Anaphylaxis
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ANAPHYLAXIS
Fatima Al-Awadh
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Objectives
Define Hypersensitivity Reaction. Mention the Types of Hypersensitivity
Reactions. Define Anaphylaxis. Mention the Etiologic Causes. Explain the Pathophysiologic Mechanism. Mention the Signs & Symptoms. Demonstrate the Diagnostic
Investigations. Display the Treatment & First Aid.
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Hypersensitivity Reaction
Injurious, or pathologic, immune reactions are called hypersensitivity reactions.
Hypersensitivity reactions may occur in two situations.
First, responses to foreign antigens may be dysregulated or uncontrolled, resulting in tissue injury.
Second, the immune responses may be directed against self antigens, as a result of the failure of self-tolerance (autoimmunity).
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Types of hyper sensitivity reactions
Mast cell release
histamine and other mediators
Immediate hypersensitivi
ty
Antibodies directed against cell or tissue
antigens
Antibody-mediated
Antibody-antigen complex
deposit in blood
vessels
immune complex diseases
Reactions
of T lymphocyt
es
T cell-mediated diseases
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Anaphylaxis
Ana (without), phylaxis (protection).
Acute multi-systemic allergic reaction involving the skin, airway, vascular system, and GI.
Sever immediate (type I) hypersensitivity reaction.
True & pseudo-anaphylaxis.
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Etiology
34%
37%
20%
7%
2%
Causes of anaphylaxis in a study of 266 patients (Data from Kemp et al)
Food
Idiopathic
Drugs
Exercise
Latex, hormons, insect bites
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Etiology
Pharmlogic agents• Antibiotics (penicillin)• Nonsteroidal anti-inflammatory drugs (Asprin)• intravenous (IV) contrast agents
Stinging insects• Ants, bees, hornets, wasps, and yellow jackets.
Food• Peanuts, seafood, and wheat
Latex• Rare• No latex-associated deaths
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Pathophysiology
First exposure Activation of TH2 cell → Stimulate IgE switiching
Allergen
TH2 Cell B Cell
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Pathophysiology
First exposure IgE production
IgE secreting B cellIgE
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Pathophysiology
First exposure IgE bind to mast cell
Mast cellFcɛRIIgE
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Pathophysiology
Second exposure Recognition Allergen
Mast cell
FcɛRIIgE
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Pathophysiology
Second exposure Activation of mast cell to release
histamine and other mediatorsAllergen
Mediators
Mast cell
FcɛRIIgE
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Pathophysiology
Mediators
Vascoactive aminase & lipid
Immediate hypersensitivity
reaction (minutes)
Cytokines
Late phase reaction (6-24 hours)
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Signs & Symptoms
Itching flushing
hives (urticaria) swelling
Skin
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Signs & Symptoms
Itching tearing
redness swelling around the eyes
Eyes
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Signs & Symptoms
Sneezingrunny nose nasal congestion
swelling of the tongue metallic taste
Nose & mouth
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Signs & Symptoms
Difficulty breathing coughing chest tightness wheezing or other
sounds
increased mucus production
throat swelling or itching change in voice or a sensation of
choking
Lungs and throat
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Signs & Symptoms
Dizziness weakness fainting
rapid, slow, or irregular heart rate low blood pressure
Heart and circulation
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Signs & Symptoms
Nausea vomiting
cramps diarrhea
Digestive system
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Signs & symptoms
Anxiety confusion
sense of impending doom
Nervous system
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Diagnosis
The diagnosis of anaphylaxis is based upon symptoms that occur suddenly after being exposed to a potential trigger.
Differential diagnosis severe asthma attack heart attack panic attack food poisoning An increased amount of tryptase protein can be
measured in a blood sample collected during the first three hours after anaphylaxis symptoms have begun.
tryptase levels are seldom elevated in food-induced anaphylaxis
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First Aid
Place patient in Trendelenburg position.
Establish and maintain airway.
Give oxygen via nasal cannula as needed.
Place a tourniquet above the reaction site.
Epinephrine at the site of antigen injection.
Start IV to rise BP.
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Treatment
EPINEPHRINE Benadryl (diphenhydramine) - H1
antagonist Tagamet (cimetidine) - H2 antagonist Corticosteroid therapy In severe anaphylaxis, observe for 6
hours or longer
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Prevention
Avoid the responsible allergen (e.g. food, drug, latex, etc.).
Keep an adrenaline kit (e.g. Epipen) and Benadryl on hand at
all times.
Wear medic Alert bracelets .
Venom immunotherapy is highly effective in protecting insect-
allergic individuals.
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References
Abbas & Lichtman, Basic Immunology 3E, Chapter 11 http://www.authorstream.com/Presentation/Moiloa-898248-
anaphylaxis/ http://med.mui.ac.ir/clinical/orjanc/Anaphylaxis.ppt http://
www.uptodate.com/contents/anaphylaxis-symptoms-and-diagnosis-beyond-the-basics
http://www.oregonems.org/Downloads/Anaphylaxis.ppt
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Fatima Al-Awadh
Thank You