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Anaphylaxis

Anaphylaxis

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Anaphylaxis

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  1. Anaphylaxis دکتر افشین شیرکانی فوق تخصص آسم و آلرژی و بیماری های نقص ایمنی عضو آکادمی آسم و آلرژی و ایمونولوژی آمریکا استادیار دانشگاه

  2. Anaphylaxis is an acute onset, potentially fatal, systemicallergic or non-allergic reaction • Lifetime prevalence=0.05%-2%. • Largest number of cases in children and/or adolescents • Anaphylaxis( IgE-Mediated) • Anaphylactoid reaction (Non-IgE-Mediated)

  3. Risk Factors • Intermittent admin • Age • Atopy • Time since reaction • Gender

  4. Clinical Features Signs and Symptoms : • Urticaria and/or angioedema • Shortness of breath • Syncope and/or dizziness • Diarrhea • Flushing • Laryngeal edema • Nausea and/or emesis • Hyportension • Rhinitis • Periorbital edema • Chest pain • Pruritus • Headache

  5. Target Organs Involve • Cutaneous (90%) • Respiratory (70%) • Gastrointestinal (30%-45%) • Cardiovascular (10%-45%) • Central nervous system (10%-15%) • Patients who do not experience skin manifestations may experience profound shock immediately

  6. Biphasic Reactions • Asthma • Ingested allergen • Prior personal history of biphasic reaction • Receiving less epinephrine • Receiving less corticosteroid

  7. Diagnosis • Clinical History : More than one target organ is involved (GI, RT,Skin, Cardiovascular);and, history often involves provocation by known food, drug, or insect allergen exposure

  8. Laboratory Findings • Check serum histamine 15-60 minutes: levels begin to rise by five minutes but remain elevated only 30-60 minutes • Check serumtryptase15-180 minutes: peaks 60-90 minutes after the onset of symptoms and can remain elevated as long as five hours • Check urinary histamine later: metabolites may remain elevated as long as 24 hours • trypteasemay not be elevated in food-induced anaphylaxis

  9. Evaluation Investigate suspected allergens or triggers for specific IgE by skin prick test (SPT) or in vitro methods. SPT is often performed at least four to six weeks after the episode due to refractory period of mast cells that can create false negatives. Selection of foods for testing should be guided by the history

  10. Management 1.Short term: • Epinephrine at dose of 0.01 mg/kg (often as 0.3-0.5 mL of 1:1000) IM • ABCs, supine positioning, and establishment of an airway. • Skin inspection • Supplemental oxygen, insertion of one or more large-bore IVs for fluids • Even if on β-blockers, administer epinephrine first but consider glucagon. (Also, recall IV fluids are particularly important for patients unresponsive to epinephrine.)

  11. 2.Long term: • Epinephrine auto-injector • Emergency action plan and medical alert bracelet • Relevant and specific preventive treatment