Symptomatic drugs for anaphylactic shock. What is anaphylactic shock

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 medication, such as an antibiotic, 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, with adequate medical care, are resolved safely. 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- a type of allergic reaction of the immediate type that occurs when the allergen is repeatedly introduced into the body. Anaphylactic shock is characterized by rapidly developing predominantly general manifestations - a decrease in blood pressure, body temperature, blood clotting, dysfunction of the central nervous system, increased vascular permeability and spasm of smooth muscle organs.

The term "anaphylaxis" (Greek ana - reverse and phylaxis - protection) was introduced by P. Portier and S. Richet in 1902 to refer to an unusual, sometimes fatal reaction in dogs to repeated administration of an anemone tentacle extract. A similar anaphylactic reaction to repeated administration of horse serum in guinea pigs was described in 1905 by the Russian pathologist G. P. Sakharov. At first, anaphylaxis was considered an experimental phenomenon. Then similar reactions were found in humans. They became known as anaphylactic shock. The frequency of anaphylactic shock in humans has increased over the past 30-40 years, which is a reflection of the general trend towards an increase in the incidence of allergic diseases.

Etiology.

Anaphylactic shock can develop with the introduction of medicinal and prophylactic drugs into the body, the use of specific diagnostic methods, hyposensitization with insect bites (insect allergy) and very rarely with food allergies.

Almost any drug or prophylactic drug can sensitize the body and cause a shock reaction. Some drugs cause this reaction more often, others less often, depending on the properties of the drug, the frequency of its use and the route of administration into the body. Most drugs are haptens and acquire antigenic properties after binding to body proteins.

Complete antigens are:

• heterologous and homologous protein and polypeptide preparations;
• Shock reactions occur to the introduction antitoxic sera, homologous gamma globulins and plasma proteins;
• polypeitide hormones(ACTH, insulin, etc.);
• Quite often, a shock reaction is caused antibiotics, especially penicillin. According to the literature, allergic reactions to penicillin occur with a frequency of 0.5 to 16%. At the same time, severe complications are observed in 0.01-0.3% of cases. Allergic reactions with a fatal outcome develop in 0.001-0.01% of patients (one death per 7.5 million injections of penicillin). The resolving dose of penicillin that causes shock can be extremely small.
• Anaphylactic shock has also been described on injection. radiopaque substances, muscle relaxants, anesthetics, vitamins and many other drugs.
  The route of administration of the drug plays an important role. The most dangerous parenteral administration, especially intravenous. However, anaphylactic shock can also develop with rectal, cutaneous (penicillin, neomycin, etc.) and oral administration of drugs.
• Anaphylactic shock may be one of the manifestations insect allergy on hymenoptera stings. When examining 300 patients with sting allergy, we diagnosed various variants of anaphylactic shock in 77% of them.
• Holding specific diagnosis and hyposensitization in patients with allergies is sometimes accompanied by anaphylactic shock. Most often this is due to violations of the technique of carrying out these events. Sometimes the development of shock may be due to the peculiarities of the reaction to the allergen. For example, in insect allergy, intradermal testing with allergens from hymenoptera tissues can, with minimal local skin reaction, cause a general reaction in the form of shock.

Pathogenesis.

The pathogenesis of anaphylactic shock is reactive mechanism.
As a result of the release mediators, vascular tone drops and collapse develops. The permeability of the vessels of the microvasculature increases, which contributes to the release of the liquid part of the blood into the tissues and thickening of the blood. The volume of circulating blood decreases. The heart is involved in the process for the second time. Usually the patient comes out of a state of shock - on his own or with medical help. With insufficiency of homeostatic mechanisms, the process progresses, metabolic disorders in tissues associated with hypoxia join, and a phase of irreversible shock changes develops.

A number of medicinal, diagnostic and prophylactic drugs (iodine-containing contrast agents, muscle relaxants, blood substitutes, gamma globulins, etc.) can cause pseudoallergic reactions.

These drugs either cause direct release of histamine and some other mediators from mast cells and basophils, or include an alternative pathway of complement activation with the formation of its active fragments, some of which also stimulate the release of mediators from mast cells.These mechanisms can operate simultaneously. The result of the inclusion of these mechanisms will also be the development of shock. Unlike anaphylactic it is called anaphylactoid.

clinical picture.

Clinical manifestations of anaphylactic shock are caused by a complex set of symptoms and syndromes from a number of organs and systems of the body. Shock is characterized by the rapidity of development, rapid manifestation, severity of the course and consequences. The type of allergen and the way it is introduced into the body do not affect the clinical picture and the severity of anaphylactic shock.

The clinical picture of anaphylactic shock is varied. In the analysis of 300 cases of anaphylactic shock of various origins - from hymenoptera stings, medicinal and arising in the process of specific hyposensitization - not even two cases were observed that were clinically identical in combination of symptoms, time of development, severity of the course, prodromal phenomena, etc.

However, there is a pattern: the less time has passed from the moment the allergen enters the body to the development of the reaction, the more severe the clinical picture of shock. Anaphylactic shock gives the highest percentage of deaths when it develops 3-10 minutes after the allergen enters the body.

After suffering from anaphylactic shock, there is Period of immunity, so-called Refractory period, which lasts 2-3 weeks. At this time, the manifestations of allergies disappear (or are significantly reduced). In the future, the degree of sensitization of the body increases dramatically, and the clinical picture of subsequent cases of anaphylactic shock, even if they occur months and years later, differs from the previous ones in a more severe course.

Anaphylactic shock may begin with prodromal events, which usually last from a few seconds to an hour.
With lightning-fast development of anaphylactic shock, there are no prodromal phenomena; the patient suddenly develops a severe collapse with loss of consciousness, convulsions, which often ends in death. In some cases, the diagnosis can only be made retrospectively. In this regard, a number of authors believe that a certain percentage of lethal cases of cardiovascular insufficiency in the elderly during the summer period actually represents anaphylactic shock due to insect stings in the absence of timely therapy.

With a less severe course of shock, there may be such phenomena as a feeling of heat with a sharp hyperemia of the skin, general arousal or, conversely, lethargy, depression, anxiety, fear of death, throbbing headache, noise or ringing in the ears, compressive pain behind the sternum. There may be skin itching, urticaria (sometimes confluent) rash, angioedema, scleral hyperemia, lacrimation, nasal congestion, rhinorrhea, itching and sore throat, spastic dry cough, etc.

Following the prodromal phenomena, very quickly (in a period of several minutes to an hour) develop Symptoms and Syndromes, which determine the further clinical picture.
Clinical manifestations in anaphylactic shock resulting from hymenoptera stings observed by us, as well as data from foreign scientists, show that generalized itching and urticaria do not occur in all cases. As a rule, in severe anaphylactic shock, skin manifestations (urticaria, Quincke's edema) are absent. They can appear after 30-40 minutes from the beginning of the reaction and, as it were, complete it. Apparently, in this case, arterial hypotension inhibits the development of urticarial rashes and reactions at the sting site. They appear later, when blood pressure returns to normal (when coming out of shock).

Usually there is a spasm of smooth muscles with clinical manifestations bronchospasm (cough, expiratory dyspnea), muscle spasm gastrointestinal tract (spastic pains throughout the abdomen, nausea, vomiting, diarrhea), as well as uterine spasm in women (pain in the lower abdomen with bloody discharge from the vagina). Spastic phenomena are aggravated swelling of the mucous membranes of the internal organs (respiratory and digestive tract). With severe laryngeal edema, asphyxia may develop; with edema of the esophagus, dysphagia is observed, etc. Tachycardia, pain in the region of the heart of a compressive nature are noted. On the ECG taken during anaphylactic shock and within a week after it, rhythm disturbances, diffuse myocardial malnutrition are recorded.

Symptoms of anaphylactic shock on hymenoptera stings.

