the patient has not previously encountered allergic reactions, then the irritant can be determined using special studies.

To this end, the doctor prescribes the following measures:

• skin tests;
• blood and urine analysis;
• provocative tests;
• allergic history.

All studies are carried out as carefully as possible so that there is no sharp response of the body to the provocation of an allergic reaction.

The safest way to identify an anaphylactic allergen is to perform an allergen sorbent test. The safety of this diagnostic method lies in the fact that the study is carried out outside the patient's body.

Hospitalization for allergic shock is simply necessary

Treatment of anaphylactic shock

After identifying the allergen that provoked an attack of anaphylaxis, complex treatment is prescribed, which is carried out in a hospital.

The main principles of treatment of allergic shock include:

• normalization of the work of all vital systems and organs;
• prevention of a sharp drop in blood pressure;
• prevention of coma development;
• prevention and removal of existing swelling of organs;
• removal of allergenic substances from the patient's blood.

If necessary, symptomatic treatment is carried out. For example, if a patient has vomit in the airways, then they are pumped out.

In most cases, the following medications are prescribed:

• antihistamines are used during outbreaks of an allergic reaction;
• intramuscular injection of adrenaline;
• glucocorticoids;
• drugs that relieve bronchospasm and clear the airways;
• drugs that activate cardiac activity;
• medicines that normalize blood pressure;
• infusion of fluids to prevent coma.

Treatment of anaphylaxis begins with the identification of the allergen that triggered the attack.

And for the prevention of anaphylactic shock, you need to avoid contact with allergenic substances, always have a mini-first aid kit with the necessary medicines, undergo tests for the presence of allergic reactions to drugs, purchase medicines in tablets, not ampoules.

And most importantly, do not allow a second attack of anaphylactic shock, otherwise the next time the symptoms will be more pronounced, and the consequences will be much more serious.

And if you have never had anaphylaxis, but have an allergy, anaphylactic shock is a possible condition that can occur at any time, so it is necessary to treat an existing allergy immediately after its manifestation. Taking all the necessary medications for allergies, the risk of anaphylaxis will be minimal.

Anaphylactic shock is an acute systemic (i.e. involving more than one organ) allergic reaction to repeated exposure to an allergen. In this case, anaphylactic shock can be life-threatening as a result of a pronounced drop in pressure, the possible development of suffocation.

General information about anaphylactic shock

Each of us may encounter this type of allergy for the first time at any time in our lives. Sometimes this happens when prescribing medications, such as antibiotics, or administering anesthesia in the dentist's office, at a restaurant while tasting an exotic dish, or at a picnic after a wasp sting. The main difference between anaphylactic shock and other allergic reactions, say urticaria, lies precisely in the severity of the manifestations of the disease. This does not mean at all that every anaphylactic shock ends in a fatal outcome for an allergic person, not at all (!), Most of these reactions are resolved successfully with adequate medical care. However, people who have experienced anaphylactic shock should always carry an "allergic passport" with them indicating what they had a similar reaction to and a syringe with epinephrine (adrenaline) in case of a possible recurrence of an episode of anaphylactic shock.

Symptoms of anaphylactic shock

Depending on the severity of anaphylactic shock, there may be different in intensity manifestations of the disease. As a rule, anaphylactic shock begins with the appearance of skin itching, urticaria and / or Quincke's edema, sore throat, cough, and blood pressure begins to decrease. You may also be disturbed by a feeling of heat, headache, tinnitus, squeezing pain behind the sternum, shortness of breath. Consciousness is maintained until a pronounced decrease in pressure, while there may be agitation and anxiety or lethargy and depression.

Possible allergens of anaphylactic shock

The most common causes of anaphylactic shock are drugs:

• antibiotics;
• non-steroidal anti-inflammatory drugs;
• anesthetics;
• radiopaque agents;
• vaccines, etc.

Even skin allergy testing and allergen-specific immune therapy can be the cause.

Anaphylactic shock can also develop under the influence of food allergens, such as peanuts or seafood.

