What are the symptoms of anaphylactic shock. How is anaphylactic shock treated. What are common triggers for anaphylaxis. How can anaphylactic shock be prevented. Why is epinephrine crucial in treating anaphylaxis. What should you do if someone experiences anaphylactic shock. How can you prepare for potential anaphylactic reactions.

Understanding Anaphylactic Shock: A Severe Allergic Reaction

Anaphylactic shock, often referred to as anaphylaxis, is a severe and potentially life-threatening allergic reaction that can occur rapidly after exposure to an allergen. This condition requires immediate medical attention due to its ability to cause a dramatic drop in blood pressure and compromise breathing.

Is anaphylaxis the same as anaphylactic shock? While these terms are often used interchangeably, there is a subtle difference. Anaphylaxis refers to the severe allergic reaction itself, while anaphylactic shock specifically describes the state when blood pressure drops dangerously low as a result of anaphylaxis, leading to inadequate oxygen supply to cells and organs.

Recognizing the Symptoms of Anaphylactic Shock

Identifying the symptoms of anaphylactic shock quickly is crucial for prompt treatment. Symptoms typically appear within 15 minutes of exposure to the allergen, though they can sometimes take up to several hours to develop.

• Swelling of the mouth and throat
• Difficulty breathing or wheezing
• Hives or itchy skin
• Nausea and vomiting
• Dizziness or fainting
• Rapid heartbeat
• Low blood pressure

Can anaphylactic shock symptoms vary in severity? Yes, symptoms can range from mild to severe and can progress rapidly. In extreme cases, a person may collapse, stop breathing, and lose consciousness within minutes of exposure to the allergen.

Life-Saving Treatment: The Importance of Epinephrine

When it comes to treating anaphylactic shock, time is of the essence. The primary and most critical treatment is an immediate injection of epinephrine.

Why is epinephrine so effective in treating anaphylaxis? Epinephrine works quickly to reverse the symptoms of anaphylaxis by:

1. Constricting blood vessels to increase blood pressure
2. Relaxing airways to improve breathing
3. Reducing swelling and hives
4. Increasing heart rate to improve circulation

Epinephrine should be administered as soon as anaphylaxis is suspected, typically via an auto-injector into the thigh muscle. After administering epinephrine, it’s crucial to call emergency services immediately, as there’s a risk of a second reaction (biphasic reaction) within 12 hours.

Additional Emergency Treatments

In the emergency room, doctors may provide additional treatments to manage anaphylactic shock:

• Intravenous fluids to maintain blood pressure
• Antihistamines to further counteract the allergic response
• Corticosteroids to prevent symptom recurrence
• Oxygen therapy or intubation if breathing is severely compromised

Common Triggers of Anaphylactic Shock

Understanding the common triggers of anaphylaxis is essential for prevention and management. While almost any substance can potentially cause an allergic reaction, certain triggers are more frequently associated with anaphylactic shock.

What are the most common causes of anaphylactic reactions? The primary triggers include:

• Foods: Particularly nuts, shellfish, eggs, and milk
• Insect stings: From bees, wasps, hornets, and fire ants
• Medications: Including antibiotics like penicillin and pain relievers such as aspirin
• Latex: Found in many medical supplies and everyday items

It’s important to note that sensitivity to these triggers can develop over time. A person may have a mild reaction to a substance initially, but subsequent exposures can lead to more severe reactions, including anaphylaxis.

Preventing Anaphylactic Shock: Strategies for At-Risk Individuals

While completely avoiding all potential triggers may not always be possible, there are several strategies that individuals at risk of anaphylaxis can employ to minimize their chances of experiencing a severe allergic reaction.

