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Anaphylaxis

Anaphylaxis. Pavel Suk. Definition. serio u s allergic reaction with rapid onset (minutes to hours) diagnos is is mainly clinical trigger - local anestetics esters ( high allergenic potential ) amids ( safer ). Pathophysiology.

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Anaphylaxis

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  1. Anaphylaxis Pavel Suk

  2. Definition • serious allergic reaction with rapid onset (minutes to hours) • diagnosis is mainlyclinical • trigger - localanestetics • esters (highallergenicpotential) • amids (safer)

  3. Pathophysiology • massive release of histamine (+othermediators) from mast cells and basophils • activation: • specificIgEdepenent = trueanaphylacticreaction • otherimmunologicpathways • non-immunologic (opiods, exercise, …) • idiopathic • histamin effects • contraction of smooth muscles • vasodilation, capillaryleakage (oedema) • myocardialdepression

  4. Skin Hives (utricaria) Flushing Itching absent in 20 % cases

  5. Facialswelling eyelids / lips / tongue / uvula

  6. Systemic symptoms • respiratory (up to 70 %) • tachypnoea • wheezes • stridor • hypoxia • nasaldischarge • voicechange • throatclosure

  7. Systemic symptoms • cardiovascular (up to 50% cases) • tachycardia • hypotension • dizziness • syncope (hypotonia) • incontinence • gastrointestinal (up to 50% cases) • crampy abdominal pain • nausea/vomiting • diarhoea

  8. Biphasiscourse • reccurenceofsymptomswithin 10 (up to 72) hours

  9. Risk factors • concomitantmedication • alpha and beta-blocker – resistence to treatment • ACE-I – more severe hypotension • antihistamines – mimickedsymptoms • comorbidities • astma – increased incidence • COPD, severe pulmonarydesease • cardiovasculardisease - severe course • acuteinfection (respiratory)

  10. Treatment • remove antigen • call forhelp • oxygen • supine/semi-recumbentpostionwithelevetedlowerlimbs

  11. Epinephrine • decreases histaminerelease from mast cells • intramuscular (thigh) • dose 0.3 to 0.5 mg • 0.01 mg/kg forchildren • mayberepeated in 10-15 min intervals

  12. Otherdrugs • H1/H2antihistamines • relieve itchingand hives • do not improveothersymptoms • glucocorticoids • effectsonset in hours • methylprednisone 1-2 mg/kg IV • bronchodilators (salbutamol, …) • adrenaline has strong BDL effect • IV fluids

  13. Follow-up • observation 4-8 hours • with risk factorslonger (> 12 hours) • labdiagnostics - serum tryptase • ideally within 3 hours from symptoms onset • pathogenidentification • specificIgE • skin testing • Epipenforhigh-risk patients

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