ANAPHYLAXISis

CASE SCENARIO

24 yr old female, H/O bee sting

 Feeling of impending death
 C/o swollen lips and periorbital area,
SOB, generalized itching & erythema,
vomiting, and abdominal pain
 Warm peripheries, BP 70/45, pulse 120
Definition

• Systemic allergic reaction

– Affects body as a whole

– Multiple organ systems may be involved

• Onset generally acute

• Manifestations vary from mild to fatal

Pathogenesis of Anaphylaxis

• IgE-mediated (Type I hypersensitivity)

• Sensitization stage

• Subsequent anaphylactic response

Pathopysiology

 Antigen (allergen)
exposure
Antigen

 Plasma cells
produce IgE antibodies Plasma cell
against the allergen

IgE

Mast cell with

 IgE antibodies fixed IgE antibodies
attach to mast cells
and basophils
Granules
containing
histamine
 Anaphylactic Reaction

 More of Antigen
same allergen
invades body

•
• •
• • • •• •
• • • •• • • •
• • • • • •

 Allergen combines • • • • •
• • • • •
• •
• • • • • •
• •• • • • • • •
• •
• • ••
• •
•
•
•
• • • • • •• • • •
•
Mast cell granules
with IgE attached to • • • • • • • • • • •
• • •
•

.
• • • •• • • • • ••
• • • • • • • •
•
•
• •
•
• •
• • • • • •
•
•
•
•
•• • •
• • • • •
• • •
•
• • • • release contents after
mast cells and basophils,
• • • • • • • • • • • • • • •
• • • •• • • •
antigen binds with IgE
• • • • • •
• • • • • ••
• • • • • • • • • • •• • • • •
• • • • • • • • ••
• • • • •• •

which triggers
• • • • • •
antibodies
• • • • •• •
• • • • • •
• • • •
• •
• • • •
• • •• • • •
•

degranulation and release •

•• •
•
• • • •

of histamine and other •

•
•

•
•
• • •
•

chemical mediators •
•

•
Histamine and other
mediators
 Common Causes of IgE-
mediated Anaphylaxis
I. Foods
II. Insect bite
III. Latex
IV. Antibiotics
V. Chemotherapeutic agents
VI. Aspirin, NSAIDs
VII. Biologicals (vaccines, monoclonal antibodies)

VIII.Insect venom
Other Causes of Anaphylactic

Radiocontrast media
Exercise
Idiopathic
Immunotherapy
Inhalant allergens
Clinical Manifestations of
Anaphylaxis

• Skin: Flushing, pruritus, urticaria,

angioedema
• Upper respiratory: Congestion, rhinorrhea
• Lower respiratory: Bronchospasm, throat or
chest tightness, hoarseness, wheezing,
shortness of breath, cough
Clinical Manifestations of Anaphylaxis

• Gastrointestinal tract:
– Oral pruritus
– Cramps, nausea, vomiting, diarrhea
• Cardiovascular system:
– Tachycardia, bradycardia,
hypotension/shock, arrhythmias,
ischemia, chest pain
ANGIO EDEMA
Clinical Course of Anaphylaxis

• Uniphasic
• Biphasic
– Recurrence up to 8 hours later
• Protracted
– Hours to days
Food-induced Anaphylaxis:

• Oropharynx: Oral pruritus, swelling

of lips and tongue, throat tightening
• GI: Crampy abdominal pain, nausea,
vomiting, diarrhea
• Cutaneous: Urticaria, angioedema
• Respiratory: Shortness of breath,
stridor, cough, wheezing
Diagnosing Anaphylaxis

 Based on clinical presentation, exposure

history hence careful history to identify
possible causes
 Cutaneous, respiratory sypmtoms most
common
 Some cases may be difficult to diagnose
Treatment of Anaphylaxis
 ABC
 Supplemental O2; airway maintenance
 Epinephrine ( is the corner stone in the management of anaphylaxis)
 Failure or delay associated with fatalities

 IM root must be used

 Adult dose O,5mg IM of Epinephrine 1:1000

 Pediatric: 0.01mg/kg IM of Epinephrine 1:1000

 IM autoinjector 0.3mg for patients>30kg and Junior autoinjector

0.15mg for those <30kg
 Glucagon inj. For those on betablockers
 Antihistamine :Diphenhydramine
Treatment of Anaphylaxis cont..
 Corticosteroids : oral is preferred if the patient is stable.
 If unstable Hydocortisone inj.200mg IV
 Nebulized beta agoinsts
 IV fluids, vasopressor therapy if required.
 Repeat epinephrine if symptoms persist or increase after 5-10-
minutes
 Repeat antihistamine ± H2 blocker if symptoms persist
 Observe for a minimum 4 hours
 Discharge with oral steroids +/- Epi-autoinjector prescription.
Questions