Allergen Avoidance

The most effective way to prevent anaphylactic shock is to avoid known allergens. This may involve:

• Carefully reading food labels
• Informing restaurant staff about allergies when dining out
• Taking precautions in environments where allergens may be present
• Being cautious with new medications and informing healthcare providers about known allergies

Preparation and Planning

For individuals with known severe allergies, being prepared is crucial. This includes:

• Always carrying an epinephrine auto-injector
• Wearing a medical alert bracelet or necklace
• Creating an emergency action plan
• Educating family, friends, and colleagues about the allergy and how to respond in an emergency

How can you create an effective emergency action plan? Work with your allergist or primary care physician to develop a written plan that includes:

1. Your known allergens
2. Symptoms to watch for
3. Step-by-step instructions for using your epinephrine auto-injector
4. Emergency contact information
5. When to call for emergency medical help

The Role of Allergy Testing and Immunotherapy

For individuals who have experienced allergic reactions or are at risk of anaphylaxis, allergy testing can be a valuable tool in identifying specific triggers and developing a management plan.

Types of Allergy Tests

There are several types of allergy tests that can help diagnose allergies:

• Skin prick tests: A small amount of the suspected allergen is placed on the skin, which is then pricked. A raised bump indicates an allergy.
• Blood tests: These measure the levels of specific antibodies in the blood in response to certain allergens.
• Oral food challenges: Conducted under medical supervision, these involve consuming small amounts of a suspected food allergen to observe for reactions.

Immunotherapy as a Preventive Measure

For some allergies, particularly insect venom allergies, immunotherapy may be recommended as a long-term treatment strategy. This involves gradually exposing the body to increasing amounts of the allergen to build tolerance over time.

Can immunotherapy prevent anaphylaxis? While not guaranteed to prevent all future reactions, immunotherapy can significantly reduce the risk and severity of anaphylactic reactions for many individuals, especially those with insect sting allergies.

Living with the Risk of Anaphylaxis: Practical Tips and Considerations

Managing the risk of anaphylaxis requires ongoing vigilance and preparation. Here are some practical tips for individuals living with severe allergies:

In Daily Life

• Always carry two epinephrine auto-injectors
• Check expiration dates on auto-injectors regularly
• Inform friends, family, and coworkers about your allergy and how to use the auto-injector
• Be cautious when trying new foods or products
• Consider using allergy apps to help identify safe foods and ingredients

When Traveling

Traveling with severe allergies requires additional planning:

• Research medical facilities at your destination
• Carry a letter from your doctor explaining your condition and need for epinephrine
• Learn how to explain your allergy in the local language when traveling abroad
• Pack safe snacks and consider bringing translation cards for restaurants

How can you ensure safe air travel with severe allergies? Notify the airline in advance of your allergy, carry your epinephrine in your carry-on luggage, and consider booking an early morning flight when the plane is at its cleanest.

Advancing Research and Treatment Options for Anaphylaxis

The field of allergy and immunology is continuously evolving, with ongoing research aimed at improving our understanding and treatment of anaphylaxis.

Current Areas of Research

Some promising areas of research in anaphylaxis include:

• Development of longer-lasting epinephrine formulations
• Exploration of biologics and immunomodulators to prevent severe allergic reactions
• Improvements in allergy diagnostics for more accurate identification of triggers
• Investigation of genetic factors that may predispose individuals to anaphylaxis

Emerging Treatments

While epinephrine remains the gold standard for treating anaphylaxis, researchers are exploring additional treatment options:

• Sublingual epinephrine: A potential alternative to auto-injectors
• Anti-IgE therapies: Medications that target the antibodies responsible for allergic reactions
• Oral immunotherapy: Gradually increasing exposure to food allergens to build tolerance

What potential benefits could these emerging treatments offer? These new approaches aim to provide more convenient administration methods, reduce the frequency and severity of reactions, and potentially offer long-term solutions for managing severe allergies.

As research continues to advance, individuals with severe allergies and their healthcare providers should stay informed about new developments that may improve management and quality of life.

Anaphylactic Shock: What You Should Know

Written by Hope Cristol

• Symptoms
• Life-Saving Treatment
• Typical Triggers
• Ways to Prevent Anaphylactic Shock

Anaphylactic shock is a rare but severe allergic reaction that can be deadly if you don’t treat it right away. It’s most often caused by an allergy to food, insect bites, or certain medications.

A shot of a drug called epinephrine is needed immediately, and you should call 911 for emergency medical help.

