Post on 15-Jan-2015
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- 1. Written by student dentist Tal Kaplan
- 2. Notion Anaphylaxis shock Classification's Types of hypersensitivity reaction's Etiology Pathophysiology Singes & Symptoms Diagnosis First aid Treatment Prevention
- 3. The term derived from greek language ana (without) , phylaxis (protection). A sudden, severe allergic reaction characterized by a sharp drop in blood pressure, urticaria (skin rash), and breathing difficulties that is caused by exposure to a foreign substance, such as a drug or bee venom, after a preliminary or sensitizing exposure. The reaction may be fatal if emergency treatment is not achieved immediately, treatment including epinephrine injections. Also called anaphylactic shock.
- 4. By the Type of shock: Typical Cardiac Asthmatic Cerebral Abdominal By type of development: Momentry Easy Medium Grave
- 5. Mast cell release histamine and other mediators Immediate hypersensitivity Antibodies directed against cell or tissue antigens Antibody- mediated Antibody- antigen complex deposit in blood vessels immune complex diseases Reactions of T lymphocytes T cell-mediated diseases
- 6. Idiopathic 37% Food 34% Drugs 20% Exercise 7% Latex, hormons, insect bites 2%
- 7. Pharmlogic agents Antibiotics (penicillin) Nonsteroidal anti- inflammatory drugs (Asprin) intravenous (IV) contrast agents Stinging insects Ants, bees, hornets, wasps, and yellow jackets. Food Peanuts, seafood, and wheat Latex Rare No latex- associated deaths
- 8. First exposure Activation of TH2 cell Stimulate IgE switiching Allergen TH2 Cell B Cell
- 9. First exposure IgE production IgE secreting B cell IgE
- 10. First exposure IgE bind to mast cell
- 11. Second exposure Recognition Allergen
- 12. Second exposure Activation of mast cell to release histamine and other mediators Mediators Allergen
- 13. Typical type: Dizziness weakness fainting rapid, slow, or irregular heart rate low blood pressure Nausea vomitingcramps Itcing swlling around the eyesItching flushinghives swelling
- 14. Respiratory type: Difficulty breathing coughing chest tightness wheezing or other sounds increased mucus production throat swelling or itching change in voice or a sensation of choking
- 15. Cardiac type: Dizziness weakness fainting rapid, slow, or irregular heart rate low blood pressure
- 16. Abdominal type: Nausea vomiting cramps diarrhea
- 17. The diagnosis of anaphylaxis is based upon symptoms that occur suddenly after being exposed to a potential trigger. Usually in dental clinic it will be more hard to get conclusive diagnosis. Differential diagnosis: severe asthma attack heart attack panic attack food poisoning - Those differential diagnosis are very similar to anaphylaxis shock and a doctor could get a wrong diagnosis due to lack of tools in reach to doctor hand. - An increased amount of tryptase protein can be measured in a blood sample collected during the first three hours after anaphylaxis symptoms have begun. - Tryptase levels are seldom elevated in food-induced anaphylaxis
- 18. Place patient in horizontal with legs up position. Establish and maintain airway. Give oxygen via nasal airway as needed. Place a tourniquet above the reaction site. Epinephrine at the site of antigen injection. Start IV to rise BP.
- 19. Adrenalina sol. 0.1% 0.5 ml, if patient state doesn't improve in 10-15 min, we Introduce 1.0 ml more of sol. Suprastine sol. 2% 1ml. Prednisolone sol. 30-60 mg (unique dose) or hydrocortisone 75-125 mg. Caffeine sol. Or cordiamine, or corazoli 20% 1-2 ml. In case of bronchospasm: eupheline sol. 2.4% 5-10 ml or galidore sol. 2ml (i/m). To maintain cardiac activity are given cardiac glycosides & diuretics: lazex sol. 2-4 ml (i/v), Corglicon sol. 0.06% 0.5-1 ml (i/v). In case of cardiovascular insufficiency: strophantini sol. 0.05% 0.5-1 ml, mazatoni sol. 0.1% 1m Ionic sol. of NaCl 0.9% 400 ml or glucose sol. 5-10% 400 ml, in perfusion introduced dopamin sol. 200 gr or noradrenaline 0.1% 1ml. Injection place should be infiltrated with adrenalin sol. Artificial respiration with extern massage of the heart.
- 20. Avoid the responsible allergen (e.g. food, drug, latex, etc.). Keep an adrenaline kit (e.g. Epipen) and Benadryl on hand at all times. Wear medic Alert bracelets . Venom immunotherapy is highly effective in protecting insect-allergic individuals.
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