• Generalized itching, urticaria,
• Massive angioedema,
• suffocation attacks,
• Nausea, vomiting, diarrhea,
• Sharp cramping pains all over the abdomen,
• Pain in the lower abdomen with bloody discharge from the vagina,
• Weakness, faintness,
• A sharp drop in blood pressure with loss of consciousness for an hour or more,
• Involuntary bowel movements and urination
• Tachycardia, bradyarrhythmia,
• throbbing headache,
• Pain in the region of the heart
• convulsions,
• Dizziness,
• Polyneuritic syndrome, paresis, paralysis,
• Violation of color vision
• local reaction.

Hemodynamic disorders in anaphylactic shock are of varying severity - from a moderate decrease in blood pressure with a subjective feeling of semi-consciousness to severe hypotension with prolonged loss of consciousness (for an hour or longer).

The appearance of such a patient is characteristic: a sharp pallor (sometimes cyanosis) of the skin, sharpened facial features, cold, sticky sweat, and sometimes foam from the mouth. The blood pressure is very low (sometimes it cannot be measured at all), the pulse is frequent, thready, the heart sounds are muffled, in some cases they are almost not audible, an accent of the II tone on the pulmonary artery may appear. Hard breathing in the lungs, dry scattered rales.

Due to ischemia of the central nervous system and edema of the serous membranes of the brain, tonic and clonic convulsions, paresis, paralysis can be observed. In this stage, involuntary defecation and urination often occur. In the absence of timely intensive care, a fatal outcome is often possible, however, timely energetic assistance cannot always prevent it.

During anaphylactic shock, 2-3 waves of a sharp drop in blood pressure can be observed. In this regard, all patients who have undergone anaphylactic shock should be placed in a hospital. With the reverse development of the reaction (when exiting anaphylactic shock), often at the end of the reaction, severe chills are noted, sometimes with a significant increase in temperature, severe weakness, lethargy, shortness of breath, pain in the heart.
The possibility of late allergic reactions is not excluded. For example, scientists note a case when a demyelinating process developed in a patient on the 4th day after suffering an anaphylactic shock due to a wasp sting. The patient died on the 14th day from allergic en(Bogolepov N. M. et al., 1978).

After anaphylactic shock, complications can develop in the form of allergic myocarditis, hepatitis, glomerulonephritis, neuritis and diffuse lesions of the nervous system, vestibulopathy, etc. In some cases, anaphylactic shock is, as it were, a trigger mechanism for latent diseases of allergic and non-allergic genesis.

Diagnosis and differential diagnosis.

The diagnosis of anaphylactic shock in most cases is not difficult: the direct connection of a violent reaction with an injection of a drug or an insect sting, characteristic clinical manifestations make it possible to diagnose anaphylactic shock.

In making the correct diagnosis, one of the main places is given to the allergological history, of course, if it can be collected.
As a rule, the development of anaphylactic shock is preceded by milder manifestations of an allergic reaction to some medication, food, insect sting, or cold allergy symptoms. With a lightning-fast form of shock, when the patient does not have time to tell others about contact with the allergen, the diagnosis can only be made retrospectively.

It is necessary to differentiate anaphylactic shock from acute cardiovascular insufficiency, myocardial infarction, epilepsy (with convulsive syndrome with loss of consciousness, involuntary defecation and urination), ectopic pregnancy (collaptoid condition combined with sharp pains in the lower abdomen and bloody discharge from the vagina), etc.

TREATMENT OF ANAPHILACTIC SHOCK.

The outcome of anaphylactic shock is often determined by timely and adequate therapy:

• aimed at removing the patient from the state of asphyxia,
• normalization of hemodynamics,
• relieve spasm of smooth muscle organs,
• decrease in vascular permeability,
• preventing further complications.

Medical assistance to the patient should be provided clearly, quickly, consistently.

• First of all, it is necessary to stop further flowallergen into the body (stop the administration of the drug, carefully remove the sting with a poisonous sac, etc.). Apply a tourniquet above the injection (stinging) site, if localization allows.
• Prick the injection site (stings) 0.3-0.5 ml 0.1% adrenaline solution and attach to it ice to prevent further absorption of the allergen. Inject another 0.5 ml of 0.1% into another area adrenaline solution.
• Place the patient in a position that will prevent retraction of the tongue and aspiration of vomit. It is necessary to provide access to the patient of fresh air.
• Most effective for relief of anaphylactic shock epinephrine, norepinephrine and their derivatives (mesathon).
  They are administered subcutaneously, intramuscularly, intravenously. It is not recommended to introduce 1 ml or more of an adrenaline solution into one place, since, having a strong vasoconstrictor effect, it also inhibits its own absorption. It is better to inject it fractionally by 0.5 ml into different parts of the body every 10-15 minutes until the patient is removed from the collaptoid state.
• Additionally, as a means of combating vascular collapse, it is recommended to inject 2 ml subcutaneously cordiamine or 2 ml 10% caffeine solution.
• If the patient's condition does not improve, 0.5-1 ml of 0.1% is injected intravenously. adrenaline solution in 10-20 ml 40% glucose solution or isotonic sodium chloride solution(or 1 ml 0.2% norepinephrine solution; 0.1 - 0.3 ml 1% mezaton solution).
• If the patient is in the hospital, then it is necessary to establish an intravenous drip of 300 ml of 5% solution glucose with 1 ml 0.1% adrenaline solution(or 2 ml 0.2% norepinephrine solution), 0.5 ml 0.05% solution strophanthin, 30-90 mg prednisolone, 1 ml 1% mezaton solution. With pulmonary edema, add 1 ml of a 1% solution furosemide. The solution is injected at a rate of 40-50 drops per 1 minute.
• Antihistamines administered after the restoration of hemodynamic parameters, since they themselves can have a hypotensive effect. They are administered mainly to relieve or prevent skin manifestations.
  Can be administered intramuscularly or intravenously: 1% diphenhydramine solution(or 2.5% solution pipolfena, 2% suprastin solution, 2,5% diprazine solution) in an amount of 2 ml.
• Corticosteroid drugs (30-60 mg prednisolone or 125 mg hydrocortisone) is administered subcutaneously, in severe cases intravenously by stream - with 10 ml of 40% glucose solution or in a dropper with 300 ml 5% glucose solution.
• In the future, to prevent allergic reactions according to the immunocomplex or delayed type and to prevent allergic complications, it is recommended to use corticosteroid drugs inside for 4-6 days with a gradual decrease in the dose of 1/4 -1/2 tablets per day.

The duration of treatment and the dose of the drug depend on the patient's condition.

• For cupping bronchospasm in addition to adrenaline, it is recommended to inject 10 ml of a 2.4% solution intravenously eufillina with 10 ml isotonic sodium chloride solution(or 40% glucose solution).
• Atswelling is easy X you need to enter intravenously 0.5 ml of a 0.05% solution strophanthin with 10 ml 40% glucose solution and 10 ml 2.4% aminophylline solution.
• When And stridor breathing and lack of effect from complex therapy (adrenaline, prednisolone, antihistamines) necessary for vital indications to produce tracheostomy.
• At convulsive syndrome with strong excitement, it is recommended to inject 1-2 ml intravenously droperidol(2.5-5 mg).
• In anaphylactic shock caused by penicillin it is recommended to enter once intramuscularly 1,000,000 IU penicillinase in 2 ml of isotonic solution sodium chloride; in anaphylactic shock bicillin penicillinase administered within 3 days, 1,000,000 IU.
• A patient who is in a state of anaphylactic shock with severe hemodynamic disorders must be warmly covered, overlaid with heating pads and constantly given oxygen. All patients in a state of anaphylactic shock are subject to hospitalization for a period of at least a week.

Forecast.

