Anaphylaxis: Causes, Symptoms and Treatment
Anaphylaxis is a severe, life-threatening allergic reaction affecting the whole body that requires immediate medical treatment.
Things worth knowing about "Anaphylaxis"
Anaphylaxis is a severe, life-threatening allergic reaction affecting the whole body that requires immediate medical treatment.
What is Anaphylaxis?
Anaphylaxis is a severe, acute, and potentially life-threatening hypersensitivity reaction of the immune system. It affects multiple organ systems simultaneously and can develop within minutes of exposure to a trigger. Anaphylaxis is a medical emergency and must be treated immediately. Without prompt medical care, it can progress to anaphylactic shock and prove fatal.
Causes and Triggers
Anaphylaxis is triggered by an excessive immune response to certain substances known as allergens. The most common triggers include:
- Foods: Peanuts, tree nuts, shellfish, fish, milk, eggs, and wheat
- Insect stings: Bees, wasps, and hornets
- Medications: Antibiotics (especially penicillin), non-steroidal anti-inflammatory drugs (NSAIDs), and radiocontrast media
- Latex: Found in rubber gloves and various medical products made from natural latex
- Physical exercise: Rarely, often in combination with specific foods (exercise-induced anaphylaxis)
In some cases, no clear trigger can be identified. This is referred to as idiopathic anaphylaxis.
Mechanism of Action
During anaphylaxis, the immune system reacts to a harmless allergen as if it were a serious threat. On previous exposure to the allergen, antibodies of the type Immunoglobulin E (IgE) were produced and bound to mast cells and basophils. Upon re-exposure to the allergen, these IgE antibodies activate the mast cells, which then release large amounts of chemical mediators such as histamine, tryptase, and leukotrienes. These mediators cause vasodilation, increased vascular permeability, bronchospasm, and other systemic effects throughout the body.
Symptoms
Symptoms of anaphylaxis can vary but typically develop very rapidly. Common signs include:
Skin and Mucous Membranes
- Itching, skin redness, hives (urticaria)
- Swelling, especially of the face, lips, and throat (angioedema)
Respiratory System
- Shortness of breath, wheezing (bronchospasm)
- Hoarseness, difficulty swallowing
- Risk of suffocation due to laryngeal swelling (laryngeal edema)
Cardiovascular System
- Drop in blood pressure, dizziness, fainting
- Rapid heartbeat (tachycardia)
- Anaphylactic shock with loss of consciousness
Gastrointestinal Tract
- Nausea, vomiting, abdominal cramps, diarrhea
Diagnosis
Anaphylaxis is primarily diagnosed clinically, based on symptoms and medical history. In an acute situation, immediate treatment takes priority. Subsequent diagnostic measures may include:
- Serum tryptase: An elevated tryptase level in the blood, measured within 1-3 hours after the event, confirms mast cell activation.
- Allergy tests: Skin tests (prick test, intradermal test) or blood tests for specific IgE antibodies to identify the trigger.
- Provocation tests: Possible in specialized centers under medical supervision.
Treatment
Emergency Measures
When anaphylaxis is suspected, immediate action is critical. The key steps are:
- Call emergency services (911 or local equivalent) and do not leave the person alone
- Administer adrenaline (epinephrine) intramuscularly into the outer thigh – this is the first-line treatment. Many affected individuals carry an adrenaline auto-injector (e.g., EpiPen).
- Lay the person flat with legs elevated (except in cases of breathing difficulty: semi-reclined position)
- If breathing or circulation stops: begin resuscitation immediately
Additional Medical Treatment
- Antihistamines: Relieve skin reactions and itching but do not replace adrenaline
- Corticosteroids (e.g., methylprednisolone): Suppress late-phase reactions
- Beta-2 agonists (e.g., salbutamol): Used for bronchospasm to open the airways
- Intravenous fluids: To stabilize circulation in cases of shock
Long-term Prevention
- Strict allergen avoidance
- Carrying an emergency kit containing an adrenaline auto-injector, antihistamine, and corticosteroid at all times
- Allergy counseling and education of family members and companions
- Allergen immunotherapy (desensitization): Possible for insect venom allergy to achieve long-term desensitization
- Carrying a medical alert card with information about the allergy and emergency medication
References
- Ring J. et al. - Guidelines on anaphylaxis: acute therapy and management. Allergo Journal International, 2014. AWMF registration number 061-025.
- Muraro A. et al. - The EAACI food allergy and anaphylaxis guidelines: diagnosis and management of food allergy. Allergy, 2014; 69(8): 1008-1025.
- World Allergy Organization (WAO) - Anaphylaxis Guidance 2020. Available at: www.worldallergy.org
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