Anaphylactic shock is an acute clinical manifestation of an allergy. A person who encounters him needs urgent medical attention, otherwise there is a high risk of death.
Death results in approximately 10% of all observed cases.
An acute allergic reaction is rare enough - about 50 cases for every 100 thousand people every year. What kind of disease, where does it come from and what are the health consequences?
Causes of shock
In the vast majority of cases, protein compounds become such substances.
This can sometimes manifest as coughing, sneezing, or slight reddening of the skin.
But in this situation, everything is much more serious.
When the pathogen of an allergy penetrates into the body, histamine (basophils, eosinophils) is released from the blood cells. This leads to a sharp, rapid drop in pressure, problems with the respiratory system and other adverse effects.
The main allergens are foods and medications. Especially at risk are people who first consume exotic foods, sweets, and some nuts, such as peanuts.
Such a phenomenon as anaphylactic shock in children can pose a threat to the life of the child, so parents should be aware of the child's predisposition to allergies.
You can familiarize yourself with the signs of anaphylactic shock in this article.
Everyone should be familiar with the methods of first aid for anaphylactic shock. Read the memo in this publication.
Symptoms of Anaphylactic Shock
Signs of anaphylactic shock develop at different rates.
Sometimes the first symptoms occur several hours after taking the allergen, but most often the manifestations become noticeable almost immediately - after a few minutes.
The symptoms of the disease are divided into two main types:
- local manifestations
- common manifestations.
In the first case, the lesion affects only areas directly in contact with the allergen, for example, during injection. The general signs relate to the functionality of the whole organism as a whole, including those organs and systems that did not come into contact with the stimulus.
The main local symptoms of anaphylactic shock:
- Redness of the skin, accompanied by swelling. Most often occurs after taking allergen medications, as well as as a result of eating an irritant. Edema sometimes takes such proportions that it is impossible to recognize a person.
- Rash and itching. They develop only after eating an allergen in food and entering it in the digestive tract. Most often appears in the area of the ears, although there are other localizations, for example, in the chest area.
- Pain. It is localized at the site of exposure to the allergen. Usually occurs after subcutaneous administration of medications. It is the first sign of impending anaphylactic shock, so it is worth paying special attention to increased pain that does not go away after the injection.
General symptoms of anaphylactic shock are more dangerous, they can lead to death. These include:
- Pain behind the chest. It occurs about 30 minutes after ingestion of an allergen. It develops due to the introduction of a medicinal product, but in rare cases manifests itself after eating certain products.
- A sharp decrease in blood pressure. It drops to 90 mm Hg. Art. and below.
- Nausea and vomiting. It is a natural attempt by the body to get rid of the allergen.
- Respiratory failure. It occurs due to laryngeal edema. Exhalation is particularly difficult, which characterizes the phenomenon as "asthmatic edema."
- Loss of consciousness. Directly associated with suffocation and a fall in blood pressure.
One of the earliest common symptoms of an acute allergic reaction is hoarse breathing, accompanied by pale skin and bluish lips.
First Aid for Anaphylactic Shock
Given that the clinical manifestations of anaphylactic shock develop very quickly, there is no time for preliminary diagnosis. Therefore, first aid should be provided immediately, after calling the medical team.
First aid is divided into two types:
- If the allergen is a medication that is injected under the skin, then a tourniquet must be applied above the injection site. This avoids the further spread of the stimulus.
- If the reaction arose due to the food product, you need to do an emergency gastric lavage. This is done with a large amount of water, and helps to prevent further absorption of the allergen into the blood.
Medical assistance provided by doctors includes:
- the introduction of 0.5 mg of a 1% solution of adrenaline (to increase pressure),
- injection of 1-2 mg of a 1 percent solution of an antihistamine (diphenhydramine, suprastin).
A 5% glucose solution is also administered.
The consequences of anaphylactic shock
ASH does not leave without a trace - the blow to the body is too strong. After stopping the attack and restoring pressure, the following often remains:
- weakness, lethargy and slight lethargy,
- pain in the joints and muscles,
- fever accompanied by fever
- vomiting and nausea
- heart pain (relieved with nitroglycerin and riboxin),
- prolonged decrease in blood pressure (eliminated with the help of adrenaline and dopamine),
- headaches and a temporary decrease in intelligence are the consequences of hypoxia due to decreased blood pressure.
These symptoms pass over time without a trace. But some consequences persist for a long time:
- Quincke's edema,
- bronchial asthma,
- diffuse damage to the nervous system (often ends in death).
Prevention of an acute allergic reaction
The main way to avoid AS is to eliminate contact with allergens. In addition, it is recommended:
- limit bad habits (tobacco and alcohol use),
- buy medicines only at licensed pharmacies,
- try not to eat glutamate-added foods.