The prognosis for anaphylactic shock depends on timely, intensive and adequate therapy, as well as on the degree of sensitization of the body. The relief of an acute reaction does not yet mean the successful completion of the pathological process.
Late allergic reactions , which are observed in 2-5% of patients who have undergone anaphylactic shock, as well as allergic complications with damage to vital organs and body systems can pose a significant danger to life in the future. The outcome can be considered favorable only 5-7 days after the acute reaction.

Prevention of shock largely depends on a carefully collected anamnesis in allergic patients.
Firstly, according to our observations, anaphylactic shock does not develop if the patient has not previously been in contact with this allergen, that is, if there was no previous sensitization.
Secondly, in the anamnesis, as a rule, any signs of an allergic reaction that occurred to this allergen (allergic fever, pruritus or rash, rhinorrhea, bronchospasm, etc.) are detected.
Thirdly, when prescribing drugs, one should be aware of cross-reactions within a group of drugs that have common determinants.

In general, one should not get involved in prescribing many drugs at the same time without proper reason, intravenous administration of drugs, if they can be administered intramuscularly or subcutaneously, especially for patients with an allergic constitution.
To provide immediate medical care, each medical facility should have a “shock kit”: 2 tourniquets, sterile syringes, 5-6 ampoules of 0.1% adrenaline solution, 0.2% norepinephrine solution, 1% mezaton solution, antihistamines in ampoules , solutions of aminophylline, glucose, water-soluble preparations of prednisolone or hydrocortisone, solutions of cordiamine, caffeine, korglucon, strophanthin in ampoules. Medical personnel should be instructed in the management of anaphylactic shock.

What is anaphylactic shock, how it can be recognized and what should be done if anaphylaxis occurs, everyone should know.

Since the development of this disease often occurs in a fraction of a second, the prognosis for the patient depends primarily on the competent actions of nearby people.

What is anaphylaxis?

Anaphylactic shock, or anaphylaxis, is an acute condition that occurs as an immediate type of allergic reaction, which occurs when the body is repeatedly exposed to an allergen (foreign substance).

It can develop in just a few minutes, is a life-threatening condition and is a medical emergency.

Mortality is about 10% of all cases and depends on the severity of anaphylaxis and the rate of its development. The frequency of occurrence annually is approximately 5-7 cases per 100,000 people.

Basically, this pathology affects children and young people, since most often it is at this age that a repeated meeting with the allergen occurs.

Causes of anaphylactic shock

The causes that cause the development of anaphylaxis can be divided into main groups:

• medications. Of these, anaphylaxis is most often provoked by the use of antibiotics, in particular penicillin. Also, unsafe drugs in this regard include aspirin, some muscle relaxants and local anesthetics;
• insect bites. Anaphylactic shock often develops when bitten by hymenoptera (bees and wasps), especially if they are numerous;
• food products. These include nuts, honey, fish, some seafood. Anaphylaxis in children can develop with the use of cow's milk, products containing soy protein, eggs;
• vaccines. An anaphylactic reaction during vaccination is rare and may occur on certain components in the composition;
• contact with latex products.

Risk Factors for Anaphylaxis

The main risk factors for the development of anaphylactic shock include:

• the presence of an episode of anaphylaxis in the past;
• weighted history. If the patient suffers, or, then the risk of developing anaphylaxis increases significantly. The severity of the course of the disease increases, and therefore the treatment of anaphylactic shock is a serious task;
• heredity.

Clinical manifestations of anaphylactic shock

Symptoms of anaphylactic shock

The time of onset of symptoms directly depends on the method of introduction of the allergen (inhalation, intravenous, oral, contact, etc.) and individual characteristics.

So, when an allergen is inhaled or consumed with food, the first signs of anaphylactic shock begin to be felt from 3-5 minutes to several hours, with intravenous ingestion of the allergen, the development of symptoms occurs almost instantly.

The initial symptoms of a state of shock are usually manifested by anxiety, dizziness due to hypotension, headache, unreasonable fear. In their further development, several groups of manifestations can be distinguished:

• skin manifestations (see photo above): fever with characteristic reddening of the face, itching over the body, rashes like urticaria; local edema. These are the most common signs of anaphylactic shock, however, with the immediate development of symptoms, they may occur later than the rest;
• respiratory: nasal congestion due to swelling of the mucosa, hoarseness and difficulty in breathing due to laryngeal edema, wheezing, coughing;
• cardio-vascular: hypotensive syndrome, increased heart rate, pain in the chest;
• gastrointestinal: difficulty in swallowing, nausea, turning into vomiting, spasms in the intestines;
• manifestations of CNS damage are expressed from initial changes in the form of lethargy to complete loss of consciousness and the occurrence of convulsive readiness.

Stages of development of anaphylaxis and its pathogenesis

In the development of anaphylaxis, successive stages are distinguished:

1. immune (introduction of the antigen into the body, further formation of antibodies and their absorption "settlement" on the surface of mast cells);
2. pathochemical (reaction of newly arrived allergens with already formed antibodies, release of histamine and heparin (inflammatory mediators) from mast cells);
3. pathophysiological (stage of manifestation of symptoms).

The pathogenesis of the development of anaphylaxis underlies the interaction of the allergen with the immune cells of the body, the consequence of which is the release of specific antibodies.

Under the influence of these antibodies, there is a powerful release of inflammatory factors (histamine, heparin), which penetrate into the internal organs, causing their functional failure.

The main variants of the course of anaphylactic shock

Depending on how quickly the symptoms develop and how quickly first aid is provided, one can assume the outcome of the disease.

The main types of anaphylaxis are:

• malignant - characterized by the instant after the introduction of the allergen, the appearance of symptoms with access to organ failure. The outcome in 9 cases out of 10 is unfavorable;
• protracted - observed with the use of drugs that are slowly excreted from the body. Requires constant administration of drugs by titration;
• abortive - such a course of anaphylactic shock is the easiest. Under the influence of drugs quickly stops;
• recurrent - the main difference is the repetition of episodes of anaphylaxis due to the constant allergization of the body.

Forms of development of anaphylaxis depending on the prevailing symptoms

Depending on which symptoms of anaphylactic shock prevail, several forms of the disease are distinguished:

• Typical. The first signs are skin manifestations, especially itching, swelling at the site of exposure to the allergen. Violation of well-being and the appearance of headaches, causeless weakness, dizziness. The patient may experience intense anxiety and fear of death.
• Hemodynamic. Significant without medical intervention leads to vascular collapse and cardiac arrest.
• Respiratory. Occurs when the allergen is directly inhaled with air flow. Manifestations begin with nasal congestion, hoarseness, then there are violations of inhalation and exhalation due to laryngeal edema (this is the main cause of death in anaphylaxis).
• CNS lesions. The main symptomatology is associated with dysfunction of the central nervous system, as a result of which there is a violation of consciousness, and in severe cases, generalized convulsions.

Severity of anaphylactic shock

To determine the severity of anaphylaxis, three main indicators are used: consciousness, blood pressure level, and the rate of effect of the treatment started.

According to severity, anaphylaxis is classified into 4 degrees:

1. First degree. The patient is conscious, restless, there is a fear of death. BP is reduced by 30-40 mm Hg. from the usual (normal - 120/80 mm Hg). The ongoing therapy has a quick positive effect.
2. Second degree. The state of stupor, the patient is difficult and slow to answer the questions asked, there may be a loss of consciousness, not accompanied by respiratory depression. BP below 90/60 mm Hg. The effect of the treatment is good.
3. Third degree. Consciousness is often absent. Diastolic blood pressure is not determined, systolic is below 60 mm Hg. The effect of the therapy is slow.
4. fourth degree. Unconscious, blood pressure is not determined, there is no effect from the treatment, or it is very slow.