Often the cause of anaphylactic shock are insects (bees, wasps, bumblebees and other hymenoptera).

Prevention of anaphylactic shock

Preventive measures are possible only in a situation where the exact cause of the development of anaphylactic shock is established. For example, in the case of drug or food allergies, avoid taking drugs or foods that cause anaphylactic shock.

Complications of anaphylactic shock

The most dangerous complications of anaphylactic shock are collapse (lowering blood pressure to 0/0 mm Hg), swelling of the larynx, trachea and large bronchi, severe cardiac arrhythmias.

Diagnosis of anaphylactic shock

As a rule, due to the severity of the symptoms, there are no big problems in making a diagnosis of anaphylactic shock.

Treatment of anaphylactic shock

If anaphylactic shock occurs, you should immediately call an ambulance. It is necessary to lay the victim on his back, turn his head to the side.

Medical care consists in ensuring the patency of the respiratory tract (if necessary, artificial ventilation of the lungs can be performed), maintaining arterial pressure (dopamine, adrenaline, saline solutions), reducing the severity of allergic reactions (glucocorticoids, antihistamines).

Anaphylactic shock: severe manifestation of an allergic reaction, life-threatening.

Anaphylaxis- a rapidly developing allergic reaction that threatens life, often manifests itself in the form of anaphylactic shock. Literally, the term "anaphylaxis" is translated "against immunity." From the Greek but" - against and phylaxis" - protection or immunity. The term was first mentioned over 4000 years ago.

• The frequency of cases of anaphylactic reactions per year in Europe is 1-3 cases per 10,000 population, mortality is up to 2% among all patients with anaphylaxis.
• In Russia, 4.4% of all anaphylactic reactions are manifested by anaphylactic shock.

What is an allergen?

Allergen is a substance, mainly a protein, that provokes the development of an allergic reaction.
There are different types of allergens:

• Inhalation (aeroallergens) or those that enter the body through the respiratory tract (plant pollen, mold spores, house dust, etc.);
• Food (eggs, honey, nuts, etc.);
• Insect or insect allergens (cockroaches, moths, moth flies, beetles, etc., allergens contained in the poison and saliva of insects such as bees, wasps, hornets are especially dangerous);
• Animal allergens (cats, dogs, etc.);
• Medicinal allergens (antibiotics, anesthetics, etc.);
• Professional allergens (wood, grain dust, nickel salts, formaldehyde, etc.).

The state of immunity in allergies

The state of immunity plays a decisive role in the development of an allergic reaction. With allergies, the immune function of the body has an increased activity. What is manifested by an excessive reaction to the ingestion of a foreign substance. Such disturbances in the functioning of the immune system are caused by a number of factors, ranging from genetic predisposition to environmental factors (polluted ecology, etc.). Psycho-emotional conflicts, both with other people and with oneself, are of no small importance in disrupting the functioning of the immune system. According to psychosomatics (a direction in medicine that studies the influence of psychological factors on the development of diseases), allergies occur in those people who are not satisfied with the circumstances of their lives and do not allow themselves an open protest. They have to endure everything in themselves. They do what they don’t want to, force themselves to unloved, but necessary things.

The mechanism of development of anaphylaxis

To understand the mechanism of development of anaphylactic shock, it is necessary to consider the main points in the development of allergic reactions.

The development of an allergic reaction can be divided into several stages:

1. Sensitization or allergization of the body. The process in which the body becomes very sensitive to the perception of a substance (allergen) and, if such a substance enters the body again, an allergic reaction occurs. When the allergen first enters the body by the immune system, it is recognized as a foreign substance and specific proteins (immunoglobulins E, G) are produced for it. Which are subsequently fixed on immune cells (mast cells). Thus, after the production of such proteins, the body becomes sensitized. That is, if the allergen enters the body again, an allergic reaction will occur. Sensitization or allergization of the body is the result of a malfunction of the immune system caused by various factors. Such factors may be hereditary predisposition, prolonged contact with the allergen, stressful situations, etc.
2. Allergic reaction. When the allergen enters the body for the second time, it is immediately met by immune cells, which already have specific proteins (receptors) formed early. After contact of the allergen with such a receptor, special substances are released from the immune cell that trigger an allergic reaction. One of these substances is histamine - the main substance of allergy and inflammation, which causes vasodilation, itching, swelling, and subsequently respiratory failure, lowering blood pressure. In anaphylactic shock, the release of such substances is massive, which significantly disrupts the functioning of vital organs and systems. Such a process in anaphylactic shock without timely medical intervention is irreversible and leads to the death of the body.