The terms “anaphylaxis” and “anaphylactic shock” are often used to mean the same thing. They both refer to a severe allergic reaction. Shock is when your blood pressure drops so low that your cells (and organs) don’t get enough oxygen. Anaphylactic shock is shock that’s caused by anaphylaxis.

You typically notice the first symptoms within 15 minutes of coming into contact with the thing you’re allergic to. They may start out mild, like a runny nose or an uneasy feeling. But they can get much worse very fast. Some typical symptoms include:

• Swelling of your mouth
• Tight feeling in your throat and difficulty breathing
• Hives
• Vomiting
• Dizziness
• Fainting
• Rapid heartbeat

In severe cases, people collapse, stop breathing, and lose consciousness in just a couple of minutes.

A shot of epinephrine in your thigh is needed right away, and you should call 911 because you’re at risk for a second reaction (called a biphasic reaction) within 12 hours. At the emergency room, doctors can keep an eye on your symptoms and treat you in case of a second reaction.

If you don’t have epinephrine, emergency room doctors can save your life. They’ll put a shot of epinephrine under your skin or in a muscle or vein. Usually this gets your blood pressure, which drops during anaphylactic shock, back to normal. You’ll also get fluids, steroids, and antihistamines (drugs used to treat allergic reactions) through a tube connected to one of your veins until your symptoms are gone.

Other possible treatments include a breathing tube and medications to help you breathe better, and a corticosteroid (a powerful anti-inflammatory drug) to keep symptoms from coming back hours later.

The most common causes of an anaphylactic reaction include:

• Foods, especially nuts and shellfish
• Latex, found in many disposable gloves, syringes, and adhesive tapes
• Medications, including penicillin and aspirin
• Insect stings

Usually, you have to come into contact with a trigger more than once before you have a severe allergy to it. So tell your doctor if you were stung by a bee and that spot swelled up or if your throat felt scratchy the one time you ate shrimp. They may want you to keep medicine on hand in case a severe reaction happens next time.

Even a mild allergic reaction can lead to more serious ones in the future. Talk to your allergist or primary care doctor about whether you should keep a shot of epinephrine handy at all times.

The best prevention is to avoid your triggers. Since you may not be able to do that all the time, make sure you have a plan to spot and treat symptoms of anaphylaxis right away. Your primary care doctor or allergist can help you with this.

It’s a good idea to wear a medical alert bracelet to let people know about your allergy in case you’re not able to talk. You also should tell your friends and family so they can help you in an emergency. Be sure they know:

• Your allergy trigger(s)
• Signs of an anaphylactic reaction
• Where you keep epinephrine and how to give you a shot
• When to call 911

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About anaphylaxis

Anaphylaxis is a severe, potentially life-threatening allergic reaction that can develop rapidly.

It is also known as anaphylactic shock.

Signs of anaphylaxis include:

• itchy skin or a raised, red skin rash
• swollen eyes, lips, hands and feet
• feeling lightheaded or faint
• swelling of the mouth, throat or tongue, which can cause breathing and swallowing difficulties
• wheezing
• abdominal pain, nausea and vomiting
• collapse and unconsciousness

What to do

Anaphylaxis should always be treated as a medical emergency. If available, an injection of a medicine called adrenaline should be given as soon as possible.

Some people with a previous history of anaphylaxis will have an auto-injector of adrenaline.

This should be injected into their outer thigh muscle and held in place for 5 to 10 seconds. Instructions for how to use these auto-injectors can be found on the side of each device.

You should call 999 for an ambulance whether adrenaline has been given or not.

If after 5 to 10 minutes the person still feels unwell, a second injection should be given. This should be given in the opposite thigh.

A second dose may also be needed if the person improves and then becomes unwell again.

The person should lie flat, with their legs raised on a chair or a low table. If they are having difficulty breathing, they should sit up to make breathing easier.

If the person is unconscious, you should move them to the recovery position – on their side, supported by one leg and one arm, with the head tilted back and the chin lifted. If the person’s breathing or heart stops, cardiopulmonary resuscitation (CPR) should be performed.

Further treatment will be carried out in hospital.