Anaphylaxis Diagnosis Options

Diagnosis of anaphylaxis should be carried out as quickly as possible, since the prognosis of the outcome of the pathology mainly depends on how quickly first aid was provided.

In making a diagnosis, the most important indicator is a detailed history taking together with the clinical manifestations of the disease.

However, some laboratory research methods are also used as additional criteria:

• General blood analysis. The main indicator of the allergic component is (the norm is up to 5%). Along with this, anemia (a decrease in hemoglobin levels) and an increase in the number of leukocytes may be present.
• Blood chemistry. There is an excess of normal values ​​of liver enzymes (ALT , ASAT, alkaline phosphatase), kidney tests.
• Plain radiography of the chest. Often, the picture shows interstitial pulmonary edema.
• ELISA. It is necessary for the detection of specific immunoglobulins, in particular Ig G and Ig E. Their increased level is characteristic of an allergic reaction.
• Determination of the level of histamine in the blood. It must be done shortly after the onset of symptoms, as histamine levels drop sharply over time.

If the allergen could not be detected, then after the final recovery, the patient is recommended to consult an allergist and perform allergy tests, since the risk of recurrence of anaphylaxis is sharply increased and prevention of anaphylactic shock is necessary.

Differential diagnosis of anaphylactic shock

Difficulties in making a diagnosis of anaphylaxis almost never arise due to a vivid clinical picture. However, there are situations when differential diagnosis is necessary.

Most often, these pathologies give similar symptoms:

• anaphylactoid reactions. The only difference will be the fact that anaphylactic shock does not develop after the first encounter with the allergen. The clinical course of pathologies is very similar and differential diagnosis cannot be carried out only on it, a thorough analysis of the anamnesis is necessary;
• vegetative-vascular reactions. They are also characterized by a decrease in blood pressure. Unlike anaphylaxis, it does not manifest itself as bronchospasm, or itching;
• collaptoid conditions caused by taking ganglioblockers or other drugs that reduce pressure;
• - the initial manifestations of this disease can also be manifested by a hypotensive syndrome, however, specific manifestations of the allergic component (itching, bronchospasm, etc.) are not observed with it;
• carcinoid syndrome.

Providing emergency care for anaphylaxis

Emergency care for anaphylactic shock should be based on three principles: the fastest possible delivery, impact on all links of pathogenesis and continuous monitoring of the cardiovascular, respiratory and central nervous systems.

Main directions:

• cupping;
• therapy aimed at relieving the symptoms of bronchospasm;
• prevention of complications from the gastrointestinal and excretory systems.

First aid for anaphylactic shock:

1. Try to identify the possible allergen as quickly as possible and prevent its further exposure. If an insect bite was noticed, apply a tight gauze bandage 5-7 cm above the bite site. With the development of anaphylaxis during the administration of the drug, it is necessary to urgently end the procedure. If intravenous administration was carried out, then the needle or catheter should not be removed from the vein. This allows subsequent therapy by venous access and reduces the duration of drug exposure.
2. Move the patient to a hard, level surface. Raise your legs above head level;
3. Turn the head to the side to avoid asphyxia with vomit. Be sure to free the oral cavity from foreign objects (for example, dentures);
4. Provide access to oxygen. To do this, unfasten the squeezing clothing on the patient, open the doors and windows as much as possible to create a flow of fresh air.
5. If the victim loses consciousness, determine the presence of a pulse and free breathing. In their absence, immediately begin artificial ventilation of the lungs with chest compressions.

Algorithm for providing medical assistance:

First of all, all patients are monitored for hemodynamic parameters, as well as respiratory function. The application of oxygen is added by supplying through a mask at a rate of 5-8 liters per minute.

Anaphylactic shock can lead to respiratory arrest. In this case, intubation is used, and if this is not possible due to laryngospasm (swelling of the larynx), then tracheostomy. Drugs used for drug therapy:

• Adrenalin. The main drug for stopping an attack:
  • Adrenaline is applied 0.1% at a dose of 0.01 ml / kg (maximum 0.3-0.5 ml), intramuscularly in the anterior outer part of the thigh every 5 minutes under the control of blood pressure three times. If therapy is ineffective, the drug can be re-administered, but overdose and the development of adverse reactions should be avoided.
  • with the progression of anaphylaxis - 0.1 ml of a 0.1% solution of adrenaline is dissolved in 9 ml of saline and administered at a dose of 0.1-0.3 ml intravenously slowly. Re-introduction according to indications.
• Glucocorticosteroids. Of this group of drugs, prednisolone, methylprednisolone, or dexamethasone are most commonly used.
  • Prednisolone at a dose of 150 mg (five ampoules of 30 mg each);
  • Methylprednisolone at a dose of 500 mg (one large ampoule of 500 mg);
  • Dexamethasone at a dose of 20 mg (five 4 mg ampoules).

Smaller doses of glucocorticosteroids are ineffective in anaphylaxis.

• Antihistamines. The main condition for their use is the absence of hypotensive and allergenic effects. Most often, 1-2 ml of a 1% diphenhydramine solution is used, or ranitidine at a dose of 1 mg / kg, diluted in a 5% glucose solution to 20 ml. Administer intravenously every five minutes.
• Eufillin used with the ineffectiveness of bronchodilator drugs at a dosage of 5 mg per kilogram of body weight every half hour;
• With bronchospasm, not stopped by adrenaline, the patient is nebulized with a solution of berodual.
• dopamine. Used for hypotension refractory to adrenaline and infusion therapy. It is used at a dose of 400 mg diluted in 500 ml of 5% glucose. Initially, it is administered until the systolic pressure rises within 90 mm Hg, after which it is transferred to the introduction by titration.

Anaphylaxis in children is stopped by the same scheme as in adults, the only difference is the calculation of the dose of the drug. Treatment of anaphylactic shock is advisable to carry out only in stationary conditions, because. within 72 hours development of repeated reaction is possible.

Prevention of anaphylactic shock

Prevention of anaphylactic shock is based on avoiding contact with potential allergens, as well as substances to which an allergic reaction has already been established by laboratory methods.

For any type of allergy in a patient, the appointment of new drugs should be minimized. If there is such a need, then a preliminary skin test is mandatory to confirm the safety of the appointment.

Anaphylactic shock(from the Greek. "Reverse protection") is a generalized rapid allergic reaction that threatens human life, because it can develop within a few minutes. The term has been used since 1902, when it was first described in terms of dogs.

The presented pathology occurs in women and men,

old people and children with the same frequency.

Lethal outcome may occur

in approximately 1% of all patients.

Development of anaphylactic shock: causes

Various factors can cause anaphylactic shock: animals, drugs, food.

The main causes of anaphylactic shock

Allergen group	Main allergens
Food	Fruits - berries, strawberries, apples, bananas, citrus fruits, dried fruits Fish products - oysters, lobsters, shrimps, crayfish, tuna, crab, mackerel Proteins – beef, eggs, dairy products and whole milk Vegetables – carrots, celery, potatoes, red tomatoes Grains - wheat, legumes, rye, corn, rice Food additives - aromatic and flavoring additives, preservatives and some dyes (glumanate, agar-agar, bitsulfites, tartrazine) Champagne, wine, nuts, coffee, chocolate
Plants	Coniferous trees - spruce, fir, larch, pine Forbs - quinoa, dandelion, wormwood, wheatgrass, ragweed, nettle Deciduous trees - ash, hazel, linden, maple, birch, poplar Flowers - orchid, gladiolus, carnation, daisy, lily, rose Cultivated plants - clover, hops, mustard, sage, calamus, sunflower
Animals	Domestic animals - wool of hamsters, guinea pigs, rabbits, dogs, cats; feathers of chickens, ducks, geese, pigeons, parrots Helminths - trichinella, pinworms, roundworms, toxocara, whipworm Insects - stings of hornets, wasps, bees, mosquitoes, ants; fleas, bedbugs, lice, flies, ticks, cockroaches
Medications	Hormones - progesterone, oxytocin, insulin Contrast agents - iodine-containing, barium mixture Antibiotics - sulfonamides, fluoroquinolones, cephalosporins, penicillins Vaccines - anti-hepatitis, anti-tuberculosis, anti-influenza Serums - anti-rabies (against rabies), anti-diphtheria, anti-tetanus Muscle relaxants - trakrium, norcunon, succinylcholine Enzymes - chymotrypsin, pepsin, streptokinase Blood substitutes - stabizol, refortan, reopoliglyukin, polyglukin, albulin Non-steroidal anti-inflammatory drugs - amidopyrine, analgin Latex - medical catheters, instruments, gloves

The state of anaphylactic shock in the body

The pathogenesis of the disease is quite complex and includes three successive stages:

immunological;

pathochemical;

pathophysiological.