Risk factors for anaphylactic shock

4. Aeroallergens

• The development of an anaphylactic reaction when an allergen enters through the respiratory tract occurs very rarely. However, during the pollen season, patients with high sensitivity to pollen may develop anaphylaxis.

5. Vaccines

• Cases of the development of severe allergic reactions to the introduction of vaccines against influenza, measles, rubella, tetanus, mumps, whooping cough are described. It is assumed that the development of reactions is associated with the components of vaccines, such as gelatin, neomycin.

6. Blood transfusion

• The cause of anaphylactic shock can be a blood transfusion, but such reactions are very rare.

• Exercise-induced anaphylaxis is a rare form of anaphylactic reactions and comes in two forms. The first, in which anaphylaxis occurs due to physical activity and the use of food or drugs. The second form occurs during exercise, regardless of food intake.

8. Systemic mastocytosis

• Anaphylaxis can be a manifestation of a special disease - systemic mastocytosis. A disease in which an excessive number of specific immune cells (mast cells) are produced in the body. Such cells contain a large number of biologically active substances that can cause an allergic reaction. A number of factors such as alcohol, drugs, food, bee stings can lead to the release of these substances from the cells and cause a severe anaphylactic reaction.

Symptoms of anaphylactic shock, photo

The first symptoms of anaphylaxis usually appear 5 to 30 minutes after an intravenous or intramuscular intake of the allergen, or a few minutes to 1 hour if the allergen enters through the mouth. Sometimes anaphylactic shock can develop within a few seconds or occur after a few hours (very rarely). You should know that the earlier the onset of an anaphylactic reaction after contact with an allergen, the more severe its course will be.

In the future, various organs and systems are involved:

Organs and systems	Symptoms and their description	A photo
Skin and mucous membranes	Heat, itching, rashes in the form of urticaria often occur on the skin of the inner surface of the thighs, palms, soles. However, rashes can occur anywhere on the body. Swelling in the face, neck (lips, eyelids, larynx), swelling of the genitals and / or lower extremities. With rapidly developing anaphylactic shock, skin manifestations may be absent or occur later. 90% of anaphylactic reactions are accompanied by urticaria and edema.
Respiratory system	Nasal congestion, mucous discharge from the nose, wheezing, cough, feeling of swelling of the throat, difficulty breathing, hoarseness. These symptoms occur in 50% of patients with anaphylaxis.
The cardiovascular system	Weakness, dizziness, decreased blood pressure, increased heart rate, chest pain, possible loss of consciousness. The defeat of the cardiovascular system occurs in 30-35% of patients with anaphylactic shock.
Gastrointestinal tract	Swallowing disorders, nausea, vomiting, diarrhea, intestinal cramps, pain in the abdomen. Gastrointestinal disorders occur in 25-30% of patients with anaphylactic shock.
central nervous system	Headache, weakness, fog before the eyes, convulsions are possible.

In what forms does anaphylactic shock develop more often?