Read more about treating anaphylaxis.

Causes and triggers

Anaphylaxis is the result of your body’s immune system overreacting to a harmless substance, such as food. Substances that trigger allergic reactions are known as allergens.

Anaphylaxis usually develops within minutes of contact with an allergen, but sometimes the reaction can happen up to 4 hours later.

The most widely reported triggers of anaphylaxis are:

• insect stings – particularly wasp and bee stings
• peanuts and tree nuts
• other types of foods – such as milk and seafood
• certain medicines – such as antibiotics

Read more about the causes of anaphylaxis.

Preventing further episodes

If you know what has triggered anaphylaxis, it’s important to take steps to avoid exposure to similar triggers.

You should be referred to a specialist allergy clinic to either find out your allergy triggers or, if you already know what causes it, for further assessment and advice about how to avoid allergens in the future.

You may be given two adrenaline auto-injectors to use during any future episodes of anaphylaxis.

Read more about preventing anaphylaxis.

Who is affected?

Anaphylaxis is not common, but people of all ages can be affected. People with other allergic conditions, such as asthma or the allergic skin condition atopic eczema, are most at risk of developing anaphylaxis.

Although the condition is life threatening, deaths are rare. There are around 20 deaths in the UK each year. With prompt and proper treatment, most people make a full recovery. 

Causes of anaphylaxis

Anaphylaxis is caused by a problem with the immune system, which is the body’s natural defence against illness and infection.

In the case of anaphylaxis, your immune system overreacts to a harmless substance and releases a number of different chemicals, such as histamine, to deal with the mistaken threat.

Triggers

Some of the more common triggers for anaphylaxis are shown below.

Insect stings

Most cases of anaphylaxis are caused by wasp and bee stings, although potentially any insect bite or sting can cause anaphylaxis.

It’s estimated around 1 in 100 people will experience an allergic reaction after a wasp or bee sting, but only a small number of these people will go on to develop severe anaphylaxis.

Foods

More than half of all cases of food-related anaphylaxis are caused by peanuts.

Other foods known to trigger anaphylaxis include:

• nuts – such as walnuts, cashew nuts, almonds, brazil nuts and hazelnuts
• milk
• fish and shellfish
• eggs
• some types of fruit – such as bananas, kiwi fruit, grapes and strawberries

Medicines

Medicines known to trigger anaphylaxis in a small amount of people include:

• antibiotics – particularly penicillin-like antibiotics
• general anaesthetic – muscle-relaxant medicines used during surgery 
• non-steroidal anti-inflammatory drugs (NSAIDs) – a type of painkiller that includes ibuprofen and aspirin

People sensitive to these types of medicines will usually develop anaphylaxis as soon as they begin a course of treatment, although they may have safely received them in the past.

The risk of anaphylaxis using these types of medicines is very small, so in most cases the benefits of treatment outweigh the potential risk.

For example, the risk of developing anaphylaxis is around:

• 1 in 1,480 after taking a NSAID-type painkiller 
• 1 in 5,000 after taking penicillin
• 1 in 10,000 after being given a general anaesthetic

Contrast agents

Contrast agents are a group of special dyes used in some medical tests to help certain areas of your body show up better on scans such as X-rays.

For example, a contrast agent injected into a blood vessel will help show up any problems in the vessel, such as a blockage, on the X-ray. This is known as angiography.

The risk of developing anaphylaxis after being injected with a contrast agent is thought to be less than 1 in 10,000.

Rubber latex

Less than 1 in 100 people in the population has a natural rubber latex allergy. Healthcare, hair, beauty, catering and motor industry workers are more likely to have a latex allergy.

Those with a history of hayfever, asthma, eczema, and certain medical conditions, like spina bifida, are more likely to be affected.

Idiopathic anaphylaxis

Sometimes, despite extensive testing, no trigger can be found for anaphylaxis, and the cause remains unknown. This is known as idiopathic anaphylaxis.

Treating anaphylaxis

If you think somebody is experiencing symptoms of anaphylaxis, you should use an adrenaline injector if one is available. Dial 999 immediately afterwards.

