Anaphylactic Shock – Causes, Symptoms and Treatment
Anaphylactic shock is a severe, life-threatening allergic reaction affecting the whole body. Immediate medical treatment is critical for survival.
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Anaphylactic shock is a severe, life-threatening allergic reaction affecting the whole body. Immediate medical treatment is critical for survival.
What is Anaphylactic Shock?
Anaphylactic shock is the most severe form of an allergic reaction and constitutes a medical emergency. It occurs when the immune system reacts excessively to a specific trigger – known as an allergen. Within a very short time, large amounts of chemical mediators such as histamine are released, causing a dramatic drop in blood pressure, circulatory failure, and life-threatening airway complications. Without immediate treatment, anaphylactic shock can be fatal within minutes.
Causes and Triggers
Common triggers of anaphylactic shock include:
- Foods: Peanuts, tree nuts, fish, shellfish, milk, eggs
- Insect stings: Bees, wasps, hornets
- Medications: Antibiotics (e.g., penicillin), nonsteroidal anti-inflammatory drugs (NSAIDs), radiocontrast agents
- Latex: Natural rubber latex in gloves or medical devices
- Physical exercise: In rare cases, intense physical exertion – sometimes in combination with food – can trigger anaphylaxis
In some cases, no trigger can be identified; this is referred to as idiopathic anaphylaxis.
Symptoms
Symptoms typically appear within seconds to minutes after exposure to the allergen and can deteriorate rapidly:
- Skin reactions: hives (urticaria), itching, redness, swelling (especially of the lips, tongue, and throat)
- Respiratory symptoms: shortness of breath, wheezing or stridor, tightness in the chest
- Cardiovascular symptoms: severe drop in blood pressure, rapid or irregular pulse, dizziness, fainting
- Gastrointestinal symptoms: nausea, vomiting, abdominal cramps, diarrhea
- Neurological symptoms: confusion, loss of consciousness
The reaction may occur in two phases (biphasic anaphylaxis), meaning symptoms can return hours after an initial apparent improvement.
Diagnosis
Anaphylactic shock is primarily diagnosed clinically, based on the characteristic symptoms and a history of exposure to a potential allergen. Laboratory testing for serum tryptase – an enzyme released during mast cell activation – can help confirm the diagnosis. Following recovery, a thorough allergy evaluation (skin-prick and blood tests) is recommended to identify the specific trigger.
Treatment
Immediate First Aid
In the event of anaphylactic shock, immediate action is critical:
- Epinephrine (adrenaline): The first-line treatment – administered as quickly as possible by intramuscular injection into the outer thigh. Individuals with known severe allergies often carry an epinephrine auto-injector (e.g., EpiPen).
- Emergency services: Call emergency services (911 or local equivalent) immediately.
- Positioning: Place an unconscious person in the recovery position; for circulatory collapse, lay the person flat with legs elevated; for breathing difficulties, allow a seated position.
Medical Treatment
Further treatment is initiated by emergency medical personnel or in hospital:
- Supplemental oxygen and airway management if required
- Intravenous fluids to stabilize circulation
- Antihistamines and corticosteroids to reduce the allergic response
- Monitoring for at least 6–24 hours due to the risk of a biphasic reaction
Prevention and Long-Term Management
Individuals with a known severe allergy should always carry an epinephrine auto-injector and ensure those around them know how to use it. Wearing a medical alert bracelet and carrying an allergy emergency card is strongly recommended. In certain cases – such as insect venom allergy – allergen immunotherapy (desensitization) can significantly reduce the risk of future anaphylactic episodes.
References
- World Allergy Organization (WAO): WAO Anaphylaxis Guidelines, 2020. Available at: www.worldallergy.org
- Ring J. et al. – Guideline on Anaphylaxis: Acute Treatment and Management. Allergo Journal International, 2014.
- Muraro A. et al. – EAACI Guidelines on Anaphylaxis. Allergy, 2022; 77(2): 357–377.
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