The form	Development mechanism	External manifestations
Typical(most common)	When allergens enter the body, they trigger a number of immune processes, as a result of which a large amount of biologically active substances (histamine, bradykinin, etc.) are released into the blood. This mainly leads to vasodilation, lowering blood pressure, spasm and swelling of the airways. Violations are growing rapidly and lead to a change in the work of all organs and systems. At the beginning of anaphylaxis, the patient feels heat in the body, rashes and itching of the skin appear, swelling is possible in the face of the neck, dizziness, tinnitus, nausea, shortness of breath, a drop in blood pressure leads to impaired consciousness, convulsions are possible. Pressure reduction down to 0-10 mm Hg. All these symptoms are accompanied by the fear of death.
Asphyxic form (form with a predominance of respiratory failure)	With this form of anaphylaxis, the symptoms of respiratory failure come to the fore. After the allergen enters the body, a person feels a stuffy nose, cough, hoarseness, wheezing, a feeling of swelling of the throat, shortness of breath. A spasm of the larynx, bronchi, pulmonary edema develops, and subsequently respiratory failure increases. If no action is taken in time, the patient dies of suffocation.
Gastrointestinal form	With this form, the main manifestations of anaphylaxis will be pain in the abdomen, vomiting, diarrhea. A harbinger of such a reaction may be itching in the oral cavity, swelling of the lips and tongue. The pressure is usually not lower than 70/30 mm Hg.
brain shape	In the cerebral form of anaphylaxis, the manifestations of the disease are dominated by disorders of the central nervous system, impaired consciousness, convulsions against the background of cerebral edema.
Anaphylaxis caused by exercise	Both physical activity alone and its combination with a preliminary intake of food or medication can cause an anaphylactic reaction to start, up to anaphylactic shock. It is more often manifested by itching, fever, redness, urticaria, swelling in the face, neck, with further progression, the gastrointestinal tract, the respiratory system are involved, laryngeal edema occurs, and blood pressure drops sharply.

How to determine the severity of anaphylactic shock?

Criterion	1 degree	2 degree	3 degree	4 degree
Arterial pressure	Below the norm by 30-40 mm Hg (Norm 110-120 / 70-90 mm Hg)	90-60/40 mmHg and below	Systolic 60-40 mm Hg, diastolic may not be detected.	not defined
Consciousness	Conscious, anxiety, excitement, fear of death.	Stupefaction, possible loss of consciousness	Possible loss of consciousness	Immediate loss of consciousness
The effect of anti-shock therapy	Good	Good	Treatment is ineffective	Virtually absent

First aid for anaphylactic shock

1. Do I need to call an ambulance?

The first thing to do at the first sign of anaphylactic shock should be to call an ambulance. Consider the fact that there is a two-phase anaphylactic reaction. When, after the resolution of the first episode of an anaphylactic reaction, after 1-72 hours, a second occurs. The probability of such reactions is 20% of all patients with anaphylactic shock.
Indications for hospitalization: absolute, with anaphylactic shock of any severity.

1. How can you help before the ambulance arrives?

• The first step is to remove the source of the allergen. For example, remove the sting of an insect or stop the administration of the drug.

• The patient must be placed on his back and legs raised.

• It is necessary to check the patient's consciousness, whether it answers questions, whether it reacts to mechanical irritation.

• Free up the airways. Turn the head to one side and remove mucus, foreign bodies from the oral cavity, pull out the tongue (if the patient is unconscious). Next, you need to make sure that the patient is breathing.

• If there is no breathing or pulse, start CPR. However, in case of severe edema and airway spasm, pulmonary ventilation prior to the administration of epinephrine may not be effective. Therefore, in such cases, only indirect heart massage is used. If there is a pulse, indirect heart massage is not performed!

• In emergency situations, a puncture or incision of the cricothyroid ligament is performed to open the airways.

The use of medicines

Three essential medicines that will help save your life!

1. Adrenalin
2. Hormones
3. Antihistamines

At the first symptoms of anaphylaxis, it is necessary to inject intramuscularly 0.3 ml of 0.1% epinephrine (adrenaline), 60 mg of prednisolone or 8 mg of dexamethasone, antihistamines (suprastin, etc.).