Call 999 straight away if an adrenaline injector is not available.

If you can see a potential trigger, such as a wasp or bee sting stuck in their skin, carefully remove it.

Adrenaline injections

Adrenaline causes the blood vessels to become narrower, which raises your blood pressure and reduces swelling. It also causes the airways to open, relieving breathing difficulties.

An adrenaline injection should be given as soon as a serious reaction is suspected.

The signs of suspected anaphylaxis are:

• problems breathing
• feeling faint or dizzy
• loss of consciousness

The injection can be done by the person with anaphylaxis, but sometimes – if it’s a young child or someone who is unconscious, for example – another person may need to do it.

Before attempting the injection, make sure you know what to do. You should read all of the instructions carefully when you, or the person you are responsible for, are first prescribed the injector.

After injecting, the syringe should be held in place for 5 to 10 seconds. Injections can be given through clothing.

After injecting the adrenaline, you should immediately dial 999 for an ambulance, even if the person is starting to feel better.

Most people should experience a rapid improvement in symptoms once the adrenaline has been used.

If there’s no improvement after 5 to 10 minutes, you should inject a second dose of adrenaline, if one is available. This should be injected into the opposite thigh.

Read Medicines and Healthcare products Regulatory Agency (MHRA) 2014 guidelines on how to use an adrenaline auto-injector (PDF, 188kb).

Positioning and resuscitation

In most cases, the person should lie flat, with their legs raised on a chair or a low table, to help maintain bloodflow to the head and heart.

Pregnant women should lie down on their left side to avoid putting too much pressure on the large vein that leads to the heart.

If the person is conscious but having trouble breathing, they should sit up to make breathing easier.

If the person is unconscious, check that their airways are open and clear, and also check their breathing. Then put them in the recovery position to make sure they don’t choke on their vomit.

Place the person on their side, making sure they are supported by one leg and one arm. Open the airway by tilting the head and lifting the chin.

If the person’s breathing or heart stops, cardiopulmonary resuscitation (CPR) should be performed.

Admission to hospital

Even if adrenaline is given, the person will need to go to hospital for observation – usually for 6 to 12 hours – as symptoms can occasionally return during this period.

While in hospital, an oxygen mask can be used to help breathing, and fluids given by an intravenous drip directly into a vein can help increase blood pressure.

As well as adrenaline, additional medications such as antihistamines and corticosteroids can be used to help relieve symptoms. Blood tests may also be carried out while you’re in hospital to confirm anaphylaxis.

You should be able to leave hospital when the symptoms are under control and it’s thought they will not return quickly. This may be after a few hours, but you may have to stay in hospital for a few days if the symptoms were severe.

You may be asked to take antihistamines and corticosteroid tablets 2 to 3 days after leaving hospital to help stop your symptoms returning.

You will probably be asked to attend a follow-up appointment so you can be given advice about how you can avoid further episodes of anaphylaxis.

An adrenaline auto-injector may be given to you for emergency use between leaving hospital and attending the follow-up appointment.

Read more about preventing anaphylaxis.

Preventing anaphylaxis

If you have anaphylaxis, you should be offered advice and medication to help prevent further episodes.

Allergy clinic

You should be referred to a specialist allergy clinic for tests to find out what caused the anaphylaxis. Knowing what allergen triggered the allergic reaction can help you avoid further episodes of anaphylaxis.

Some of the tests commonly used to determine allergies include:

• a skin prick test – your skin is pricked with a tiny amount of a suspected allergen to see if it reacts by becoming red, raised and itchy
• a blood test – a sample of your blood is taken to test its reaction to a suspected allergen

Read more about diagnosing allergies.

Adrenaline auto-injectors

You may be prescribed an adrenaline auto-injector if you’ve had a previous episode of anaphylaxis and there’s a risk of you having another episode in the future.

There are 3 types of auto-injector:

• EpiPen
• Jext 
• Emerade

Each type is slightly different, and you should make sure you know how to use your auto-injector correctly.

You can also ask for a “trainer” kit so you can practise giving yourself or your child injections.