One of the controversial methods of prevention is to ask the doctor not to prescribe a large number of drugs at the same time when treating any disease.
- regularly ventilating the room to remove particles from the home or office that could cause a negative reaction,
- wearing safety glasses and masks during flowering plants,
- refusal to use upholstered furniture and toys (it is recommended only in those cases when the source of allergy is precisely installed, otherwise it is pointless to refuse comfort),
- constant wet cleaning of the premises (as well as airing, this measure removes small particles that can provoke AS).
When introducing new drugs, the doctor should check the body for sensitivity to allergens. Feel free to remind him of this.
Anaphylactic shock sometimes occurs unexpectedly. Why anaphylactic shock occurs and how it manifests is discussed in the next article.
The mechanism of development of cardiogenic shock is described in this topic.
Anaphylactic shock is a dangerous phenomenon that can lead to serious health problems, and sometimes death.
First aid is to limit the spread of the allergen: tourniquet above the injection site, gastric lavage. Arriving doctors will try to increase the pressure by injecting adrenaline. The main principle of prevention of ASH is to limit contact with allergens. Regular wet cleaning, quality control of the food consumed, and compliance with personal hygiene can help with this.
Causes and Risk Factors
Various substances can become the cause of anaphylaxis, more often of a protein or polysaccharide nature. Low-molecular compounds (haptens or incomplete antigens), which acquire allergenic properties when bound to the host protein, can also provoke the development of a pathological condition.
The main provocateurs of anaphylaxis are as follows.
Medicines (up to 50% of all cases):
- antibacterial drugs (most often - natural and semi-synthetic penicillins, sulfonamides, Streptomycin, Levomycetin, tetracyclines),
- protein and polypeptide preparations (vaccines and toxoids, enzyme and hormonal agents, plasma preparations and plasma-substituting solutions),
- some aromatic amines (hypothiazide, paraaminosalicylic acid, paraaminobenzoic acid, a number of dyes),
- non-steroidal anti-inflammatory drugs (NSAIDs),
- anesthetics (Novocain, Lidocaine, Trimecaine, etc.),
- radiopaque substances
- iodine preparations
- vitamins (to a greater extent group B).
Second place in the ability to cause anaphylaxis is occupied by bites of hymenopteran insects (about 40%).
The third group is food products (approximately 10% of cases):
- fish, canned fish, caviar,
- cow's milk,
- egg white,
- food additives (sulfites, antioxidants, preservatives, etc.).
The frequency of anaphylactic shock in the Russian Federation is 1 in 70,000 people per year.
The main provocateurs also include therapeutic allergens, physical factors and latex products.
Factors that increase the severity of anaphylaxis:
- bronchial asthma,
- diseases of the cardiovascular system,
- therapy with beta-blockers, MAO inhibitors, ACE inhibitors,
- allergy vaccination (specific immunotherapy).
Anaphylactic shock is classified depending on the clinical manifestations and the nature of the pathological process.
In accordance with clinical symptoms, the following options are distinguished:
- typical (mild, moderate and severe)
- hemodynamic (manifestations of circulatory disorders prevail),
- asphyxial (symptoms of acute respiratory failure come to the fore),
- cerebral (leading are neurological manifestations),
- abdominal (symptoms of damage to the abdominal organs prevail),
By the nature of the course of anaphylactic shock is:
- acute malignant
- acute benign
The international classification of diseases of the 10th revision (ICD-10) offers a separate gradation:
- anaphylactic shock, unspecified,
- anaphylactic shock caused by a pathological reaction to food products,
- anaphylactic shock associated with the introduction of serum,
- anaphylactic shock caused by a pathological reaction to an adequately prescribed and correctly applied drug.
In the formation and course of anaphylaxis, 3 stages are distinguished:
- Immunological - changes in the immune system that occur when an allergen first enters the body, the formation of antibodies, and sensitization itself.
- Pathochemical - release into the systemic circulation of mediators of an allergic reaction.
- Pathophysiological - detailed clinical manifestations.
The time for the appearance of clinical signs of shock depends on the method of introducing the allergen into the body: with intravenous administration, the reaction can develop after 10-15 seconds, intramuscularly after 1-2 minutes, and oral after 20-30 minutes.
Symptoms of anaphylaxis are very diverse, however, a number of leading symptoms are determined:
- hypotension, up to vascular collapse,
- spasm of the smooth muscles of the gastrointestinal tract,
- blood stasis in both arterial and venous parts of the circulatory system,
- increased permeability of the vascular wall.