Preparations	In what cases to apply?	How and how much to enter?	effects
Adrenalin 1 Ampoule - 1 ml-0.1%	Anaphylaxis, anaphylactic shock, allergic reactions of various types, etc.	Anaphylaxis: Adrenaline should be administered at the first symptoms of anaphylaxis! In any place intramuscularly, even through clothing (preferably in the middle part of the thigh from the outside or the deltoid muscle). Adults: 0.1% adrenaline solution, 0.3-0.5 ml. Children: 0.1% solution of 0.01 mg / kg or 0.1-0.3 ml. With severe respiratory failure and a sharp drop in blood pressure, 0.5 ml - 0.1% can be injected under the tongue, in this case, the drug is absorbed much faster. If there is no effect, the introduction of adrenaline can be repeated every 5-10-15 minutes, depending on the patient's condition. For anaphylactic shock: Doses of administration: 3-5 mcg / min, for an adult 70-80 kg, to obtain a complex effect. After administration, adrenaline remains in the bloodstream for only 3-5 minutes. It is better to administer the drug in solution intravenously (30-60 drops per minute): 1 ml of 0.1% adrenaline solution, diluted in 0.4 l of isotonic NaCl. Or 0.5 ml of 0.1% adrenaline solution, diluted in 0.02 ml of isotonic NaCl and injected intravenously in a stream of 0.2-1 ml with an interval of 30-60 seconds. Perhaps the introduction of adrenaline directly into the trachea if it is impossible to enter intravenously.	Increases blood pressure constriction of peripheral vessels. Increases cardiac output increasing the efficiency of the heart. Eliminates spasm in the bronchi. Suppresses surge substances of an allergic reaction (histamine, etc.).
Syringe - pen (Epipen)- containing a single dose of adrenaline (0.15-0.3 mg). The handle is designed for ease of insertion.			See the adrenaline
Syringe pen (EpiPen) ​​- video instruction:
Allerjet- devices for the introduction of adrenaline, containing a sound instruction for use.	Anaphylaxis, anaphylactic shock.	It is injected once into the middle part of the thigh. Fig.20	See the adrenaline
Allerjet - videoinstruction:
Hormones(hydrocortisone, prednisolone, dexamethasone)	Anaphylaxis, anaphylactic shock. Allergic reactions of various types.	Hydrocortisone: 0.1-1 g intravenously or intramuscularly. Children 0.01-0.1 g intravenously. Dexamethasone (Ampoule 1ml-4mg): intramuscularly 4-32 mg, In shock, 20 mg IV, then 3 mg/kg every 24 hours. Tablets (0.5 mg) up to 10-15 mg per day. Tablets: Prednisolone(5 mg) 4-6 tablets, up to a maximum of 100 mg per day. With anaphylactic shock, 5 ampoules of 30 mg (150 mg). If it is impossible to inject intravenously or intramuscularly, you can pour the contents of the ampoule under the tongue, holding it for a while until the drug is absorbed. The action of the drug occurs very quickly, since the drug, being absorbed through the sublingual veins, bypasses the liver and goes directly to the vital organs.	Stop the release of substances that cause allergic reactions. Relieve inflammation, swelling. Eliminate bronchospasm. Increase blood pressure. Contribute to the improvement of the work of the heart.
Antihistamines	Allergic reactions of various types.	Clemastine (Tavegil) - intramuscularly, 1 ml - 0.1%; Suprastin - 2ml-2%; Dimedrol - 1ml-1%; The combined administration of H1 antihistamines and H2 blockers gives a more pronounced effect, such as diphenhydramine and ranitidine. Preferably intravenous administration. With a mild course of anaphylaxis, it is possible in the form of tablets. H1 - histamine blockers: Loratadine - 10mg Cetirizine -20 mg Ebastine 10 mg Suprastin 50 mg H2-histamine blockers: Famotidine - 20-40 mg Ranitidine 150-300 mg	They stop the release of substances that trigger an allergic reaction (histamine, bradykinin, etc.). Eliminate swelling, itching, redness.
Drugs restoring the patency of the respiratory tract (Eufillin, Albuterol, metaproterol)	Severe bronchospasm, respiratory failure.	Eufillin - 2.4% - 5-10 ml., intravenously. Albuterol - intravenously for 2-5 minutes, 0.25 mg, if necessary, repeat every 15-30 minutes. If it is impossible to administer intravenously, Salbutamol in the form of an aerosol, inhalation administration.	Expansion of the respiratory tract (bronchus, bronchioles);

How to ensure the patency of the respiratory tract with laryngeal edema?