The following points are important:

• Carry your auto-injector(s) at all times – there should be no exceptions. It may also be recommended that you get an emergency card or bracelet with full details of your allergy and doctor’s contact details to alert others.
• Extremes of heat can make adrenaline less effective, so don’t leave your auto-injector in the fridge or your car’s glove compartment.
• Check the expiry date regularly. An out-of-date injector will offer limited protection.
• The manufacturers offer a reminder service, where you can be contacted near the expiry date. Check the information leaflet that comes with your medicine for more information.
• If your child has an auto-injector, they will need to change over to an adult dose once they reach 30kg (approximately 4.5 stone).
• Don’t delay injecting yourself if you think you may be experiencing the beginning of anaphylaxis, even if your initial symptoms are mild. It’s better to use adrenaline early and then find out it was a false alarm than delay treatment until you’re sure you are experiencing severe anaphylaxis.

Avoid triggers

If a trigger has been identified as causing your episode of anaphylaxis, you will need to take steps to avoid it in the future.

Food

You can reduce the chances of being exposed to a food allergen by:

• checking food labels
• letting staff at a restaurant know what you’re allergic to, so it’s not included in your meal
• remembering that some types of food may contain small traces of potential allergens – for example, some sauces contain wheat and peanuts

See our page on living with a food allergy for more information.

Insect stings

You can reduce your risk of being stung by an insect by taking basic precautions, such as:

• moving away from wasps, hornets or bees slowly without panicking – don’t wave your arms around or swat at them
• using an insect repellent if you spend time outdoors, particularly in the summer

Some specialist allergy centres also offer special treatment to help desensitise you to insect stings if you are at a particularly high risk of a further sting – for example, if you are a beekeeper or gardener.

Read more about preventing insect stings.

Medicines

If you’re allergic to certain types of medicines, there are normally alternatives that can be safely used. For example, if you’re allergic to:

• penicillin – you can normally safely take a different group of antibiotics known as macrolides
• non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and aspirin – you can normally safely take paracetamol, but read the ingredients of things like colds medicines carefully to make sure they don’t contain NSAIDs
• one type of general anaesthetic – others are available, or it may be possible to perform surgery using a local anaesthetic or an epidural injection
• angiotensin-converting enzyme (ACE) inhibitors – alternative blood pressure medications, such as calcium channel blockers, can be used

Always tell any healthcare professional about medicine allergies you have, as they may not be aware of them.

Contrast agents

There may be times when it’s necessary to use contrast agents – for example, if you had bleeding inside your brain – even if this places you at risk of anaphylaxis.

In such circumstances, you can be given injections of antihistamines and corticosteroids before the contrast agents, which may help prevent symptoms occurring or at least make them less severe.

Anaphylactic shock. Clinical recommendations of the Russian Association of Allergists and Clinical Immunologists and the All-Russian Public Organization “Federation of Anesthesiologists and Resuscitators”

Anaphylactic shock. Clinical recommendations of the Russian Association of Allergists and Clinical Immunologists and the All-Russian Public Organization “Federation of Anesthesiologists and Resuscitators”

• Registration

• Entrance

No. 3 (2020) , RECOMMENDATIONS

No. 3 (2020)

RECOMMENDATIONS

02 Published
09/02/2020

• N.I. Ilyina ^{+ −}
• Igor Borisovich Zabolotskikh ^{+ −}
• N.G. Astafieva ^{+ –}
• A. J. Bayalieva ^{+ –}
• A.V. Kulikov ^{+ –}
• T.V. Latysheva ^{+ –}
• K.M. Lebedinsky ^{+ –}
• T.S. Musaeva ^{+ –}
• T.N. Myasnikova ^{+ –}
• A.N. Pampura ^{+ −}
• R.S. Fassahov ^{+ –}
• L.G. Khludova ^{+ –}
• E.M. Shifman ^{+ –}

