Anaphylaxis and Systemic Allergic Reactions
Anaphylaxis is a severe and potentially life-threatening reaction associated with massive release in the circulation of potent, vasoactive products from mast cells and basophils. Those vasoactive chemicals can profoundly impact the integrity of multiple life-sustaining organs and systems such as the cardiovascular and pulmonary systems. Anaphylaxis is most commonly due to exposure to allergens such as medications, usually antibiotics, foods, hymenoptera stings, and triatoma bites and mast cell activators such as radiocontrast media and certain medications. In some cases, anaphylaxis is labeled idiopathic when no etiology can be found.
During anaphylaxis, patients may experience hives, itching, and hypotension that may lead to dizziness, unconsciousness, and seizures as well as swelling of the upper and lower airways causing respiratory distress. One of the clinical manifestations of anaphylaxis is wheezing due to acute bronchospasm. Wheezing tends to occur particularly in patients with a history of asthma. Many of the symptoms of anaphylaxis are due to the effects of histamine, platelet-activating factor (PAF), and proteases on the cardiovascular, respiratory, and cutaneous systems.
The diagnosis of anaphylaxis can be challenging due to its syndromic nature and the variability of its manifestations as well as its transient duration. Perioperative anaphylaxis is a case in point as the signs and symptoms may not be obvious in the anesthetized and draped patient. During childhood, anaphylaxis can be confused with irritability, foreign body aspiration, and sepsis. Anaphylaxis can be uniphasic, biphasic, or protracted. Therefore, patients should be monitored closely and treated for recurrent symptoms. Several factors can put patients at higher risk of anaphylaxis including mast cell disease, exercise, and medications such as beta-blockers.
Anaphylaxis can be fatal, especially when treatment with epinephrine is delayed or is ineffective because of concomitant use of drugs such as beta-blockers and/or ACE inhibitors. Patients with uncontrolled asthma may also be at higher risk of fatal anaphylaxis. Anaphylaxis should be addressed promptly and aggressively and almost always can be managed successfully.
KeywordsAnaphylaxis Epinephrine Histamine Tryptase Hymenoptera venom allergy Anaphylactic shock Hypotension Biphasic anaphylaxis Mastocytosis Antihistamine Glucagon
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