Anaphylaxis Shock

What is Anaphylaxis Shock?

Anaphylaxis shock or anaphylactic shock or anaphylactic reactions are serious allergic reactions that could be fatal if not contained immediately. Unlike an allergy, anaphylaxis causes multi-organ reaction.

Some people experience allergy reactions to an extend that it becomes a life-threatening case. This is what is known as anaphylaxis or anaphylaxis shock. The immune system of the person experiencing this disorder releases chemicals that overwhelm the body resulting in anaphylactic shock.

Anaphylaxis Shock Anaphylaxis reaction

When the body enters anaphylactic shock, usually there is sudden drop in blood pressure and the airways constrict. This could in turn result in blocking of normal breathing. The allergy reaction may be so rapid that when it sets off, it could lead to death.

The reaction causes more swelling of throat or tongue, shortness of breath, itchy rash, reduced or low blood pressure, feeling lightheaded, or vomiting. These symptoms manifest within minutes to hours of the episode or activity that results in the allergy.

How Does it Happen?

Such reactions take place due to chemicals being over released by the immune system and can lead to a person going into shock. For an anaphylactic reaction to happen, it all starts with becoming sensitive towards an allergen, which is then followed by a subsequent re-exposure, causing the life-threatening reaction. An allergen is a substance that you may become allergic to and can range from food to medication.

Common Triggers

There are common allergens which trigger anaphylaxis in people. Some include:

  • Medication – you may react because of some prescription drugs such as aspirin and penicillin. Non-steroidal anti-inflammatory drugs like ibuprofen can also trigger anaphylaxis.
  • Latex– disposable gloves, catheters and adhesive tapes can rouse serious allergic reactions
  • Insect stings– such as bee stings are usually common during flowering seasons
  • Food- peanuts, fish, tree nuts, milk and eggs

Length of Time

When you develop an anaphylaxis shock, it may take between 3 to 30 min for you to experience the highest severity of the reaction. A subsequent reaction known as biphasic may occur after about 8 to 12 hrs.

Symptoms

Before you experience the full blown reactions of anaphylaxis, you are likely to experience mild symptoms such as formation of few skin rashes or a runny nose. A number of symptoms could be fatal and severe, some include:

  • Difficulty in breathing
  • Development of hives or swellings on the skin
  • Chest congestion and discomfort
  • Periodic palpitations
  • Feeling dizzy
  • Swelling of the eyes, tongue, throat and the whole face
  • Cardiac arrest
  • Abdominal pains, bloating and cramping
  • Skin becomes moist
  • Wheezing
  • State of confusion and anxiety sets in
  • Slurred speech
  • Increased rate of heart beat
  • Unconsciousness or fainting
  • Tightening of the throat
  • Nausea and vomiting

swollen face due to allergy

Fig.2 A patient with swollen face due to allergy

Diagnosis

People with asthma, other previous allergies or a family background of anaphylaxis have higher chances of developing this reaction. Once you discover any symptom, visit an allergist who is a specialist in diagnosing and identifying the specific allergen that you are reacting to. Examinations are done through enquiries, tests include:

  • Blood tests
  • Skin prick tests
  • Oral food challenges

Treatment & Prevention

In anaphylaxis management the main prevention measure is to avoid the triggers. Each trigger can be avoided uniquely in the following ways:

Medication

  • Inform your doctors that you are allergic and they will be careful when prescribing drugs for you. Your triggers will be omitted in your doses.
  • In the event that the only drug that you need has ingredients that you are allergic to, the doctor will have to conduct desensitization. This involves prescribing small doses of your trigger medicine increasing it over time so that you do not react.

Insect stings

To be safe from insect stings avoid:

  • Walking bare foot in the grass
  • Applying sweet smelling lotion and spraying hair sprays and perfume that can attract insects
  • Dressing in brightly or flowered clothing as you can attract bees

Food

  • If you are sensitive to any food, you have to be careful when you purchase food stuffs. Be on the lookout for the trigger ingredients from the labels and avoid them.
  • When you have a child who is anaphylactic, make sure all the concerned parties at school are aware and have knowledge in administering epinephrine.
  • You can eat out, but always enquire about what was used to prepare the food and avoid getting reactions.

First Aid

Even with prevention measures in place accidents do happen. What should you do when someone near gets anaphylaxis shock?

Step 1 – ABC: For first aid, the action you always have to perform first is to A- check the airways, B- confirm if the casualty is breathing and C- check out for circulation through the pulse. In case breathing is not normal, conduct CPR.

Step 2- Reassurance: The casualty should be kept calm through constant reassurance that everything will turn out just fine.

Step 3 – Trigger removal: If possible aim to get rid of the trigger. For casualties who have reacted to bee stings, aim to remove the stinger from the skin. Use a firm object such as a plastic card to conduct this, no tweezers or squeezing as they can enhance the release of venom.

Step 4- Administer allergy medicine for emergencies: Inject using an adrenaline auto injector or help them take medication. These medications will enable the casualty to come out of the emergency phase. If you have injected the casualty, and the symptoms persist, give another injection after a period of 5-15 minutes.

Step 5 – Prevent shock: Casualties who have suffered an aphylactic shock are likely to go into shock therefore making it important to prevent it. Lie the person down, raise his or her legs and cover the casualty with a blanket or any warm clothing.

Don’ts of Anaphylaxis First Aid

  • If the casualty has difficulty in breathing, do not give medication through the mouth.
  • For casualties who are unconscious, have injury, have breathing problems or are pregnant, do not make them lie down.
  • When you discover that a casualty has difficulty in breathing avoid placing a pillow under his or her head
  • Finally, do not stop at administering an adrenaline auto injector, follow up with a visit to the emergency room.

Complications

When early treatment is not provided, casualties may develop:

  • Blocked air passages
  • Heart attack
  • Respiratory attack
  • As well as shock

When to see An Allergist

You should probably visit an allergist when:

  • You are not sure that what you experienced was an allergic reaction
  • Symptoms are recurring and are out of control
  • If you face difficulty in managing breathing
  • The allergen causing anaphylaxis is unknown
  • You need to know more about preventive measures
  • After taking the prescribed medication, it doesn’t contain the anaphylactic reactions.

Be S.A.F.E

An action guide for anaphylaxis patients can be summarised as:

  • S- Seek medical care immediately
  • A- know your Allergen
  • F- Follow up with an allergist
  • E– have your Epinephrine in case of emergencies. You can do this by always having a kit of self-administering epinephrine and wearing bracelets/necklace to identify yourself as an aphylactic patient.

Reference Links

  1. Anaphylaxis. Available at http://acaai.org/allergies/anaphylaxis
  2. Anaphylaxis. Available at http://www.aaaai.org/conditions-and-treatments/allergies/anaphylaxis
  3. Anaphylaxis- NHS choices http://www.nhs.uk/conditions/Anaphylaxis/Pages/Introduction.aspx
  4. What is Anaphylactic Shock. Available at http://www.healthline.com/health/anaphylactic-shock
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