Mild anaphylactic shock
The mild degree of typical anaphylactic shock is characterized by:
- itchy skin
- headache, dizziness,
- feeling of heat, hot flashes, chills,
- sneezing and outflow of mucus from the nose,
- sore throat,
- difficulty breathing out with bronchospasm,
- vomiting, cramping pain in the umbilical region,
- progressive weakness.
Anaphylactic shock is an immediate type of hypersensitivity reaction and refers to life-threatening conditions. A full-fledged clinical picture of shock unfolds in the period from a few seconds to 30 minutes.
Hyperemia (less often cyanosis) of the skin, rash of varying severity, hoarseness of the voice, wheezing, audible at a distance, a decrease in blood pressure (to 60 / 30-50 / 0 mm Hg), filamentous pulse and tachycardia to 120– are objectively determined. 150 bpm
Anaphylactic shock of moderate degree
Symptoms of anaphylactic shock of moderate severity:
- anxiety, fear of death,
- spilled pain in the abdominal cavity,
- indomitable vomiting
- feeling of lack of air, choking.
Objectively: consciousness is depressed, cold, sticky sweat, skin is pale, nasolabial triangle is cyanotic, pupils are dilated. Heart sounds are deaf, the pulse is filiform, arrhythmic, rapid, blood pressure is not determined. Spontaneous urination and defecation, tonic and clonic convulsions, rarely bleeding of various localization are possible.
Severe anaphylactic shock
The severe course of anaphylactic shock is characterized by:
- lightning-fast deployment of the clinic (from several seconds to several minutes),
- lack of consciousness.
Marked cyanosis of the skin and visible mucous membranes, profuse sweat, persistent dilated pupils, tonic-clonic convulsions, wheezing, labored breathing with elongated exhalation, foamy sputum are noted. Heart sounds are not heard, blood pressure and pulsation of peripheral arteries are not determined. The injured person, as a rule, does not have time to file complaints due to a sudden loss of consciousness, if medical assistance is not provided immediately, a high probability of death.
Severity of anaphylactic shock:
Decreases to 90/60 mm Hg. Art.
Decreases to 60/40 mm Hg. Art.
Effect of treatment
The effect is slow, long-term observation is required
When exiting anaphylactic shock, the victims have weakness, lethargy, lethargy, severe chills, sometimes fever, muscle and joint pain, headache, stitching pains and discomfort in the heart.
Diagnosis of anaphylactic shock is not difficult, since the relationship of characteristic clinical manifestations with a previous insect bite, eating an allergenic product, or using a drug is usually obvious.
Treatment of shock begins directly at the place of its occurrence, without waiting for the transportation of the victim to the specialized department. The outcome of the shock is decided by the timeliness and adequacy of first aid measures. The patient needs to be laid, raising his legs, turn his head to the side.
Careful monitoring of vital signs is necessary throughout the entire period of treatment and several hours after the relief of shock, since clinical symptoms can recur within a day.
In 50% of cases, anaphylactic shock is caused by taking medications.
Principles of Anaphylactic Shock Therapy:
- immediate cessation of allergen intake (for example, removing an insect sting or stopping the administration of the drug),
- relief of acute respiratory and hemodynamic disorders,
- compensation for advanced adrenocortical insufficiency,
- neutralization of allergic mediators of anaphylaxis in the systemic circulation and antigen-antibody bonds,
- maintenance of vital functions or resuscitation if necessary,
- normalization of acid-base balance,
- increased total peripheral vascular resistance,
- replenishment of the volume of circulating blood.
Hospitalization in the intensive care unit and round-the-clock monitoring are indicated for patients with moderate or severe anaphylaxis, as well as those living away from medical facilities (since complex treatment lasts for 72 hours).
Specific immunotherapy is prescribed for patients with anaphylaxis from insect bites after discharge - a set of measures that reduce the body's sensitivity to the allergen by preventing the development or inhibition of sensitization (developing tolerance to the allergen by sequentially introducing its microdoses in increasing concentrations).
Consequences and Complications
Possible complications (may develop delayed, up to several weeks):
- allergic myocarditis,
- Quincke's edema,
- recurrent urticaria
- pulmonary edema,
- myocardial infarction
- heart failure,
- the development of chronic allergic reactions,
- bronchial asthma,
- “Shock kidney”, “shock lung”, “shock liver”,
- bleeding of various localization,
- neuritis, diffuse damage to the nervous system, vestibulopathy,
- autoimmune diseases.
Up to 40% of patients suffer a relapse of anaphylaxis over the next 2-3 years.
With timely emergency care and adequate complex therapy, the prognosis is favorable. It worsens significantly when antishock events begin 30 minutes or more after the development of anaphylactic shock.
For the first time anaphylactic shock is mentioned in documents dated 2641 BC. e. According to the records, the Egyptian pharaoh Menes died from an insect bite.