Pathology is based on the contact of a certain allergen with immune cells, as a result of which specific antibodies (Ig E, Ig G) are released. These antibodies provoke a large release of inflammatory factors (leukotrienes, prostaglandins, heparin, histamine, etc.). Then the factors of the inflammatory process penetrate into all tissues and organs, causing a violation of coagulation and blood circulation in them to such serious complications as acute heart failure and cardiac arrest. Usually, the manifestation of any allergic reaction is possible only with repeated exposure to the allergen on the body. The danger of anaphylactic shock lies in the fact that it can develop even if the allergen first enters the body.

Symptoms of anaphylactic shock

Variations in the course of the disease:

Abortive is the easiest option, in which there is no threat to worsen the patient's condition. Anaphylactic shock does not provoke residual effects, it is easily stopped.

Protracted - develops with the use of long-acting drugs (bicillin, etc.), so patient monitoring and intensive care should be extended for several days.

Malignant (fulminant) - has a very rapid development of acute respiratory and cardiovascular failure in a patient. Regardless of the operation performed, it is characterized by a lethal outcome in 90% of cases.

Recurrent - is in the nature of recurring episodes of the pathological condition for the reason that without the knowledge of the patient, the allergen continues to enter the body.

During the development of symptoms of the disease, doctors distinguish 3 periods:

Period of harbingers

At first, patients feel headache, nausea, dizziness, general weakness, rashes on the mucous membranes and skin in the form of urticaria blisters may occur.

The patient complains of a feeling of discomfort and anxiety, numbness of the hands and face, lack of air, deterioration of hearing and vision.

peak period

It is characterized by loss of consciousness, a drop in blood pressure, general pallor, increased heart rate (tachycardia), noisy breathing, cyanosis of the extremities and lips, cold sticky sweat, itching, urinary incontinence, or vice versa, the cessation of its excretion.

Recovery period from shock

May continue for several days. Lack of appetite, dizziness, weakness in patients persist.

Severity of the condition

	easy current	Medium	Severe course
Arterial pressure	Reduced to 90/60 mm T.st	Reduced to 60/40 mm T.st	not defined
Period of harbingers	10 to 15 min.	2 to 5 min.
Loss of consciousness	Brief syncope		More than 30 min.
The effect of the treatment	Treats well	Requires long-term follow-up, slow effect	No effect

With mild flow

With a mild form of anaphylactic shock, the precursors usually develop within 10-15 minutes:

Quincke's edema of diverse localization;

burning and feeling of heat in the whole body;

urticaria, erythema, pruritus.

The patient manages to tell others about his feelings with mild anaphylactic shock:

Feeling pain in the lower back, headache, numbness of the fingers, lips, tongue, dizziness, fear of death, lack of air, general weakness, decreased vision, pain in the abdomen, chest.

There is pallor or cyanosis of the skin of the face.

Some patients may develop bronchospasm, characterized by labored exhalation and resonant wheezing that can be heard from a distance.

In most cases, abdominal pain, diarrhea, vomiting, defecation, or involuntary urination are observed. But at the same time, patients remain conscious.

Tachycardia, muffled heart sounds, thready pulse, sharply reduced blood pressure.

For moderate flow

Harbingers:

Involuntary urination and defecation, dilated pupils, pallor of the skin, cold sticky sweat, cyanosis of the lips, urticaria, general weakness, Quincke's edema - as with mild leakage.

Often - clonic and tonic convulsions, after which the person loses consciousness.

Pressure is not determined or very low, bradycardia or tachycardia, muffled heart sounds, thready pulse.

Rarely - bleeding from the nose, gastrointestinal, uterine bleeding.

Severe course

There are five clinical forms of the disease:

Asphyxic - with this form of pathology, patients are dominated by signs of bronchospasm (hoarseness, difficulty breathing, shortness of breath) and respiratory failure, Quincke's edema often occurs (severe swelling of the larynx, the development of which can stop a person's breathing).

Abdominal - the predominant symptom is abdominal pain, which mimics the symptoms of a perforated stomach ulcer (due to spasm of the smooth muscles of the intestine) or acute appendicitis, diarrhea, vomiting.

Cerebral - this form is characterized by the development of edema of the brain and meninges, which manifests itself in the form of a state of coma or stupor, nausea and vomiting, which does not give relief, convulsions.

Hemodynamic - the diagnostic symptom of this form is a rapid drop in blood pressure and pain in the region of the heart, which is similar to myocardial infarction.

Generalized (typical) - the most common clinical form of anaphylactic shock, which includes general manifestations of the disease.

Diagnosis of anaphylactic shock

Pathology needs to be diagnosed as soon as possible.

after all, in many respects the question of the patient's life depends on the experience of the doctor.

The state of anaphylactic shock is easily confused with other diseases, the main factor in making a diagnosis is the correct history taking!

A plain chest x-ray can detect inverse pulmonary edema.

A biochemical blood test determines an increase in kidney samples (urea, keratin), liver enzymes (bilirubin, alkaline phosphatase, ALT, AST).

A complete blood count may indicate anemia (a decrease in the number of red blood cells) and leukocytosis (an increase in the level of white blood cells) with eosinophilia (an increase in the level of eosinophils).

ELISA is used to determine specific antibodies (Ig E, Ig G).

If the patient is not able to name the cause of the allergic reaction, he is recommended to conduct allergic tests with a consultation with an allergist.

First medical aid for anaphylactic shock: an algorithm of actions

Lay a person on a flat surface, slightly raise his legs (for example, put a pillow or a blanket rolled up with a roller under his feet).

Turn your head to the side to prevent aspiration of vomit, pull dentures out of your mouth.

Open a door or window to let fresh air into the room.

Carry out measures aimed at stopping the entry of the allergen into the patient's body - remove the sting with poison, apply a cold compress to the injection or bite site, apply a pressure bandage above the bite site and other actions.

Feel the victim's pulse: first on the wrist, and if absent, on the femoral or carotid arteries. If the pulse cannot be detected, an indirect heart massage should be performed - put your hands in the lock, put them in the middle of the sternum and carry out rhythmic pushes, up to 5 cm deep.

Check if the patient is breathing: follow the movements of the chest, lean a mirror against the victim's mouth. In the absence of breathing, it is recommended to start artificial respiration using the "mouth-to-mouth" or "mouth-to-nose" technology, directing the air flow through a handkerchief or napkin.

Transport the person to the hospital on their own or call an ambulance immediately.

Emergency medical care algorithm for anaphylactic shock:

Monitoring of vital functions - electrocardiography, determination of oxygen saturation, measurement of pulse and blood pressure.

Ensure the patency of the respiratory tract - remove vomit from the mouth, remove the lower jaw according to the Safar triple intake, and intubate the trachea. With Quincke's edema or spasm of the glottis, a conitocomy is recommended (performed by a doctor or paramedic in emergency cases, the essence of this manipulation is to cut the larynx between the cricoid and thyroid cartilages to ensure the flow of fresh air) or tracheotomy (performed only in medical hospitals, doctor performs an incision of the tracheal rings).

