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

August 25, 2017 23:00 | Allergies

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

Features of the ailment

Anaphylaxis shock( anaphylaxis, allergic shock) is an acute, rapidly developing pathological reaction of the body in response to an attack of allergens in which all systems and organs undergo extremely pronounced painful changes,Incompatible with life( each 5-10 patients). The speed of all processes characteristic of banal allergies is accelerated in the event of a shock effect, and their severity is increased tens of times.

The following are affected:

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

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

Children

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

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

In addition, it is the children who develop anaphylaxis for food more often.

Pregnancy

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

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

Classification

By flow patterns

The classification by the forms of the course of anaphylactic shock( AS) is based on the key signs of the disorder of specific systems and target organs, to which the main aggression of allergens is directed.

In the course of anaphylaxis, the forms are divided into the following:

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

Due to the severity of

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

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

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

Flow type

Classification AS according to flow type:

Flow / type Features
Acute malignant.It is more common in a typical form.
  • sudden progressive onset;

  • sharp drop in blood pressure( lower - systolic falls to 0);

  • confusion, progression of signs of a breathing disorder, spasm of the bronchi.

  • severity of manifestations is increasing, the response to active treatment is weak or absent.

  • there is a development of severe pulmonary edema, persistent depression of pressure, coma.The risk of death of a patient is high.

Acute benign The main pathological manifestations are quite pronounced.But when the therapy is carried out, they are not characterized by an increase, they give in to reverse development and subsidence.

A favorable prognosis is highly likely in emergency treatment.
Abortive Pathological symptoms are mild, quickly suppressed, often without the use of drugs.

occurs in patients with asthma taking hormones( Prednisolone, Dexamethasone).
Extended Both types are characterized by:
  1. Fast start.

  2. Typical clinical manifestations of anaphylaxis.


Treatment with a protracted flow type gives a temporary, partial effect.

A recurrent course is characterized by a secondary sharp drop in blood pressure after stabilization and removal of the patient from an acute condition.

Other symptoms are not as pronounced as in acute types of pathology, but with difficulty respond to therapy.

More often observed with prolonged admission of patients with prolonged drugs( for example - Bicillin).
Relative
Lightning Lightning-fast development of the anaphylactic reaction - within 10 to 30 seconds.

This occurs more often when the drug is injected into a vein.The outlook is disappointing.Favorable completion is possible only with the same immediate introduction of adrenaline and other anti-shock drugs.

For the causes of anaphylactic shock, read on.

Reasons for the occurrence

Development mechanism

Stage I

Sensitization( abnormal sensitization to a specific allergenic substance).

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

Stage II

Anaphylactic-shock-relief Directly anaphylactic reaction.

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

The main causes of

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

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

Other causes of ASH:

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

Risk Factors:

Risk Factors:

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

    Usually this happens when the medicine is injected into a vein.A typical increase in signs is in the range of 5 to 40 minutes.

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

    Basic symptoms of anaphylaxis frequently combined or manifest a complex - in accordance with the forms AL:

    manifestations frequency Signs
    In 9 cases out of 10
    • exhaustion, dizziness, fear of dying;

    • feeling of fever on the face, redness of the skin;

    • itching rash, red spots and blisters as urticaria( with rapid development of pathology - changes on the skin occur later than other symptoms);

    • laryngeal edema, lips, tongue, throat, eyelids, genitals, fingers, neck

    • pressure.

    Half of the patients
    • swelling of the sinuses, sneezing, mucus from the nose;

    • attacks of dry cough;

    • feeling of a lump in the pharynx, superficial panting, hoarseness;

    • stridor( wheezing and exhaling), wheezing in the lungs;

    • bronchospasm;

    • sharp pallor, blue lips, skin around the nose and mouth, nail plates;

    • eye irritation, itching;

    • loss of consciousness.

    third of patients
    • pain in the head pressing or throbbing;

    • significant and dramatic pressure drop;

    • pain and squeezing sensation behind the sternum, in the near-cardiac region;

    • slowing the pulse, a failure in the rhythm of contractions of the heart.

    Each 3 - 4 patient
    • itching of the oral mucosa;

    • complicated swallowing;

    • attacks of nausea, vomiting, loose stools, cramping pains, spasms in the stomach, intestines.

    in 5 - 10% of anaphylaxis:
    • numbness of facial muscles, lips;

    • vision impairment( blurred vision, twitching, nebula);

    • panic attacks, tremor( trembling), convulsions;

    • uncontrolled urinary excretion and defecation;

    • cerebral edema.