In the case when breathing is impossible due to swelling of the upper respiratory tract, and drug therapy has not helped or simply does not exist, an emergency puncture (puncture) of the cricothyroid (cricothyroid) ligament should be performed. This manipulation will help buy time before the arrival of specialized medical care and save a life. Puncture is a temporary measure that can provide adequate air supply to the lungs for only 30-40 minutes.

Technique:

1. Definition of the cricothyroid ligament or membrane. To do this, moving a finger along the front surface of the neck, the thyroid cartilage is determined (in men, the Adam's apple), immediately below it is the desired ligament. Below the ligament, another cartilage (cricoid) is determined, it is located in the form of a dense ring. Thus, between the two cartilages, the thyroid and the cricoid, there is a space through which it is possible to provide emergency air access to the lungs. In women, this space is more convenient to determine, moving from the bottom up, first finding the cricoid cartilage.

1. A puncture or puncture is carried out with what is at hand, ideally this is a wide puncture needle with a trocar, however, in an emergency, you can use a puncture with 5-6 needles with a large clearance or make a transverse incision of the ligament. Puncture, the incision is made from top to bottom at an angle of 45 degrees. The needle is inserted from the moment when it becomes possible to draw air into the syringe or a feeling of failure into an empty space when the needle is advanced. All manipulations should be done with sterile instruments, in the absence of such, sterilized on fire. The surface of the puncture should be pre-treated with an antiseptic, alcohol.

Video:

Treatment in the hospital

Hospitalization is carried out in the intensive care unit.
Basic principles for the treatment of anaphylactic shock in a hospital setting:

• Eliminate contact with the allergen
• Treatment of acute disorders of the circulatory, respiratory and central nervous system. To do this, use the introduction of epinephrine (adrenaline) 0.2 ml 0.1% with an interval of 10-15 minutes intramuscularly, if there is no response, then the drug is administered intravenously (0.1 mg at a dilution of 1: 1000 in 10 ml of NaCl).
• Neutralization and stopping the production of biologically active substances (histamine, kallikrein, bradykinin, etc.). Glucocorticoid agents (prednisolone, dexamethasone) and antihistamines, blockers of H1 and H2 receptors (suprastin, ranitidine, etc.) are introduced.
• Detoxification of the body and replenishment of the volume of circulating blood. To do this, solutions of polyuglyukin, reopoluglyukin, isotonic solution of NaCl b, etc.) are administered.
• According to the indications, drugs that eliminate spasm of the respiratory tract (eufillin, aminophylline, albuterol, metaproterol) are administered, with convulsions, anticonvulsants, etc.
• Maintaining the vital functions of the body, resuscitation. Dopamine, 400 mg in 500 ml of 5% dextrose solution intravenously, is used to maintain pressure and pump function of the heart. If necessary, the patient is transferred to an artificial respiration apparatus.
• All patients who have undergone anaphylactic shock are advised to be under the supervision of a doctor for at least 14-21 days, since complications from the cardiovascular and urinary systems may develop.
• It is obligatory to conduct a general analysis of blood, urine, ECG.

Prevention of anaphylactic shock

• Always have the necessary medicines on hand. Be able to use an automatic injector for the introduction of adrenaline (Epi-pen, Allerjet).
• Try to avoid insect bites (do not wear bright clothes, do not wear perfume, do not eat ripe fruit outdoors).
• Learn correctly, evaluate information about the components of purchased products in order to avoid contact with allergens.
• If you have to eat outside the home, the patient must make sure that the dishes do not contain allergens.
• At work, contact with inhalation and skin allergens should be avoided.
• Patients with a severe anaphylactic reaction should not use beta-blockers and, if necessary, should be replaced with drugs from another group.
• When conducting diagnostic studies with radiopaque substances, it is necessary to pre-administer prednisolone or dexamethasone, diphenhydramine, ranitidine