The introduction of adrenaline in a proportion of 1 ml of a 0.1% solution of adrenaline hydrochloride per 10 ml of saline. If there is a certain place through which the allergen has entered the body (injection site, bite), it is advisable to prick it subcutaneously with a diluted adrenaline solution. Next, you should enter from 3 to 5 ml of the solution sublingually (under the root of the tongue, since it is well supplied with blood) or intravenously. The rest of the adrenaline solution must be diluted in 200 ml of physiological saline and continue to be administered intravenously, while controlling the level of blood pressure.

The introduction of glucocorticosteroids (hormones of the adrenal cortex) - most often used prednisolone (dosage 9-12 mg) or dexamethasone (dosage 12-16 mg).

The introduction of antihistamine drugs - first by injection, then with the transition to tablet forms (tavegil, suprasin, diphenhydramine).

Inhalation of humidified oxygen (40%) at a rate of 4 to 7 liters per minute.

When determining respiratory failure, the introduction of aminophylline (5-10 ml) and methylxanthines - 2.4% is recommended.

As a result of the redistribution of blood, acute vascular insufficiency develops. At the same time, the introduction of colloidal neoplasmagel (gelofusin) and crystalloid (sterofundin, plasmalite, ringer-lactate, ringer) solutions is recommended.

In order to prevent pulmonary and cerebral edema, diuretics are prescribed - minnitol, torasemide, furosemide.

In the cerebral form of analphylactic shock, tranquilizers are prescribed (seduxen, relanium, sibazon), anticonvulsants - 25% magnesium sulfate (10-15 ml), 20% sodium oxybutyrate (GHB) 10 ml.

Anaphylactic shock: How not to die from allergies? video:

Consequences of anaphylactic shock

Not a single disease passes without a trace, such is anaphylactic shock. After elimination of respiratory and cardiovascular insufficiency, the following symptoms may persist in the patient:

Abdominal pain, vomiting, nausea, heart pain, shortness of breath, chills, fever, muscle and joint pain, weakness, lethargy, lethargy.

Prolonged hypotension (low blood pressure) - treated with prolonged administration of vasopressors: norepinephrine, dopamine, mezaton, adrenaline.

Pain in the hearts as a result of ischemia of the heart muscle - the introduction of cardiotrophics (ATP, riboxin), antihypoxants (mexidol, thiotriazoline), nitrates (nitroglycerin, isoket) is recommended.

Decrease in intellectual functions due to prolonged hypoxia of the brain, headache - vasoactive substances (cinnarizine, ginkgo biloba, cavinton), nootropic drugs (citicoline, piracetam) are used.

If infiltrates occur at the injection or bite site, local treatment is recommended - ointments and gels with a resolving effect (lyoton, troxevasin, heparin ointment).

Sometimes after anaphylactic shock, late complications occur:

Diffuse damage to the nervous system, vestibulopathy, glomerulonephritis, neuritis, allergic myocarditis, hepatitis are often the cause of death.

Approximately 2 weeks after shock, angioedema, recurrent urticaria and the development of bronchial asthma may occur.

Repeated contact with allergenic drugs leads to the development of diseases such as systemic lupus erythematosus, periarteritis nodosa.

Anaphylactic shock, what is it and how to deal with it, video:

Primary prevention of shock

It is based on preventing the body from coming into contact with the allergen:

control over the quality manufacturing of medical devices and medicines;

exclusion of bad habits (substance abuse, drug addiction, smoking);

fight against chemical products polluting the environment;

combating the one-time prescription of a huge number of medical drugs by doctors;

a ban on the use of certain food additives (glumanate, agar-agar, bisulfites, tartrazine).

Secondary prevention of shock

Promotes early detection and timely treatment of the disease:

conducting allergological tests in order to determine a specific allergen;

timely treatment of eczema, hay fever, atopic dermatitis, allergic rhinitis;

indication of intolerable medications in red paste on the outpatient card or the title page of the medical history;

careful collection of allergic anamnesis;

observation of patients for at least half an hour after the injection;

carrying out sensitivity tests of the body in relation to the drugs administered intramuscularly or intramuscularly.

Tertiary prevention of shock

Prevents the manifestation of recurrence of the disease:

the use of a mask and sunglasses during the flowering period of plants;

careful control of food intake;

removal of unnecessary upholstered furniture and toys from the apartment;

ventilation of premises;

frequent cleaning of rooms to remove insects, mites, house dust;

compliance with the rules of personal hygiene.

Photo of the consequences:

How can doctors minimize the risk of anaphylactic shock in a patient?

In order to prevent the disease, the main aspect is a closely collected anamnesis of diseases and the patient's life. To minimize the risk of its development from taking medications, it is necessary:

Carry out the appointment of any drugs strictly according to indications, in the optimal dosage, taking into account compatibility and tolerability.

The age of the patient must be taken into account. Single and daily doses of antihypertensive, sedative, neuroplegic, cardiac drugs for the elderly should be reduced by 2 times compared with doses for middle-aged people.

Do not administer multiple drugs at the same time, only one drug. It is possible to prescribe a new drug only after testing for its tolerability.

When prescribing several drugs that are identical in chemical composition to the pharmacological action, the risk of allergic cross-reactions should be taken into account. For example, if promethazine is intolerant, it is forbidden to prescribe its antihistamine derivatives (pipolene and diprazine), if you are allergic to anesthesin and procaine, there is a high probability of intolerance to sulfonamides.

Without fail, antibiotics must be prescribed, taking into account the data of microbiological studies and determining the sensitivity to microorganisms.

As a diluent for antibiotics, it is better to use distilled water or saline, since the use of procaine often causes allergic reactions.

When treating, take into account the functional state of the kidneys and liver.

Monitor the content of eosinophils and leukocytes in the patient's blood.

Before drug therapy, patients who are prone to developing anaphylactic shock 3-5 days and 30 minutes before the administration of the drug should be given second and third generation antihistamines (Telfast, Semprex, Claritin), calcium and corticosteroids - according to indications.

In order to be able to apply a tourniquet in case of shock above the injection, the first injection of the drug (1/10 of the dose, antibiotics - at a dose of less than 10,000 units) should be injected into the upper third of the shoulder. If signs of intolerance appear, it is necessary to tightly apply a tourniquet above the injection site until the pulse stops below the application site, prick the injection site with an adrenaline solution (calculated as 1 ml of 0.1% adrenaline together with 9 ml of saline), cover this area with ice or apply a cloth soaked cold water.

In the treatment rooms there should be anti-shock first aid kits and tables containing a list of medicines with common antigenic determinants that cause cross-allergic reactions.

Rooms for patients with anaphylactic shock should not be located near manipulation rooms. It is forbidden to place patients who have repeatedly experienced anaphylactic shock in the same room with those who are injected with drugs that cause allergies in the first.

To prevent the occurrence of the Arthus-Sakharov phenomenon, the injection site should be monitored (redness, swelling, itching of the skin, with repeated injections in one area - skin necrosis).

Patients who have suffered anaphylactic shock at discharge from the hospital are marked with red paste on the title page of the case history as “anaphylactic shock” or “drug allergy”.

After discharge, patients who have undergone anaphylactic shock are referred to doctors at the place of residence for dispensary registration and receiving hyposensitizing and immunocorrective treatment.

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 therefore tell you about the pathogenesis of anaphylactic shock in children and adults, give clinical recommendations and tell you what first aid kit you need to have if you are overtaken by anaphylactic shock.