N.I. Ilyina

“SSC Institute of Immunology” FMBA of Russia, Moscow, Russia

https://orcid.org/0000-0002-3556-969X

Igor Borisovich Zabolotskikh

Kuban State Medical University of the Ministry of Health of Russia, Krasnodar, Russia

https://orcid.org/0000-0002-3623-2546

N.G. Astafieva

Saratov State Medical University. IN AND. Razumovsky» Ministry of Health of the Russian Federation, Saratov, Russia

https://orcid. org/0000-0002-7691-4584

A.J. Bayalieva

Kazan State Medical University, Ministry of Health of Russia, Kazan, Russia

https://orcid.org/0000-0001-7577-3284

A.V. Kulikov

Ural State Medical University, Ministry of Health of Russia, Yekaterinburg, Russia

https://orcid.org/0000-0002-7768-4514

T.V. Latysheva

“SSC Institute of Immunology” FMBA of Russia, Moscow, Russia

https://orcid.org/0000-0003-1508-0640

K.M. Lebedinsky

North-Western State Medical University. I.I. Mechnikov” of the Ministry of Health of Russia, St. Petersburg, Russia

https://orcid.org/0000-0002-5752-4812

T.S. Musaeva

Kuban State Medical University of the Ministry of Health of Russia, Krasnodar, Russia

https://orcid.org/0000-0001-9285-852X

T.N. Myasnikova

“SSC Institute of Immunology” FMBA of Russia, Moscow, Russia

https://orcid.org/0000-0001-8491-195X

A. N. Pampura

Academician Yu.E. Veltishchev FGBOU VO RNIMU them. N.I. Pirogov of the Ministry of Health of Russia, Moscow, Russia

https://orcid.org/0000-0001-5039-8473

R.S. Fassakhov

Kazan (Volga Region) Federal University, Kazan, Russia

https://orcid.org/0000-0001-9322-2689

L.G. Khludova

“SSC Institute of Immunology” FMBA of Russia, Moscow, Russia

https://orcid.org/0000-0003-3767-0924

E.M. Shifman

GBUZ MO “Moscow Regional Research Clinical Institute. M.F. Vladimirsky, Moscow, Russia

https://orcid.org/0000-0002-6113-8498

Keywords

anaphylactic shock
epinephrine
anaphylaxis

How to quote

Ilyina NI, Zabolotskikh IB, Astafieva NG, Bayalieva AZh, Kulikov AV, Latysheva TV, Lebedinsky KM, Musaeva TS, Myasnikova TN, Pampura AN, Fassakhov RS, Khludova LG, Shifman EM Anaphylactic shock. Clinical recommendations of the Russian Association of Allergists and Clinical Immunologists and the All-Russian Public Organization “Federation of Anesthesiologists and Resuscitators”. Bulletin of Intensive Care named after A.I. Saltanova . 2020;(3):15–26. doi:10.21320/1818-474X-2020-3-15-26.

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The increase in the frequency and adverse outcomes of anaphylactic shock in recent decades determines the need to develop clear and precise definitions for the diagnosis and treatment of both shock and the prevention of possible complications associated with it. The article presents variants of the course of anaphylactic shock, diagnostic and treatment algorithms.

https://doi.org/10.21320/1818-474X-2020-3-15-26

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Bibliographic references

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2. Soar J., Pumphrey R., Cant A., et al. Emergency treatment of anaphylactic reactions – Guidelines for healthcare providers. resuscitation. 2008; 77(2): 157–169. DOI: 10.1016/j.resuscitation.2008.02.001
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Anaphylactic shock: how to prevent a deadly threat

Anaphylactic shock is the extreme severity of an allergic reaction. The sudden start and rapid development leave no time for reflection. Every second of delay can cost a person their life.

Is it possible to play ahead of the curve and foresee the possibility of developing anaphylactic shock? How to help a person stay alive? About this and not only our conversation with the head of the allergological department of the 4th Children’s Clinical Hospital of Minsk, Ph.D. Dmitry Buza.

What is anaphylactic shock

Anaphylactic shock is a severe, systemic, life-threatening immediate allergic reaction that develops upon repeated contact with an allergen of any origin. It is believed that if assistance is not provided in time, a tragic outcome is likely in 50-75% of cases.

A feature of such a reaction is that it never occurs on a substance that first enters the human body. Anaphylactic shock provokes the repeated introduction of the allergen, even if no reaction to it was observed before. This is one of the reasons why it is almost impossible to predict the occurrence of a life-threatening situation. Ph.D.:

– In anaphylactic shock, there is a massive release of biologically active substances into the blood, resulting in the development of numerous systemic manifestations of the cardiovascular and respiratory systems, gastrointestinal tract, and skin. As a result of the release of mediators, vascular tone sharply decreases, relative hypovolemia develops (discrepancy between the volume of circulating blood and the volume of the expanded vascular bed), which provokes a state of shock. The main manifestation of anaphylactic shock is acute cardiovascular failure, which, in the absence or delay of emergency medical care, can result in the death of a person. Therefore, action must be taken immediately.

Causes of anaphylactic shock

There are three leading factors that provoke the occurrence of anaphylactic shock.

• Medicines and medications . Here, three groups can be distinguished separately:

1. penicillin preparations;
2. anti-inflammatory and analgesic agents such as ibuprofen, aspirin, diclofenac;
3. iodinated radiopaque agents for medical procedures.

• Insect stings (bee, wasp), whose venom can provoke anaphylactic shock .
• Food products. It is extremely rare, but it still happens that products that have a high allergenic effect can cause a dangerous reaction: chicken protein and cow’s milk protein, eggs, honey, nuts, citrus fruits, food additives, etc.

How to recognize anaphylactic shock

A life-threatening reaction develops at lightning speed – within minutes or even seconds after repeated contact with the allergen. In exceptional cases, it may be delayed by several hours. But, as a rule, we are still talking about a rapid start.

Also characteristic of anaphylactic shock:

• Drop in blood pressure.

Dmitry Buza, head of the allergological department of the 4th Children’s Clinical Hospital of Minsk, Ph.D. The vessels dilate, tachycardia develops (due to the fact that the heart tries to replenish blood flow, and the vessels are empty), followed by collapse (acute cardiovascular failure), loss of consciousness and cardiac arrest.

• Respiratory damage . In anaphylactic shock, the airways narrow, wheezing occurs, breathing is disturbed: a person can neither inhale nor exhale.
• Skin lesions. Due to the lack of oxygen, the skin acquires a bluish tint. In addition, anaphylactic shock is often accompanied by urticaria, swelling of the tongue and soft palate, and unbearable itching.

Sometimes there may be manifestations of the gastrointestinal tract: spasms, severe pain, vomiting, diarrhea.

First aid for anaphylactic shock

1. Call an ambulance. This is the first and most important thing to do.
2. Put a person to bed. Elevate the legs so that they are above the level of the head (to increase blood flow to the heart and, accordingly, reduce tachycardia). If there is vomiting, the person should lie on their side.
3. Provide fresh air: unbutton shirt, open windows.
4. In case of cardiac arrest, perform basic cardiopulmonary resuscitation: chest compressions and artificial respiration.

Dmitry Buza, head of the allergological department of the 4th Children’s Clinical Hospital of Minsk, PhD:

– And that’s probably all. Treatment of anaphylactic shock should be carried out only by a qualified medical professional. The so-called first-line therapy: the introduction of intramuscular or intravenous adrenaline (epinephrine) and infusion therapy (droppers with saline) in order to fill the blood vessels and restore blood pressure. And only then hormonal and antihistamine preparations are introduced.

Life after shock

If adequate medical assistance was provided in a timely manner, the experienced anaphylactic shock will not entail any special consequences for the body. But in the future, contact with the substance that caused such a reaction must be categorically excluded.

Still, the main question remains open: is it possible to prevent the development of anaphylactic shock by “prophylactic” examinations? Ph.D.:

– No. As practice shows, it is impossible to prevent a reaction with an additional examination. It’s like driving a car: it’s impossible to know in advance whether an accident will happen or not. Even the car diagnostics passed the day before, which will show that everything is perfect, will not give such a guarantee. Anaphylactic shock is a very rare reaction. If we are talking about the injection of drugs – 1 case per million.