    Next, the diagnosis of anaphylactic shock is considered.

    Diagnosis

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

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

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

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

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

    Anaphylactic-shock-action

    Detection of the allergen-aggressor that caused anaphylactic shock is a very important step that must be included directly in the treatment of pathology.If the patient does not come across allergic reactions, special studies are carried out.They are able to confirm the diagnosis of allergic organism as a whole, as well as the causative allergen in the specific case of anaphylaxis.

    The following are isolated from them:

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

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

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

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

    Treatment

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

    Basic principles

    Basic principles of the treatment of anaphylactic shock:

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

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

    Activities and Drugs

    1. Intramuscular injections of epinephrine( epinephrine) 0.1% after 10 - 15 minutes at 0.2-0.8 ml.When calculating children's doses, the norm is 0.01 mg( 0.01 ml) per kilogram of the baby's weight.If a positive reaction does not occur, intravenous injection of 1 ml of epinephrine in 10 ml of NaCl solution - slowly - 5 minutes to prevent myocardial ischemia.Or 1 ml of medicine in 400 ml of NaCl through a dropper, which is more rational.
    2. Infusion of liquids to prevent coma: 1 liter of NaCl solution, then -0.4 liters of Polyglucin.Initially, a jet injection of up to 500 ml in 30-40 minutes, later - through a dropper.It is believed that colloidal solutions actively fill the vascular bed, but the crystalloid fluid is safe, since dextrans themselves are able to cause anaphylaxis.
    3. Glucocorticoids.
      • Hydrocortisone in the muscle or vein: adults from 0.1 to 1 gram.For children, intravenous injection is 0.01 to 0.1 grams.
      • Dexamethasone: 4 - 32 mg intramuscularly, daily dose for intravenous injection of 3 mg per kilogram.After excretion of 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 0.1666 mg per kilogram.
      • Prednisolone: ​​150-300 mg once intramuscularly, infants up to a year per kilogram of weight 2 to 3 mg, from 1 year to 14 years of 1 to 2 mg.
    4. Means for restoring respiratory patency and relieving bronchospasm, suppressing histamine emissions.
      • Eufillin 2,4% 5 - 10 ml intravenously.Drip administration provides a dose of 5.6 mg per kilogram( 20 ml of the drug is diluted in 20 ml of 0.9% NaCl and 400 ml of saline).The largest doses per day per kilogram of weight: 10 to 13 mg, children from 6 years - 13 mg( 0.5 ml), from 3 to 6 to 20 - 22 mg( 0.8 - 0.9 ml).Carefully use Euphyllin in the last trimester of pregnancy, because the mother and the fetus can have tachycardia.
      • In addition to Euphyllin, Aminophylline, Albuterol, Metaproterol are used.
    5. Medications to activate the heart.Atropine 0.1% subcutaneously 0.25 - 1 mg.Children's single doses are prescribed by weight and age in the range of 0.05-0.5 mg.
    1. Drugs that prevent pressure loss and increase cardiac output.
      • Dopamine.Applied intravenously after dilution in a solution of glucose 5% or sodium chloride.Adults( per kilogram of weight per minute) from the minimum dosages of 1.5 to 3.5 μg( infusion rate of 100 to 250 μg / min) to 10.5 to 21 μg( 750 to 1500 μg per minute).Children over 12 years of age with the highest dose per kilogram of 4 - 8 mcg( per minute).
      • In pregnant women, dopamine is used only in case of a life threat for the mother, the teratogenic( disfiguring fetus) action of Dopamine is not revealed.Breastfeeding is discontinued.
    1. Antihistamines, which stop the release of allergic agents into the blood, eliminate itching, swelling, and flushing.It is rational to prescribe after the recovery of the circulating blood volume, since they can lower the pressure.
      • Intramuscularly: Suprastin( 20 mg) 2 to 4 mL;Initial infantile doses: 6-14 years to 1 ml, 1 to 6 years 0.5 ml, from month to year 0.25 ml.The single largest dose per kilogram of weight can not exceed 2 mg.
      • Pipolphen, Tavegil, Dimedrol are also used.

    After passing through the acute period, the patient is prescribed glucocorticosteroids in tablets with a smooth dose reduction for 7 to 10 days, and antihistamines.

    Therapeutic treatment

    Signs-anaphylactic-shock

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

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

    Therefore in the hospital several times do:

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

    Next, the prevention of anaphylactic shock is considered.

    Prevention of the disease

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

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

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

    Complications

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

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

    Forecast

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

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

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