Features of the disease

Anaphylactic shock (anaphylaxis, allergic shock) is an acute, rapidly developing pathological reaction of the body in response to an attack (shock - shock) of allergens, in which all systems and organs experience extremely pronounced painful changes, often incompatible with life (everyone has 5 - 10 patient). The speed of all processes characteristic of a banal allergy, in the case of a shock effect, accelerates, and their severity increases tenfold.

Are exposed to:

• all organs and ways of breathing, vessels and capillaries;
• brain, heart;
• organs of the gastrointestinal system;
• skin and mucous membranes.

The greatest frequency of this allergic reaction of the immediate type occurs in women, boys and young men.

The video below will tell you what anaphylactic shock is:

Children

Anaphylaxis is especially dangerous for the child's body due to the underdevelopment of many systems and organs, the protective function, anatomical and physiological features. For example, laryngeal edema in a child is a critical condition, since the respiratory lumen is extremely small and swelling of the mucosa to a thickness of only 1 mm will easily block the access of air to the newborn and infant.

At this age, vaccination, drugs often provoke an acute allergic reaction. But if in adults shock usually occurs when allergens enter the blood again, then in children anaphylaxis can develop upon first contact with an allergic shock provocateur, if mothers used a certain medication during pregnancy and breastfeeding, and it got into the placenta or milk through the placenta or milk. baby's blood. Moreover, neither the dose nor the method of administration of the pharmacological agent does not matter if the child is already sensitized (has an increased sensitivity to a particular substance).

In addition, it is in children that anaphylaxis to foods is more likely to develop.

Pregnancy

Pregnancy also creates particular vulnerability for the expectant mother and fetus. With overloads experienced by the heart and vascular system during anaphylaxis, the likelihood of miscarriages, early placental abruption, premature birth and intrauterine death is very high. The pregnant woman herself is also at risk of catastrophic bleeding, respiratory and.

Read about the types and forms of anaphylactic shock below.

Classification

According to flow patterns

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

Downstream, anaphylaxis is divided into forms:

1. Typical. It occurs most often, accompanied by violations of the functions of blood vessels, organs and respiratory tract,.
2. Hemodynamic. Accompanied by impaired blood circulation, insufficiency of the functioning of the myocardium, heart vessels.
3. Asphyxic, with the dominance of manifestations of acute respiratory failure, edema and spasms of the respiratory tract, reaching the degree of asphyxia (suffocation).
4. Abdominal or gastrointestinal form with symptoms of acute poisoning, "acute abdomen", diseases of the stomach, intestines.
5. cerebral, with characteristic lesions of the central trunks of the nervous system, cerebral vessels, developing to cerebral edema.
6. Form of AS provoked physical overload.

According to the severity of the course

The severity of the pathology according to the criteria:

Basic criterion	Severity
I	II	III	IV
Blood pressure in mm Hg. Art.	below the normal rate of 110 - 120 / 70 - 90 by 30 - 40 units	Systolic (upper) 90 - 60 and below, diastolic (lower) 40 and below	Upper 60 - 40, lower - up to 0 (during measurement - not determined)	not defined
Consciousness	Saved. Severe panic, fear of death	Confused consciousness, state of stupor (stupor), probability of loss of consciousness	High risk of loss of consciousness	Sudden loss of consciousness
Patient response to antishock treatment	Active	Good or Satisfactory	Weak	Weak or absent

The severity of the shock determines the timing of the onset of the first symptoms. The sooner the symptoms begin to appear from the moment the allergen enters the body, the more severe the manifestations of anaphylaxis.

By type of flow

Classification of AS by flow type:

Leak / type	Peculiarities
Acute malignant. More common in the typical form.	sudden progressive onset; a sharp drop in blood pressure (lower - systolic drops to 0); confusion, progression of signs of respiratory distress, bronchospasm. the severity of manifestations increases, the response to active treatment is weak or absent. there is a development of severe pulmonary edema, a persistent decrease in pressure, a coma. The patient's risk of death is high.
Acute benign	The main pathological manifestations are quite pronounced. But during therapy, they are not characterized by an increase, they are amenable to reverse development and subsidence. A favorable prognosis is highly likely with emergency treatment.
Abortive	Pathological symptoms are mild, quickly suppressed, often without the use of drugs. Occurs in asthma patients taking hormones (Prednisolone, Dexamethasone).
lingering	Both types are characterized by: Rapid start. Typical clinical manifestations of anaphylaxis. Treatment with a protracted type of leakage gives a temporary, partial effect. The recurrent course is characterized by a secondary sharp drop in blood pressure after its stabilization and removal of the patient from an acute state. The rest of the symptoms are not as pronounced as in acute types of pathology, but they hardly respond to therapy. More often observed with prolonged use by patients of prolonged drugs (for example, Bicillin).
Recurrent
Lightning	Lightning-fast development of an anaphylactic reaction - within 10 - 30 seconds. Most often this occurs when the drug is injected into a vein. The prognosis is disappointing. A favorable conclusion is possible only with the equally immediate introduction of adrenaline and other anti-shock agents.

Read more about the causes of anaphylactic shock.

Causes

Development mechanism

Stage I

Sensitization (an abnormal increase in sensitivity to a specific allergen substance).

The initial hit of the allergen is perceived by the immune system as the penetration of a foreign agent, which produces special protein compounds - immunoglobulins E, G, after which the body is considered sensitized, that is, ready for a sharp allergic reaction when the allergen is reintroduced. Immunoglobulins are fixed on immune (mast) cells.

Stage II

Directly - an anaphylactic reaction.

When the allergen enters the blood again, immunoglobulins immediately come into contact with it, after which specific substances are released from mast cells that regulate allergic and inflammatory reactions, the main of which is histamine. It causes edema, vasodilation - and, as a result, a drop in pressure, impaired breathing. In anaphylactic shock, histamine is released simultaneously and in large volume, which leads to catastrophic disruption of the work of all organs.

With anaphylaxis, a similar pathological process, if medical intervention does not occur, develops rapidly, irreversibly leading to death.

Main reasons

Among the numerous reasons for the development of AS, there are, firstly, the administration of drugs, including:

• antibiotics (penicillin, aminoglycosides, trimethoprim, vancomycin);
• Aspirin, other non-hormonal anti-inflammatory drugs (NSAIDs);
• ACE inhibitors (drugs for hypertension - Fosinopril, even if the medicine has been taken for several years before);
• sulfonamides, iodinated preparations, B vitamins;
• plasma substitutes, iron preparations, nicotinic acid, immunoglobulins.

With an intravenous infusion of the drug, the reaction develops after 10-15 seconds, with an intramuscular injection - after 1-2 minutes, when taking tablets and capsules - after 20-50 minutes.

Risk factors:

1. Existing allergic diseases (, allergic rhinitis)
2. Chronic respiratory diseases, 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 reaction of the respiratory tract to histamine, bradykinin increases and the effect of adrenaline used to remove the patient from shock decreases).
   • MAO inhibitors (suppress the enzyme that breaks down adrenaline, thus increasing the side effects of adrenaline).
   • ACE inhibitors (may cause swelling of the larynx, tongue, pharynx with the development of suffocation, "kapoten cough").

Signs of anaphylactic shock

Symptoms

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. This usually happens when the drug is injected into a vein. A typical increase in symptoms is in the range of 5 to 40 minutes.

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

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

Frequency of manifestations	signs
In 9 cases out of 10	exhaustion, fear of death; feeling of heat on the face, hyperemia (redness) of the skin; itchy rash, red spots and blisters of the type of urticaria (with the 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 drop.
In half of the patients	swelling of the sinuses, sneezing, mucus from the nose; bouts of dry cough; feeling of a lump in the throat, superficial heavy breathing, hoarseness; stridor (whistling inhalation and exhalation), wheezing in the lungs; bronchospasm; sharp, blue lips, skin around the nose and mouth, nail plates; eye irritation, itching;
In a third of patients	pain in the head is pressing or throbbing; a significant and sharp decrease in pressure; pain and a feeling of squeezing behind the sternum, in the pericardial region; , failure in the rhythm of contractions of the heart.
Every 3-4 patients	itching of the oral mucosa; difficulty swallowing; seizures, vomiting, loose stools, cramping pains, cramps in the stomach, intestines.
In 5 - 10% of anaphylaxis:	numbness of the muscles of the face, lips; visual impairment (blurring, double vision, nebula); panic attacks, tremor (trembling), convulsions; uncontrolled urination and defecation; swelling of the brain.

Diagnostics

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 to one degree or another can be predicted:

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

Since anaphylaxis is a condition in which all manifestations increase very quickly, the diagnosis is most often made already 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 death of the patient, a detailed study of each symptom at this moment is impossible and simply - extremely dangerous.

The 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 form) anaphylaxis, all the signs are very similar to the symptoms of acute poisoning, appendicitis, pancreatitis, biliary colic.
• In the hemodynamic form, with its severity of heart pain and manifestations of insufficiency, a person is diagnosed with "".
• Spasms of the bronchi, and even swelling of the larynx, are attributed to signs of an asthmatic attack, and brain and neurological disorders are attributed to, and other diseases that have nothing to do with anaphylactic shock.

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

Therefore, if, after a glass of orange juice, severe pain behind the sternum suddenly occurs, this immediately indicates the development of anaphylaxis. And don't wait for any other signs.

Actions for AS

Problem Identification

Identification of the aggressor allergen that caused anaphylactic shock is a very important step that should be included directly in the treatment of pathology. If the patient has not experienced allergic reactions, special studies are carried out. They are able to confirm the diagnosis of allergization of the body as a whole, as well as the causative allergen in a particular case of anaphylaxis.

Among them are:

• skin, skin, application tests (Patch-test);
• a blood test for the presence of immunoglobulins E (IgE), which are responsible for allergic reactions;

In order to guarantee the safety of the patient's health in the event of a sharp response to an allergy provocation, all studies are carried out with a high degree of caution. The safest is the radioimmunological method during the allergen sorbent test (RAST), which most accurately determines the anaphylactic allergen without affecting the structure of the body.

Safety is ensured by conducting an analysis outside the patient's body. Different types of allergens are alternately added to the blood taken from the patient. If, after the next interaction of the blood with the allergen, an abnormal amount of antibodies is released, this indicates this allergen as the cause of the anaphylactic reaction.

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

Treatment

In the hospital - in the intensive care unit and the intensive care unit, the main treatment of anaphylactic shock is carried out.

Basic principles

Basic principles of treatment of anaphylactic shock:

1. Elimination of serious dysfunctions in the work of the heart muscle, blood vessels, respiratory and nervous systems.
2. Prevention of a sudden drop in pressure and the development of coma.
3. Prevention, 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.

About whether adrenaline is administered in case of anaphylactic shock and what other drugs will be needed, we will tell further.

Activities and medicines

1. Intramuscular injections of Adrenaline (epinephrine) 0.1% every 10-15 minutes, 0.2-0.8 ml. When calculating children's doses, the rate of 0.01 mg (0.01 ml) per kilogram of the baby's weight is taken into account. If a positive reaction does not occur, intravenous administration of 1 ml of adrenaline in 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 fluids to prevent coma: 1 liter of NaCL solution, then -0.4 liters of Polyglucin. Initially, a jet injection of up to 500 ml is provided for 30-40 minutes, later - through a dropper. It is believed that colloidal solutions fill the vascular bed more actively, however, crystalloid liquids are safe, since dextrans themselves can cause anaphylaxis.
3. Glucocorticoids.
   • Hydrocortisone in a muscle or vein: adults from 0.1 to 1 gram. For children, intravenous injections of 0.01 to 0.1 grams.
   • : 4 - 32 mg intramuscularly, daily dose for intravenous injection 3 mg per kilogram. After removing the patient from an acute condition, Dexamethasone is prescribed 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 0.16665 mg per kilogram.
   • : 150 - 300 mg once intramuscularly, infants up to a year per kilogram of weight 2 - 3 mg, from 1 year to 14 years, 1 - 2 mg.
4. Means for restoring respiratory patency and relieving bronchospasm, suppressing histamine releases.
   • 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 highest doses per day per kilogram of weight: 10-13 mg, for children from 6 years old - 13 mg (0.5 ml), from 3 to 6, 20-22 mg (0.8-0.9 ml). Carefully use Eufillin in the last trimester of pregnancy, since tachycardia is possible in the mother and fetus.
   • In addition to Eufillin, Aminophylline, Albuterol, Metaproterol are used.
5. Medicines to activate the work of the heart. Atropine 0.1% subcutaneously 0.25 - 1 mg. Pediatric single doses are prescribed by weight and age in the range of 0.05 - 0.5 mg.

1. Medicines that prevent pressure drops 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 minimum dosages of 1.5 - 3.5 mcg (infusion rate 100 - 250 mcg / min) to 10.5 - 21 mcg (750 - 1500 mcg per minute). For children over 12 years of age, the highest dose per kilogram is 4-8 mcg (per minute).
   • In pregnant patients, Dopamine is used only when life is threatened for the mother; no teratogenic (disfiguring fetus) effect of Dopamine has been identified. Breastfeeding is stopped.

1. Antihistamines, which stop the release of allergic provocateur substances into the blood, eliminate itching, swelling, and hyperemia. It is rational to prescribe after the restoration of the circulating blood volume, since they can lower the pressure.
   • Oxygen therapy. Helps with an increase in oxygen starvation of tissues and bronchospasm.
   • Hemosorption- a special extrarenal technique for removing allergens from the blood when passing it through sorbents.

   All patients who survived anaphylaxis should be observed in the hospital for up to 2-3 weeks, because of the likelihood of recurrent anaphylaxis and late complications from the heart, blood vessels, respiratory and urinary systems.

   Therefore, in the hospital several times they do:

   • analysis of blood, urine;
   • study of indicators of urea, creatinine in the blood;
   • or ;
   • study of feces for the Gregersen reaction.

   Disease prevention

   To reduce the risk of developing AS in people who are at high risk of exposure to an allergen, you should:

   • be sure to have a set of emergency medicines (we wrote about it separately):
     • adrenaline solution;
     • Prednisolone in ampoules;
     • Ventolin, Salbunanol;
     • Suprastin or Tavegil or Diphenhydramine (in ampoules)
     • tourniquet
   • be able to use an automatic syringe for injection of adrenaline (Epi-pen, Allerjet);
   • avoid insect bites (cover open places, do not eat sweets and ripe fruits outside the home), use special repellents;
   • correctly evaluate the components in the products used in order to avoid the penetration of allergens through the stomach;
   • at work, avoid contact with industrial chemicals, inhalation and skin allergens;
   • do not use β-blockers at the risk of developing severe anaphylaxis, replacing them with drugs from another group;
   • when conducting studies using radiopaque substances, pre-injection of Prednisolone
   • make tests for allergies from medicinal and other substances;
   • choose medicines in tablets, not in injections;
   • always have a “passport” (card, bracelet, pendant) with you with information about allergic diseases and drugs that help with AS.

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

   Complications

   • Severe complications can be diagnosed:
   • Glomerulonephritis
   • Intestinal and stomach bleeding
   • Cardiac pathologies, including myocarditis
   • Bronchospasm and pulmonary edema;
   • Edema and bleeding in the brain

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

   Forecast

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

   According to statistics, almost 10% of people die with anaphylactic shock.

   However, even stopping the acute state of anaphylaxis with drugs does not mean that everything ended successfully, since there is a high probability of a secondary drop in pressure and the development of anaphylaxis (usually within 3 days, but a longer period also occurs).

   This video will tell you what to do when anaphylactic shock occurs: