Severe anaphylactic shock: Anaphylaxis – Symptoms and causes
Anaphylaxis – Symptoms and causes
Anaphylaxis is a severe, potentially life-threatening allergic reaction. It can occur within seconds or minutes of exposure to something you’re allergic to, such as peanuts or bee stings.
Anaphylaxis causes your immune system to release a flood of chemicals that can cause you to go into shock — your blood pressure drops suddenly and your airways narrow, blocking breathing. Signs and symptoms include a rapid, weak pulse; a skin rash; and nausea and vomiting. Common triggers include certain foods, some medications, insect venom and latex.
Anaphylaxis requires an injection of epinephrine and a follow-up trip to an emergency room. If you don’t have epinephrine, you need to go to an emergency room immediately. If anaphylaxis isn’t treated right away, it can be fatal.
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Anaphylaxis symptoms usually occur within minutes of exposure to an allergen. Sometimes, however, it can occur a half-hour or longer after exposure. Signs and symptoms include:
- Skin reactions, including hives and itching and flushed or pale skin
- Low blood pressure (hypotension)
- Constriction of your airways and a swollen tongue or throat, which can cause wheezing and trouble breathing
- A weak and rapid pulse
- Nausea, vomiting or diarrhea
- Dizziness or fainting
When to see a doctor
Seek emergency medical help if you, your child or someone else you’re with has a severe allergic reaction. Don’t wait to see if the symptoms go away.
If the person having the attack carries an epinephrine autoinjector, administer it right away. Even if symptoms improve after the injection, you still need to go to an emergency room to make sure symptoms don’t recur, even without more exposure to your allergen. This second reaction is called biphasic anaphylaxis.
Make an appointment to see your doctor if you or your child has had a severe allergy attack or signs and symptoms of anaphylaxis in the past.
The diagnosis and long-term management of anaphylaxis are complicated, so you’ll probably need to see a doctor who specializes in allergies and immunology.
Your immune system produces antibodies that defend against foreign substances. This is good when a foreign substance is harmful, such as certain bacteria or viruses. But some people’s immune systems overreact to substances that don’t normally cause an allergic reaction.
Allergy symptoms aren’t usually life-threatening, but a severe allergic reaction can lead to anaphylaxis. Even if you or your child has had only a mild anaphylactic reaction in the past, there’s a risk of more severe anaphylaxis after another exposure to the allergy-causing substance.
The most common anaphylaxis triggers in children are food allergies, such as to peanuts, and tree nuts, fish, shellfish and milk. Besides allergy to peanuts, nuts, fish and shellfish, anaphylaxis triggers in adults include:
- Certain medications, including antibiotics, aspirin and other over-the-counter pain relievers, and the intravenous (IV) contrast used in some imaging tests
- Stings from bees, yellow jackets, wasps, hornets and fire ants
Although not common, some people develop anaphylaxis from aerobic exercise, such as jogging, or even less intense physical activity, such as walking. Eating certain foods before exercise or exercising when the weather is hot, cold or humid also has been linked to anaphylaxis in some people. Talk with your doctor about precautions to take when exercising.
If you don’t know what triggers your allergy attack, certain tests can help identify the allergen. In some cases, the cause of anaphylaxis is never identified (idiopathic anaphylaxis).
There aren’t many known risk factors for anaphylaxis, but some things that might increase your risk include:
- Previous anaphylaxis. If you’ve had anaphylaxis once, your risk of having this serious reaction increases. Future reactions might be more severe than the first reaction.
- Allergies or asthma. People who have either condition are at increased risk of having anaphylaxis.
- Certain other conditions. These include heart disease and an abnormal accumulation of a certain type of white blood cell (mastocytosis).
An anaphylactic reaction can be life-threatening — it can stop your breathing or your heartbeat.
The best way to prevent anaphylaxis is to avoid substances that cause this severe reaction. Also:
- Wear a medical alert necklace or bracelet to indicate you have an allergy to specific drugs or other substances.
- Keep an emergency kit with prescribed medications available at all times. Your doctor can advise you on the contents. If you have an epinephrine autoinjector, check the expiration date and be sure to refill your prescription before it expires.
- Be sure to alert all your doctors to medication reactions you’ve had.
- If you’re allergic to stinging insects, use caution around them. Wear long-sleeved shirts and pants; don’t walk barefoot on grass; avoid bright colors; don’t wear perfumes, colognes or scented lotions; and don’t drink from open soda cans outdoors. Stay calm when near a stinging insect. Move away slowly and avoid slapping at the insect.
If you have food allergies, carefully read the labels of all the foods you buy and eat. Manufacturing processes can change, so it’s important to periodically recheck the labels of foods you commonly eat.
When eating out, ask how each dish is prepared, and find out what ingredients it contains. Even small amounts of food you’re allergic to can cause a serious reaction.
Even if you’re careful, at some point you’ll likely be exposed to what you’re allergic to. Fortunately, you can respond quickly and effectively to an allergy emergency by knowing the signs and symptoms of an anaphylactic reaction and having a plan to quickly treat those symptoms.
Sept. 14, 2019
Anaphylaxis – NHS
Anaphylaxis is a severe and potentially life-threatening reaction to a trigger such as an allergy.
At the moment it can be hard to know what to do if you’re unwell.
It’s still important to get medical help if you need it.
Do not delay if you feel very unwell or think there’s something seriously wrong. Call 999.
Symptoms of anaphylaxis
Anaphylaxis usually develops suddenly and gets worse very quickly.
The symptoms include:
There may also be other allergy symptoms, including an itchy, raised rash (hives); feeling or being sick; swelling (angioedema) or stomach pain.
What to do if someone has anaphylaxis
Anaphylaxis is a medical emergency. It can be very serious if not treated quickly.
If someone has symptoms of anaphylaxis, you should:
- Use an adrenaline auto-injector if the person has one – but make sure you know how to use it correctly first.
- Call 999 for an ambulance immediately (even if they start to feel better) – mention that you think the person has anaphylaxis.
- Remove any trigger if possible – for example, carefully remove any stinger stuck in the skin.
- Lie the person down flat – unless they’re unconscious, pregnant or having breathing difficulties.
- Give another injection after 5 to 15 minutes if the symptoms do not improve and a second auto-injector is available.
If you’re having an anaphylactic reaction, you can follow these steps yourself if you feel able to.
Read about how to treat anaphylaxis for more advice about using auto-injectors and correct positioning.
Triggers of anaphylaxis
Anaphylaxis is the result of the immune system, the body’s natural defence system, overreacting to a trigger.
This is often something you’re allergic to, but not always.
Common anaphylaxis triggers include:
In some cases, there’s no obvious trigger. This is known as idiopathic anaphylaxis.
If you have a serious allergy or have experienced anaphylaxis before, it’s important to try to prevent future episodes.
The following can help reduce your risk:
- identify any triggers – you may be referred to an allergy clinic for allergy tests to check for anything that could trigger anaphylaxis
- avoid triggers whenever possible – for example, you should be careful when food shopping or eating out if you have a food allergy
- carry your adrenaline auto-injector at all times (if you have 2, carry them both) – give yourself an injection whenever you think you may be experiencing anaphylaxis, even if you’re not completely sure
Read more about preventing anaphylaxis
Page last reviewed: 29 November 2019
Next review due: 29 November 2022
Anaphylaxis (Anaphylactic Reaction): Symptoms, Causes, Treatment
Anaphylaxis is a severe allergic reaction that needs to be treated right away. If you have an anaphylactic reaction, you need an epinephrine (adrenaline) shot as soon as possible, and someone should call 911 for emergency medical help. Left untreated, it can be deadly.
Epinephrine can reverse the symptoms within minutes. If this doesn’t happen, you may need a second shot within half an hour. These shots, which you need a prescription to get, come pre-filled and in ready-to-use pens.
You shouldn’t take an antihistamine for an anaphylactic reaction.
Anaphylaxis is rare, and most people recover from it. But it’s important to tell your doctor about any drug allergies you have before any kind of medical treatment, including dental care. It’s also a good idea to wear a medical alert bracelet or pendant or carry a card with information about your allergy.
If you’ve had an anaphylactic reaction before, you have a higher risk of having another one. You also have a higher risk if you have a family history of anaphylaxis or have asthma.
The first signs of an anaphylactic reaction may look like typical allergy symptoms: a runny nose or a skin rash. But within about 30 minutes, more serious signs appear.
There is usually more than one of these:
- Coughing; wheezing; and pain, itching, or tightness in your chest
- Fainting, dizziness, confusion, or weakness
- Hives; a rash; and itchy, swollen, or red skin
- Runny or stuffy nose and sneezing
- Shortness of breath or trouble breathing and rapid heartbeat
- Swollen or itchy lips or tongue
- Swollen or itchy throat, hoarse voice, trouble swallowing, tightness in your throat
- Vomiting, diarrhea, or cramps
- Weak pulse, paleness
Some people also remember feeling a “sense of doom” right before the attack.
Symptoms can move to shock and loss of consciousness.
As many as 1 out of every 5 people may have a second anaphylactic reaction within 12 hours of the first. This is called a biphasic anaphylaxis.
Epinephrine is the most effective treatment for anaphylaxis, and the shot should be given right away (usually in the thigh). If you’ve had an anaphylaxis reaction before, you should carry at least two doses of epinephrine with you at all times.
Epinephrine expires after about a year, so make sure your prescription is up to date. If you have an anaphylactic reaction and the pen has expired, take the shot anyway.
When medical personnel arrive, they may give you more epinephrine. If you’re not able to breathe, they may put a tube down your mouth or nose to help. If this doesn’t work, they might do a kind of surgery called a tracheostomy that puts the tube directly into your windpipe.
Either in the ambulance or at the hospital, you may need fluids and medications to help you breathe. If the symptoms don’t go away, doctors may also give you antihistamines and steroids.
You probably will need to stay in the emergency room for several hours to make sure you don’t have a second reaction.
After the initial emergency is over, see an allergy specialist, especially if you don’t know what caused the reaction.
Anaphylaxis happens when you have an antibody, something that usually fights infection, that overreacts to something harmless like food. It might not happen the first time you come in contact with the trigger, but it can develop over time.
In children, the most common cause is food. For adults, the main cause is medication.
Typical food triggers for children are:
Common food triggers for adults are:
- Tree nuts (walnuts, hazel nuts, cashews, pistachios, pine nuts, and almonds)
Some people are so sensitive that even the smell of the food can trigger a reaction. Some are also allergic to certain preservatives in food.
Common medication triggers are:
- Penicillin (more often following a shot rather than a pill)
- Muscle relaxants like the ones used for anesthesia
- Aspirin, ibuprofen, and other NSAIDs (nonsteroidal anti-inflammatory drugs)
- Anti-seizure medications
Anaphylaxis also can be triggered by a few other things. But these aren’t as common:
- Pollen, such as ragweed, grass, and tree pollen
- Stings or bites from bees, wasps, yellow jackets, hornets, and fire ants
- Latex, found in hospital gloves, balloons, and rubber bands
Some people can have an anaphylactic reaction if they breathe in latex.
Some can have a reaction to a combination of things:
- Breathe in birch pollen and eat apple, raw potato, carrots, celery, or hazelnut
- Breathe in mugwort pollen and eat celery, apples, peanuts, or kiwi
- Breathe in ragweed pollen and eat melons or bananas
- Touch latex and eat papaya, chestnuts, or kiwi
In rare cases, it can be triggered by 2 to 4 hours of exercise after eating certain foods or by exercise on its own.
Anaphylactic reactions usually start within minutes of contact with the trigger, but they can also happen an hour or more later.
Some people never figure out what caused their reactions. That’s known as idiopathic anaphylaxis. If you don’t know your triggers, you can’t avoid them. So it’s especially important to carry epinephrine injectors, make sure you and people close to you know how to use them, and wear medical alert jewelry.
Anaphylaxis | Johns Hopkins Medicine
What is anaphylaxis?
Anaphylaxis, also called allergic or anaphylactic shock, is a sudden, severe and life-threatening allergic reaction that involves the whole body. The reaction is marked by constriction of the airways, leading to difficulty breathing. Swelling of the throat may block the airway in severe cases. Gastrointestinal symptoms, such as severe abdominal pain, vomiting and diarrhea, may also occur. Histamines, the substances released by the body during an allergic reaction, cause the blood vessels to expand, which in turn causes a dangerous drop in blood pressure. Fluid can leak into the lungs, causing swelling (pulmonary edema). Anaphylaxis can also cause heart rhythm disturbances. Any allergen can cause this reaction, but the most common ones are insect bites, food and drugs.
Symptoms develop suddenly and escalate in seconds:
- Difficulty breathing
- Rapid heart beat
- Swelling of the lips, tongue, throat
- Slurred speech
- Bluish skin (cyanosis)
- Light-headedness, dizziness, fainting
- Hives and generalized itching
- Heart palpitations
- Nausea, vomiting
- Abdominal pain or cramping
As anaphylaxis is a dramatic reaction, diagnosis is relatively easy. The child will need allergy testing to determine what caused the reaction.
Anaphylaxis is an emergency. Assessment of the airway, breathing and circulation should be done immediately. CPR may be needed. Children with known allergies and/or past episodes of anaphylaxis should carry an EpiPen® (epinephrine injection) that must be administered immediately. Emergency intubation, which opens the airway by placing a tube through the nose or mouth, may be needed. Another option is placing the tube into the trachea by directly cutting into the trachea. Children who have a history of allergy to insect bites/stings should be instructed to carry (and use) an emergency kit consisting of an EpiPen and should wear a MedicAlert bracelet/necklace showing their allergy.
When to Call for Help
If your child develops the above symptoms, call 911 or go to the nearest emergency room.
Anaphylaxis: Signs, Symptoms, and Complications
Anaphylaxis is a sudden and severe allergic reaction that involves more than one body system. It is a life-threatening medical emergency. You will often have skin reactions and shortness of breath, which can develop into anaphylactic shock with a drop in blood pressure. Learn how to identify an anaphylactic reaction so you can seek immediate medical care.
Illustration by Verywell
Anaphylaxis is primarily an allergic reaction. Allergic reactions become anaphylaxis once an allergy begins to affect more than one body system, such as the skin and respiratory system. Anaphylaxis comes on suddenly and the symptoms progress quickly. It will develop most commonly after eating, getting stung by an insect, or taking medications.
What to Watch For
To identify anaphylactic shock, first look for symptoms of allergy which include:
- Red, raised, blotchy skin, seen in 90 percent of cases
- Wheezing or shortness of breath, seen in 70 percent of cases
Symptoms can be seen in many parts of the body:
- Skin: You may have flushing and itching. Hives can develop, which are raised itchy bumps that blanch (turn white) when you press on them. Angioedema can develop, which is swelling under the skin.
- Eyes: You may have signs of irritation including itching, redness, production of tears, and the skin may swell around the eyes.
- Upper respiratory: Congestion, a runny nose, and sneezing can develop. You can feel throat swelling, choking, or hoarseness.
- Oral: You may experience a swollen tongue, lips, or throat, or abnormal taste sensations.
- Lower respiratory: You can have difficulty breathing, wheezing, and chest tightness
- Circulatory: You may have a rapid or slow heartbeat and low blood pressure. You may feel dizzy, faint, or you may pass out.
- Nervous system: You can become anxious or confused, have slurred speech, and may even feel a sense of impending doom.
- Digestive system: Nausea, vomiting, diarrhea, or abdominal pain may be experienced.
Anaphylaxis becomes anaphylactic shock when a person shows signs of low blood pressure:
- Pale color
Anaphylactic shock often includes shortness of breath. A person doesn’t always have trouble breathing, but if the symptom is present, it’s a good indicator that the allergic reaction is turning into anaphylaxis.
Signs of Anaphylactic Shock
Some of the telltale signs include:
- Unable to speak more than one or two words
- Sitting straight up or with hands on knees
- Gasping for breath
- Pursing lips to breathe
- Using neck muscles to take breaths
Allergen Exposure as a Sign
It’s easier to identify the signs and symptoms of anaphylactic shock if there is a known allergen exposure. For instance, those with allergies to bee stings will usually know they’ve been stung. Anyone who’s had allergic reactions in the past should be aware of any symptoms, even if no allergen exposure has been identified. For example, people with food allergies are more likely to have anaphylaxis while eating even when they don’t think they’re eating the food they are allergic to.
If someone is wearing medical alert jewelry that indicates an allergy, that can help identify the cause of the symptoms.
An episode of anaphylaxis typically begins within 5 to 30 minutes of coming into contact with the allergen to which you are allergic, though it can take more than an hour. However, there are atypical patterns.
Biphasic anaphylaxis is seen in up to 20 percent of patients, occurring in both children and adults, though it was once thought to be rarer. In this presentation, the initial anaphylactic reaction would manifest and it would resolve, only to have the reaction return hours to days later. This is why someone may be admitted to the hospital for observation after an anaphylactic reaction. In some cases, people won’t experience the most severe symptoms of anaphylaxis, such as difficulty breathing, and thus decide not to seek medical care. However, this puts them at risk for a biphasic reaction, which can lead to severe consequences.
A study of pediatric cases published in 2015 found a higher incidence in children of age 6 to 9. They were more likely to have been treated with more than one dose of epinephrine, indicating they had a more severe reaction. They were also more likely to have had a delay in getting treatment with epinephrine or arriving at an emergency department.
Protracted anaphylaxis is seen rarely. In this case, the symptoms can last from several days to over a week without clearly resolving completely.
Anaphylaxis can result in death if not treated. A myocardial infarction or atrial fibrillation can develop during anaphylaxis, and these cardiac risks are greater in patients over the age of 50.
Epinephrine is the drug of choice to treat anaphylaxis, but it carries a risk of overdose and of triggering cardiovascular complications. In older patients, some research suggests it is safer to administer intramuscular injections rather than intravenous epinephrine.
When to See a Doctor
If you have any symptoms of anaphylaxis, get to medical care immediately. It is appropriate to call 911 for emergency treatment.
Don’t wait to summon emergency care. The reaction can progress rapidly. Hives can turn into anaphylactic shock in minutes. If you are alone, you risk becoming unconscious before you can call for care.
If you know you are at risk of anaphylaxis from an allergy, call for emergency medical care as soon as you know you have been exposed. Even if you use an epinephrine self-injector, you will need emergency treatment.
Frequently Asked Questions
What is anaphylaxis?
Anaphylaxis is a severe, potentially life-threatening allergy affecting the whole body. It is caused by an extreme overreaction of the immune system to an allergy-causing substance (allergen), When anaphylaxis occurs, the immune system will flood the body with inflammatory compounds that can cause you to go into shock.
What causes anaphylaxis?
Anaphylaxis is triggered by an allergen. Foods like nuts, fish, shellfish, and milk are allergens commonly linked to anaphylaxis in children. In adults, insect bites, latex, and certain medications are common causes of anaphylaxis in addition to foods.
What are the signs and symptoms of anaphylaxis?
Anaphylaxis can be recognized by the following signs and symptoms:
- Severe rash or hives
- Shortness of breath
- Weak and rapid heartbeat
- Lightheadedness, dizziness, or fainting
- Nausea or vomiting
- Swelling of the face, tongue, or throat
- A feeling of impending doom
How long does it take for anaphylaxis to occur?
Anaphylaxis mostly occurs within 20 minutes to two hours of exposure to an allergen. With that said, some people have a delayed reaction and only experience symptoms several days later. Others have biphasic anaphylaxis, in which initial mild symptoms appear to resolve, only to return more severely within hours or days.
When is anaphylaxis life-threatening?
Anaphylaxis can cause shock. This is a critical condition brought on by a sudden drop of blood flow throughout the body. Anaphylactic shock can cause death by restricting the amount of blood and oxygen that reaches organs, causing unconsciousness, coma, cardiac arrest, and even death. Anaphylaxis can also cause suffocation due to severe swelling of the throat. If left untreated, anaphylaxis can cause death within minutes to hours.
How is anaphylaxis treated?
The first line of treatment for anaphylaxis is an injection of epinephrine, which relaxes smooth muscles and increases blood circulation. Cardiopulmonary resuscitation (CPR) may be needed if the affected person stops breathing. Other treatments may include:
- High-flow oxygen therapy
- Intravenous antihistamines to temper the allergic response
- Intravenous corticosteroids to temper the overall immune response
- A beta-agonist like albuterol to ease breathing
What can you expect after receiving treatment for anaphylaxis?
If treated early and appropriately, anaphylaxis can usually improve within a few hours (although you may be admitted to the hospital for overnight observation). In severe cases, recovery may take several days. If not treated appropriately, anaphylaxis can cause permanent heart, brain, lung, and kidney injury.
Who should carry an anaphylaxis kit?
Anyone with a history of anaphylaxis should carry an anaphylaxis kit, which includes an epinephrine auto-injector (called an EpiPen) and sometimes a strong oral antihistamine like diphenhydramine. You may also be advised to carry an anaphylaxis kit as well as a medical ID bracelet if you have a history of severe allergies. An allergist can advise you if you need one.
What to Do When Someone is in Anaphylactic Shock
Whether someone you love has severe allergies and you’re looking for general best safety practices or you are helping someone right now who is in a medical emergency, knowing what to do when someone is in anaphylactic shock can make all the difference. In case you’re reading this blog for the latter reason, let’s jump right to the instructions.
What is the first aid treatment for anaphylaxis?
- Call 911 immediately or send someone to call 911 immediately; don’t wait to see if the symptoms get better.
- Ask if the person has an epinephrine autoinjector (EpiPen, Auvi-Q, etc.) and if they need help using it. Typically, the autoinjector is pressed into the person’s thigh.
- Have the person lay down and elevate their legs; if the person is vomiting, turn them on their side to help prevent choking. If breathing becomes difficult, allow the person to sit up (but not stand).
- Monitor vital signs such as breathing and pulse.
- If the person stops breathing, begin CPR.
- If vital signs remain stable, do what you can to keep the person comfortable until the paramedics arrive; loosen tight clothing, cover them with a blanket, etc.
FAQs with regard to what to do when someone is in anaphylactic shock:
Q: If anaphylactic shock is the result of a bug bite, should I remove the stinger?
A: Yes, flick out the sting if possible, but do not remove ticks.
Q: What do you do if someone goes into anaphylactic shock without an EpiPen?
A: Make sure that you’ve called 911. If antihistamines are on-hand, these can be administered and may provide some relief, but antihistamines are never a suitable medication for fully treating anaphylactic shock.
Q: If the person appears to be getting better, should we still go to the ER?
A: Yes, almost all cases of anaphylactic shock are cases for when to go to the ER for an allergic reaction. In some cases of anaphylaxis, secondary reactions can occur.
Q: How can I tell if my child is having an allergic reaction?
A: Please check the symptoms for allergic reactions below. Especially in young children, individuals in anaphylactic shock may be pale and floppy in addition to other symptoms.
For more information, please see our article: What to Do if a Child Has an Allergic Reaction.
Anaphylactic shock symptoms
The signs and symptoms of an allergic reaction will vary depending on the type of reaction that occurs. For example, mild to moderate allergic reactions may involve swelling of the lips, face, and eyes, hives and welts, congestion, runny nose, and sneezing.
However, individuals experiencing anaphylaxis — a severe allergic reaction — may or may not experience the above symptoms, but typically do exhibit:
- Difficulty breathing or noisy breathing
- Swelling of the tongue
- Swelling and/or tightness in the throat
- Persistent cough
- Difficulty talking
- Fainting or collapsing
- Paleness and floppiness (in young children)
Keep in mind that there are a wide variety of allergens out there that can trigger allergic reactions; doctors regularly see everything from allergic reaction to bug bites to lactose intolerance symptoms. It’s when the allergic reaction to these allergens becomes severe that an ER trip is necessary.
Anaphylactic shock treatment at Complete Care
Whether you know exactly what to do when someone is in anaphylactic shock or have never experienced one of these severe allergic reactions before, it’s critical that the person experiencing anaphylaxis gets emergency medical treatment.
It is typical for patients who experience these types of reactions to need up to 4 hours of observation. Some patients may require additional adrenaline doses or other types of treatment.
At Complete Care, our state-of-the-art facilities and award-winning doctors and nurses are well equipped to give patients who are experiencing anaphylactic shock the professional, emergency medical treatment they need.
We have ER locations in both Texas (Austin, Corpus Christi, San Antonio, Dallas/Fort Worth, East Texas, and Lubbock) and Colorado (Colorado Springs). Whether you have an emergency or just a simple health question, we will take complete care of you.
More Helpful Articles by Complete Care:
Causes, Symptoms and Treatment Options
Medically reviewed by Drugs.com. Last updated on Feb 15, 2021.
What is Anaphylaxis?
Anaphylaxis is a severe, sometimes life-threatening, allergic reaction that occurs within minutes to several hours of exposure an allergy-causing substance (allergen). Anaphylaxis also is called anaphylactic shock.
In an allergic reaction, the body’s immune system responds to the presence of an allergen by releasing histamine and other body chemicals. These chemicals cause the symptoms of allergies, which are usually mild but annoying, such as the runny nose of hay fever (allergic rhinitis) or the itchy rash of poison ivy. However, in some cases, the symptoms can be much worse and involve the entire body. Anaphylaxis is the most severe allergic reaction. In anaphylaxis, these immune chemicals cause serious skin symptoms, such as hives and swelling, as well as severe breathing problems, such as swelling in the throat, narrowing of the lower airways and wheezing). The chemicals also cause blood vessels to widen dramatically, which leads to a rapid, severe drop in blood pressure (shock). Anaphylaxis is a life-threatening medical emergency.
Although the specific allergen that triggers anaphylaxis may be different for each patient, it often can be traced to one of the following sources:
- Foods — Especially eggs, seafood, tree nuts, grains, milk and peanuts
- Drugs — Especially an antibiotic from the penicillin or cephalosporin group, a “sulfa” antibiotic, or ibuprofen and other non-steroidal anti-inflammatory pain medicines (NSAIDs).
- Insect stings — From bees, yellow jackets, paper wasps, hornets or fire ants
- Injected anesthetics — Procaine, lidocaine
- Dyes — Used in diagnostic X-rays and scans
- Industrial chemicals — Latex and rubber products used by health care workers
- Allergy shots (immunotherapy)
Symptoms of anaphylaxis usually occur within seconds to minutes of exposure to the allergen, but symptoms can be delayed for several hours. For some people, symptoms do not always show up after an exposure, but are triggered if an exposure is followed by vigorous exercise. Symptoms range from mild to very severe. These symptoms can include:
- Rapid pulse, sweating, dizziness, fainting, unconsciousness
- Wheezing, chest tightness, difficulty breathing, coughing
- Itchy hives, which may blend together to form larger areas of skin swelling
- Swelling of the lips, tongue or eyes
- Nausea, vomiting, abdominal cramps, diarrhea
- Paleness, bluish skin color
- Throat swelling, with a feeling of throat tightness, a lump in the throat, hoarseness or obstructed air flow
The doctor will ask about the patient’s allergy history and about his or her exposure to any of the common allergens that trigger anaphylaxis. It is very important for the doctor to know if the patient’s symptoms started soon after exposure to an allergen, for instance after eating nuts, after a bee sting or after taking an antibiotic. Because the patient may be too sick to provide this information, a family member, friend, co-worker or school nurse will need to help. People with a history of severe allergic reactions should consider wearing a medical alert identification necklace or bracelet to save valuable time in identifying the problem.
The doctor usually can diagnose anaphylaxis based on the patient’s history and the results of a physical examination.
With early and appropriate treatment, cases of anaphylaxis can improve quickly within a few hours. If a person has already developed the more serious symptoms and dangerous conditions, it may take a few days to fully recover after treatment. If untreated, anaphylaxis can cause death within minutes to hours.
You can prevent anaphylaxis by avoiding the allergens that trigger your symptoms. For example, people with food allergies should always check the list of ingredients on food labels, and they should always ask the waiter or waitress to check with the chef about food ingredients before eating at a restaurant. If you are allergic to bee stings, you should limit gardening and lawn mowing, and you should not wear perfumes, hair sprays or bright clothing that attracts insects.
People with a history of anaphylaxis should wear a medical identification bracelet or necklace to alert others in the event of another reaction. In addition, ask your doctor if you should carry a pre-loaded syringe of epinephrine (adrenaline), a medicine used to treat anaphylaxis. At the first sign of symptoms, you or a helper (family member, co-worker, school nurse) would inject the pre-loaded epinephrine to treat your allergic reaction until you reach medical attention.
Allergy shots, also called immunotherapy, are used to gradually change the type of reaction that a person has after an insect sting. Allergy shots cause the immune system to react by producing varieties of antibodies and cells that do not cause dangerous symptoms, instead of producing antibodies and chemicals that result in allergy symptoms. On rare occasions, allergy shots also can be used to prevent certain medication allergies. Allergy shots are not used to treat food allergies, because the shots themselves are too likely to cause anaphylaxis. However, oral (swallowed) immunotherapy using extraordinarily diluted samples of peanut is a new treatment for peanut allergy. The results of treatment so far suggest this therapy will be effective and appears to be relatively safe.
Symptoms of anaphylaxis usually require treatment with epinephrine, by injection. People who have had anaphylaxis can carry a pre-loaded syringe containing epinephrine. This is the most important treatment for anaphylaxis symptoms, because it can help to prevent a blocked airway from throat swelling, which can otherwise result in suffocation. Symptoms can also be improved with antihistamines, anti-acid medicines known as “h3 blockers,” and corticosteroids such as prednisone. It is important for a doctor to see you right away for allergy reactions that are severe, and for all reactions that are treated with epinephrine. Low blood pressure may need treatment with intravenous fluids or with medication to support blood pressure.
When To Call A Professional
Call for emergency assistance immediately whenever you have or a person you are assisting has symptoms of anaphylaxis. If you have a history of severe allergic reaction and have not mentioned this to your doctor, schedule an appointment soon. He or she can review your history and help you take the necessary precautions to avoid future problems.
With prompt, appropriate treatment, most patients who have had a severe allergic reaction can recover completely. Unfortunately, even with treatment, some people die from anaphylaxis.
A person who has had anaphylaxis is at risk of future severe reactions if he or she is exposed again to the same allergen.
Learn more about Anaphylaxis
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CDC Kind Doctor LLC – Anaphylactic shock
Anaphylactic shock (anaphylaxis) is a severe systemic allergic reaction of an immediate type that develops upon contact with foreign substances-antigens (medications, serums, radiopaque drugs, food, snake and insect bites), which is accompanied by severe circulatory and organ dysfunctions and systems.
Anaphylactic shock develops in about one in 50 thousand people, and the number of cases of this systemic allergic reaction is growing every year.So, in the United States of America, more than 80 thousand cases of anaphylactic reactions are recorded every year, and the risk of at least one episode of anaphylaxis during a lifetime exists in 20-40 million US residents. According to statistics, in about 20% of cases, the cause of the development of anaphylactic shock is the use of drugs. Often, anaphylaxis is fatal.
Any substance that enters the human body can become an allergen leading to the development of an anaphylactic reaction.Anaphylactic reactions often develop in the presence of a hereditary predisposition (there is an increase in the reactivity of the immune system, both cellular and humoral). The most common causes of anaphylactic shock are:
- Administration of medications . These are antibacterial (antibiotics and sulfonamides), hormonal agents (insulin, adrenocorticotropic hormone, corticotropin and progesterone), enzyme preparations, anesthetics, heterologous sera and vaccines.An overreaction of the immune system can also develop on the introduction of X-ray contrast agents used in instrumental studies.
- Bites and stings . Another causal factor in the occurrence of anaphylactic shock is snake and insect bites (bees, bumblebees, hornets, ants). In 20-40% of cases of bee stings, beekeepers become victims of anaphylaxis.
- Food allergy . Anaphylaxis often develops to food allergens (eggs, dairy products, fish and seafood, soy and peanuts, food additives, dyes and flavors, as well as biological products used to process fruits and vegetables).Thus, in the United States, more than 90% of cases of severe anaphylactic reactions develop on hazelnuts. In recent years, the number of cases of the development of anaphylactic shock to sulfites – food additives used for a longer preservation of the product – has become more frequent. These substances are added to beer and wine, fresh vegetables, fruits, sauces.
- Physical factors . The disease can develop under the influence of various physical factors (work associated with muscle tension, sports training, cold and heat), as well as with a combination of certain foods (usually shrimp, nuts, chicken, celery, white bread) and subsequent physical loads (work in the personal plot, sports games, running, swimming, etc.)etc.)
- Latex allergy . Cases of anaphylaxis to latex products (rubber gloves, catheters, tire products, etc.) are becoming more frequent, and cross-allergy to latex and some fruits (avocados, bananas, kiwi) is often observed.
Anaphylactic shock is an immediate generalized allergic reaction, which is caused by the interaction of a substance with antigenic properties and immunoglobulin IgE.When the allergen re-enters, various mediators (histamine, prostaglandins, chemotactic factors, leukotrienes, etc.) are released and numerous systemic manifestations develop from the cardiovascular, respiratory systems, gastrointestinal tract, and skin.
These are vascular collapse, hypovolemia, smooth muscle contraction, bronchospasm, mucus hypersecretion, edema of various localization and other pathological changes. As a result, the volume of circulating blood decreases, blood pressure decreases, the vasomotor center is paralyzed, the stroke volume of the heart decreases and the phenomena of cardiovascular failure develop.A systemic allergic reaction in anaphylactic shock is accompanied by the development of respiratory failure due to spasm of the bronchi, accumulation of viscous mucous discharge in the lumen of the bronchi, the appearance of hemorrhages and atelectasis in the lung tissue, stagnation of blood in the pulmonary circulation. Violations are also noted on the part of the skin, abdominal and pelvic organs, the endocrine system, and the brain.
Symptoms of anaphylactic shock
Clinical symptoms of anaphylactic shock depend on the individual characteristics of the patient’s body (sensitivity of the immune system to a specific allergen, age, the presence of concomitant diseases, etc.), the method of penetration of substances with antigenic properties (parenterally, through the respiratory tract or digestive tract), the predominant “shock organ” (heart and blood vessels, respiratory tract, skin). In this case, the characteristic symptoms can develop both at lightning speed (during parenteral administration of the drug), and 2-4 hours after meeting with the allergen.
Acute disorders of the cardiovascular system are characteristic of anaphylaxis: a decrease in blood pressure with the appearance of dizziness, weakness, fainting, arrhythmias (tachycardia, extrasystole, atrial fibrillation, etc.).and the development of vascular collapse, myocardial infarction (chest pain, fear of death, hypotension). Respiratory signs of anaphylactic shock are the appearance of severe shortness of breath, rhinorrhea, dysphonia, wheezing, bronchospasm and asphyxia. Neuropsychiatric disorders are characterized by severe headache, psychomotor agitation, fear, anxiety, convulsive syndrome. Dysfunction of the pelvic organs (involuntary urination and defecation) may occur. Skin signs of anaphylaxis – the appearance of erythema, urticaria, angioedema.
The clinical picture will differ depending on the severity of the anaphylaxis. Allocate 4 degrees of severity:
- At I degree of shock, the disturbances are insignificant, blood pressure (BP) is reduced by 20-40 mm Hg. Art. Consciousness is not impaired, dry throat worries, cough, chest pain, fever, general anxiety, there may be a rash on the skin.
- For II degree of anaphylactic shock, more pronounced disorders are characteristic. In this case, systolic blood pressure drops to 60-80, and diastolic – to 40 mm Hg.Disturbed by a feeling of fear, general weakness, dizziness, rhinoconjunctivitis phenomena, skin rash with itching, Quincke’s edema, difficulty in swallowing and speaking, pain in the abdomen and lower back, heaviness behind the breastbone, shortness of breath at rest. Often there is repeated vomiting, control of the process of urination and defecation is impaired.
- III degree of the severity of shock is manifested by a decrease in systolic blood pressure to 40-60 mm Hg. Art., and diastolic – up to 0. Loss of consciousness occurs, the pupils dilate, the skin is cold, sticky, the pulse becomes threadlike, convulsive syndrome develops.
- IV degree anaphylaxis develops with lightning speed. In this case, the patient is unconscious, blood pressure and pulse are not determined, there is no cardiac activity and breathing. Urgent resuscitation measures are needed to save the patient’s life.
When recovering from the state of shock, the patient remains weak, lethargic, lethargic, fever, myalgia, arthralgia, shortness of breath, pain in the heart. There may be nausea, vomiting, pain throughout the abdomen.After relief of acute manifestations of anaphylactic shock (in the first 2-4 weeks) complications often develop in the form of bronchial asthma and recurrent urticaria, allergic myocarditis, hepatitis, glomerulonephritis, systemic lupus erythematosus, periarteritis nodosa, etc.
The diagnosis of anaphylactic shock is established mainly by clinical symptoms, since there is no time left for a detailed collection of anamnestic data, laboratory tests and allergological tests.It can only help to take into account the circumstances during which anaphylaxis occurred – parenteral administration of a drug, a snakebite, eating a certain product, etc.
During the examination, the general condition of the patient, the function of the main organs and systems (cardiovascular, respiratory, nervous and endocrine) are assessed. Already a visual examination of a patient with anaphylactic shock makes it possible to determine the clarity of consciousness, the presence of a pupillary reflex, the depth and frequency of breathing, the condition of the skin, maintaining control over the function of urination and defecation, the presence or absence of vomiting, and convulsive syndrome.Further, the presence and qualitative characteristics of the pulse in the peripheral and main arteries, the level of blood pressure, auscultatory data when listening to heart sounds and breathing over the lungs are determined.
After the provision of emergency care to a patient with anaphylactic shock and the elimination of an immediate threat to life, laboratory and instrumental studies are carried out to clarify the diagnosis and exclude other diseases with similar symptoms:
- Laboratory tests .When conducting a general clinical laboratory examination, a clinical blood test is performed (more often leukocytosis is detected, an increase in the number of erythrocytes, neutrophils, eosinophils), the severity of respiratory and metabolic acidosis is assessed (pH, partial pressure of carbon dioxide and oxygen in the blood are measured), water-electrolyte balance, indicators blood coagulation systems, etc.
- Allergy examination . In case of anaphylactic shock, it involves the determination of tryptase and IL-5, the level of general and specific immunoglobulin E, histamine, and after the relief of acute manifestations of anaphylaxis, the identification of allergens using skin tests and laboratory tests.
- Instrumental diagnostics . On the electrocardiogram, signs of overload of the right heart, myocardial ischemia, tachycardia, arrhythmia are determined. A chest x-ray may show signs of pulmonary emphysema. In the acute period of anaphylactic shock and for 7-10 days, blood pressure, heart rate and respiration rate, ECG are monitored. If necessary, pulse oximetry, capnometry and capnography are prescribed, as well as determination of arterial and central venous pressure by an invasive method.
Differential diagnosis is carried out with other conditions that are accompanied by a pronounced decrease in blood pressure, impaired consciousness, breathing and cardiac activity: with cardiogenic and septic shock, myocardial infarction and acute cardiovascular failure of various origins, pulmonary embolism, syncope and epileptic syndrome, hypoglycemia, acute poisoning, etc. Anaphylactic shock should be distinguished from similar manifestations of anaphylactoid reactions that develop at the first encounter with an allergen and in which immune mechanisms are not involved (antigen-antibody interaction).
Sometimes differential diagnosis with other diseases is difficult, especially in situations where there are several causal factors that have caused the development of a shock state (a combination of various types of shock and the addition of anaphylaxis to them in response to the administration of any medication).
Treatment of anaphylactic shock
Therapeutic measures for anaphylactic shock are aimed at the earliest elimination of dysfunctions of vital organs and body systems.First of all, it is necessary to eliminate contact with the allergen (stop the administration of the vaccine, drug or radiopaque substance, remove the wasp sting, etc.), if necessary, limit the venous outflow by applying a tourniquet to the limb above the injection site or stinging by insects, and prick this place with an adrenaline solution and apply cold. It is necessary to restore the patency of the airways (introduction of an airway, urgent tracheal intubation or tracheotomy), to ensure the supply of pure oxygen to the lungs.
Injection of sympathomimetics (adrenaline) is performed subcutaneously again followed by intravenous drip until the condition improves. In severe anaphylactic shock, dopamine is injected intravenously in an individually selected dose. The emergency care regimen includes glucocorticoids (prednisone, dexamethasone, betamethasone), infusion therapy is carried out, which makes it possible to replenish the circulating blood volume, eliminate hemoconcentration and restore an acceptable level of blood pressure.Symptomatic treatment includes the use of antihistamines, bronchodilators, diuretics (according to strict indications and after stabilization of blood pressure).
Inpatient treatment of patients with anaphylactic shock is carried out within 7-10 days. In the future, observation is necessary to identify possible complications (late allergic reactions, myocarditis, glomerulonephritis, etc.) and their timely treatment.
Forecast and prevention
The prognosis for anaphylactic shock depends on the timeliness of adequate therapeutic measures and the general condition of the patient, the presence of concomitant diseases.Patients who have had an episode of anaphylaxis should be registered with a local allergist. They are issued an allergic passport with notes on the factors that cause anaphylactic shock. To prevent such a condition, contact with such substances must be excluded.
90,000 Help with anaphylactic shock
Anaphylaxis, or in other words anaphylactic shock, is a very life-threatening allergic manifestation.
How does anaphylaxis proceed
When an allergen enters the body, the immune system begins to produce immunoglobulins. The body’s sensitivity to the effects of foreign substances, allergens increases, which manifests itself in the form of edema, itching, and a decrease in pressure.
When the human body meets an allergen for the second time, anaphylactic shock may already occur. Immunoglobulins recognize a foreign substance (allergen), and mediators are injected by immune cells in large quantities, which causes an allergic manifestation already palpable by a person.
In the absence of qualified medical care, a lethal outcome can occur.
What causes anaphylactic shock
Any substance can become an allergen. Allergic reactions accumulate in the body and the range of active kamponets expands. If there have already been manifestations of allergies, then an allergist immunologist is needed to prevent unexpected and sad consequences in the near future.
Can cause reaction:
- Preparations for the treatment of bacterial infections;
- Medicines which reduce skeletal muscle tone;
Meat products may contain muscle relaxants and cause reactions.
Insect bites . If a person is bitten by insects such as wasps, bees, anaphylactic shock may occur.
Food products. The most allergenic are citrus fruits, milk, seafood, nuts, and various food additives.
Pollen. Flower or grass pollen can cause anaphylaxis.
Helminths. Parasitic diseases often cause an allergic reaction caused by the waste products of helminths.
Excessive muscle work. Heavy sports training can cause anaphylaxis. Especially in combination with the use of various kinds of drugs.
Symptoms of anaphylaxis
When an allergen enters the human body, the reaction can be immediate, or it can occur within a few minutes.
The severity of the reaction depends on the time of its occurrence after contact with the allergen. The sooner the onset, the harder the reaction itself will be.
- the appearance of the fear of death;
- fever, itching;
- weakness, lethargy, malaise, loss of consciousness;
- asphyxiation, suffocation;
- reduced pressure.
Anaphylaxis can develop in different ways:
- breathing is impaired – narrowing of the lumen of the small bronchi, narrowing of the larynx, Quincke’s edema;
- Disruption of the gastrointestinal tract;
- convulsions, severe nausea, urinary incontinence;
- pain in the region of the heart, palpitations, a sharp decrease in blood pressure.
The number of allergens received by the body does not matter. Even small doses can cause severe reactions.
First aid for anaphylaxis
In such a difficult situation, only immediate qualified medical assistance can help. It can save a person’s life.
Algorithm of actions
- Stop the intake of the substance that caused anaphylactic shock (contact, administration of the substance, food, inhalation of vapors and other options).In case of an insect bite, it is necessary to immediately remove the sting and apply ice to the affected area. If food has caused anaphylaxis, then you need to remove its remnants from the oral cavity.
- Calling an ambulance In such a difficult situation, calling an ambulance is mandatory, regardless of the symptoms with which anaphylactic shock occurs. The shock can be biphasic and may recur in 1-3 days.
- To alleviate the condition, the patient should lie on his back with legs raised above the head.
- In case of nausea, the patient’s head should be turned to the side in order to prevent vomiting from entering the respiratory organs.
- Open windows for a stream of fresh air, unfasten the patient’s clothes to facilitate breathing.
- Cleansing the mouth to facilitate breathing.
- If you have dentures, you need to remove them. If there is mucus in your mouth after vomiting, you need to clear your mouth with water.
- Check breathing, pulse. If there is no pulse, artificial heart massage is required.If the patient stops breathing, the artificial respiration process will be of little effect due to laryngeal edema. An intramuscular injection of 0.1% adrenaline solution can help the patient, save his life.
If a person has had anaphylactic shock before, he should always have a syringe pen containing a single dose of adrenaline with him.
In the medical center “Heratsi”, there is an allergist-immunologist who will help to find out the causes of your allergic reactions and help prevent anaphylactic shock.He will give all the necessary recommendations and a treatment plan. We can take all tests for allergens. The doctor conducts an appointment at home and in the clinic (in Zapadny and Aleksandrovka). The cost of the services of the medical center can be viewed in the “Price” section or by calling the round-the-clock hotline +7 (863) 320-19-87.
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90,000 Doctors have called the “iron” grounds for medical removal from vaccination against COVID-19 :: Society :: RBC
Food allergies (for example, to strawberries or honey), pollen or dust allergies are not a contraindication to vaccination, the allergist-immunologist Vladimir Bolibok told RBC. According to him, Russian vaccines against coronavirus are hypoallergenic, because their components do not intersect with food, pollen, mold or household dust. “They are free of antibiotics, preservatives, chicken eggs, yeast, bacterial lipopolysaccharides, which is what happens in other vaccines and can cause cross-allergies,” he explains.Urticaria (dermatitis of allergic origin) is not a contraindication to vaccination, Oksana Drapkina, the chief freelance specialist in therapy of the Ministry of Health of Russia, said earlier.
What vaccine manufacturers and the Ministry of Health say about contraindications due to allergies:
- “GamKovidVak” (“Sputnik V”) : history of severe allergic reactions, hypersensitivity to any component of the vaccine or a vaccine containing similar components; with the introduction of the second component – severe post-vaccination complications for the first component of the vaccine.
- “Kovivac” : serious post-vaccination reaction or complication to any previous vaccine in history, aggravated allergic history (anaphylactic shock, angioedema, polymorphic exudative eczema, hypersensitivity or allergic reactions to vaccines, in anamnesis .
- “EpiVacCorona” : hypersensitivity to the components of the drug (aluminum hydroxide and others), severe forms of allergic diseases, reaction or post-vaccination complication to the previous vaccine administration.
Sources: instructions for vaccines “GamCovidVac” (“Sputnik V”), “Kovivac”, “EpiVacCorona”, recommendations of the Ministry of Health.
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The second serious contraindication is if a person has experienced with a serious reaction to previously administered vaccines. This reaction can be expressed as a high and prolonged temperature, redness and swelling at the injection site larger than 8 cm.
In general, a slight increase in temperature often accompanies vaccination and may not be a contraindication to vaccinations in the future, explains Kondrakhin.Only the really high temperature matters, above 40 ° C. In addition, according to him, the vaccine is not always regarded as the cause of the temperature. “A strong general reaction is an increase in body temperature above 40 ° C in the post-vaccination period. In this case, an increase in temperature associated with the vaccination occurs up to three days after vaccination with inactivated drugs and in the period from the fifth to the 15th day after the introduction of the live vaccine. Fever outside these deadlines is not related to vaccination, ”said the therapist.
According to him, collaptoid reactions (manifestations of vascular insufficiency, which resemble shock in pathogenesis and clinical signs – RBC ) and febrile, that is, caused by a sharp jump in body temperature, convulsions are referred to severe side effects, sometimes resulting from vaccines.
An allergic reaction to the previous administration of the same vaccine is also a contraindication, says Vladimir Bolibok, an allergist-immunologist.
“For example, we vaccinate children with DPT, if any reaction occurs (most often the pertussis component causes a reaction), then the next time the child is vaccinated with any other vaccine without the pertussis component,” the expert gives an example.In the case of a vaccine against coronavirus infection, you need to look at which vaccines and their components a person has already had an allergic reaction before, and analyze each specific case, he said.
In each case when people have had reactions to other vaccines, you need to understand separately, agrees Kondrakhin. “In some cases, it is better to get vaccinated, because it will be difficult for a person to transfer a new coronavirus infection,” warns the therapist.
According to the head of the temporary covid hospital at the clinical hospital “Russian Railways Medicine” named afterON THE. Semashko of Professor Zaur Shugushev, the officially approved contraindications of the Ministry of Health do not change. “Severe allergic reactions such as anaphylactic shock, severe systemic diseases, but not mild diseases,” Shugushev told RBC.
The Rassvet Clinic notes in the recommendations regarding vaccination against COVID-19 that anaphylactic shock to other vaccines in the past implies an increase in the observation interval for such a patient from the standard 30 minutes to 2 hours.
The Moscow mayor’s office gave advice to people with a medical withdrawal from vaccinations
Temporary contraindications to vaccination
The recommendations of the Ministry of Health, which speak of contraindications for those who have an exacerbation of a chronic disease or an acute phase of infectious diseases, are considered temporary by doctors, explains the professor, head of the laboratory for vaccine prophylaxis and immunotherapy of allergic diseases at the N.N.I. Mechnikov RAMS Mikhail Kostinov.
“They are given for two to four weeks and are associated with an exacerbation of any disease in humans. After he gets well, in a week or two, you can vaccinate. And yet, if a person now has a respiratory illness, two to four weeks after it, you can get a vaccine, ”says Kostinov. Kostinov calls an absolute contraindication for vaccination against COVID-19 only “severe allergy” in the form of anaphylactic shock to the administration of the first dose of the same vaccine.
What vaccine manufacturers and the Ministry of Health say about temporary contraindications:
- GamKovidVak (Sputnik V). Acute infectious and non-infectious diseases, exacerbations of chronic diseases – vaccination is carried out two to four weeks after recovery or remission. With mild ARVI, infectious diseases of the gastrointestinal tract, vaccination is carried out after the temperature has returned to normal.
- Kovivak. Acute febrile conditions, acute infectious and non-infectious diseases.In case of mild ARVI, vaccination can be carried out after normalization of temperature and / or disappearance of acute symptoms of the disease. In chronic diseases, vaccination is carried out during the period of remission in agreement with the attending physician.
- EpiVacCorona. Acute infectious and non-infectious diseases, chronic diseases in the acute stage – vaccinations not earlier than one month after recovery or remission. With mild ARVI, infectious diseases of the gastrointestinal tract, vaccination is carried out after the temperature has returned to normal.
Sources: instructions for vaccines “GamCovidVac” (“Sputnik V”), “Kovivac”, “EpiVacCorona”, recommendations of the Ministry of Health.
By itself, a chronic disease is not a contraindication, but its aggravation in a certain period is a contraindication, agrees Tatyana Romanenko, the head physician of the clinic “Your Doctor”. The category of patients with a temporary withdrawal from vaccination can also include those who have had a coronavirus infection in the past six months, as well as those who have recently undergone surgery, according to therapist Kondrakhin.
WHO head announced the victory of new strains of coronavirus in the race with vaccines
A temporary medical waiver from vaccination can also be obtained by people who want to consult with a narrow specialist about whether they can be vaccinated against COVID-19, says allergist Bolibok.So, for example, if previously there were allergies to vaccinations, then the issue should be resolved together with an allergist.
“The patient may say before the examination that he had a reaction to the previous administration of such and such a vaccine. And the therapist who examines the patient before vaccination can give a temporary medical appeal for a specific period until the specialist confirms or does not confirm this decision, ”says Bolibok.
Contraindications that relate to patients with chronic diseases can also be considered as a temporary withdrawal from vaccination, such people need to discuss vaccinations with their attending physicians, says general practitioner Albina Strelchenko.
“Most chronic diseases are not a contraindication for vaccination. For example, a cardiovascular disease, a person suffers from arterial hypertension, he has the right therapy, he observes everything, why not vaccinate him? There are no contraindications, ”she says. The same applies to diabetes as long as the person follows the prescription of the attending physician.
However, in some cases, you still have to contact specialized specialists. “If, for example, systemic diseases like rheumatoid arthritis, people on hormones, constant changes in dosage, then, of course, only a narrow specialist.We need to see who has what, the decision depends on the severity of the disease, the degree of its severity – there is no single template for everyone, ”Strelchenko is sure. The same applies to oncological diseases; in this case, only an oncologist can advise.
Pregnancy and breastfeeding
The period of breastfeeding of the child and pregnancy were indicated as contraindications in the instructions for all three Russian vaccines – vector “GamKovidVac”, peptide “EpiVacCorona” and inactivated vaccine “Kovivac”, follows from the data of the State Register of Medicines.
However, on July 6, the latest recommendations of the Ministry of Health (.pdf) regarding vaccination against COVID-19 were published. The document no longer states that pregnancy is a contraindication for the use of GamCovidVac (Sputnik V); this item was excluded from the list of contraindications.
It is recommended to vaccinate pregnant women after the 22nd week, it follows from the fourth version of the guidelines (.pdf) of the Ministry of Health on the organization of medical care for coronavirus infection for pregnant women and newborns, also published on July 6.For unvaccinated pregnant women with COVID-19, the rate of premature birth is higher, the risk of developing a sudden critical condition. If a woman has any chronic diseases or obesity, the chance of developing a severe course of COVID-19 increases.
Clinical data on the use of the drug “Sputnik V” in women who are breastfeeding are not yet available, so the risk for breastfed babies cannot be ruled out.
The Ministry of Health allowed the use of “Covid-globulin” in pregnant women
During pregnancy, women take a certificate from the obstetrician-gynecologist with whom they are registered, and provide this certificate to the employer or to the clinic, therapist Albina Strelchenko explained to RBC.
How to get a certificate of medical recusal
To start your journey for a certificate of medical exemption from vaccination, it is worth contacting a therapist, says Andrei Kondrakhin. “If a person has had an allergic reaction, then, as a rule, he already has a certificate. If this certificate is not available, then the therapist makes his conclusion on the basis of the discharge, which is in the medical history, ”the doctor explains.
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90,000 When can vaccinations be allowed and when not?
Here is a list of FALSE vaccinations
Perinatal encephalopathy .This is a collective diagnosis that combines temporary residual manifestations of mild CNS damage during pregnancy and childbirth: changes in muscle tone, sleep disturbances, delay in the formation of mental and motor skills. For safe vaccination, it will be enough to be examined by a neurologist at dispensary terms to exclude a progressive process.
Stable neurological conditions (epilepsy with adequate therapy, cerebral palsy, Down syndrome, etc.) – the risk of post-vaccination reactions and complications does not exceed that in the general population.
Not severe anemia is not a reason to prohibit or postpone vaccinations. In parallel with vaccination, anemia is treated. Severe anemia can be a temporary medication against vaccination in order to identify its causes and select therapy.
“Dysbacteriosis” is not a medical treatment or even a diagnosis in the practice of a modern doctor. Changes in the composition of microflora in the analysis of feces is not a reason either for diagnosis or for postponing vaccinations.
Increase in the shadow of the thymus on the radiograph .This is usually an incidental finding on chest x-ray. It is a variant of the norm or the result of temporary post-stress hyperplasia of the thymus (for example, after ARVI). It does not affect the effectiveness of vaccination, the risk of complications from it does not increase.
Allergic diseases . With the exception of anaphylactic reactions to previous administration of specific vaccines or to their components, allergic pathology is not a permanent contraindication. Vaccinations are administered against the background of the maximum achievable remission (at least even against the background of the use of drugs, sometimes immunosuppressive drugs).
Allergy to chicken egg protein of any severity is not a contraindication to the administration of measles-rubella-mumps vaccine according to Western protocols (USA, UK, Australia). However, in the Russian instructions for measles vaccines, hypersensitivity / severe allergic reactions / anaphylaxis to chicken egg protein are contraindicated.
Congenital malformations , including heart defects – also frequent false medical withdrawals.
Treatment of chronic disease , including antibacterial and hormonal drugs – as a rule, not an obstacle to vaccinations.Sometimes, with systemic hormone therapy, the issue is resolved in conjunction with an allergist. Local hormone therapy (skin, inhalation) should not be a reason for medical removal.
History of severe illness . Infants who have undergone serious illnesses after birth (sepsis, pneumonia, severe jaundice) and have recovered are vaccinated in the usual or catch-up mode.
An unfavorable family history is not a reason to withdraw from vaccinations. For example, severe post-vaccination reactions or complications in parents, brothers, sisters do not predispose the child to similar consequences.An exception may be BCG vaccination.
Anaphylactic shock: what to do?
Anaphylactic shock is the most formidable allergic complication.
Reasons. Almost any drug or prophylactic agent can cause shock reactions. Only some of them cause this reaction more often, others less often. It depends on the properties of the drug (the degree of its allergenicity), frequency of use, routes of administration into the body, and other reasons.
Contributing factors. Drug anaphylactic shock develops, as a rule, in patients treated with any drug repeatedly, as well as in patients suffering from allergic diseases (bronchial asthma, hay fever, neurodermatitis, urticaria, other manifestations of allergy).
Symptoms. Symptoms of shock are diverse, and the degree of this manifestation of a drug disease ranges from a few seconds or minutes to 2 hours. Some patients after injection only have time to say that they are “bad”, that “the whole body seemed to have burned with nettles,” after which they lose consciousness.Most patients complain of sudden onset of weakness, a feeling of tightness in the chest, dizziness, headache, a feeling of heat in the body. At the same time, suffocation with severe bronchospastic syndrome, fear of death, decreased vision, hearing loss, severe itching or a feeling of heat throughout the body occur. The patient notes the urge to stool and urination, nausea, vomiting, abdominal pain. This is followed, although not always, by loss of consciousness.
When examining a patient, attention is drawn to cold sweat, dilated pupils, convulsions, foam at the mouth, cyanosis or sharp flushing of the skin (pallor is extremely rare).The skin may have itchy rashes, frequent threadlike pulse, low or undetectable blood pressure. Dry wheezing sounds are heard in the lungs, heart sounds are muffled.
In severe cases, symptoms of collapse immediately appear: cold extremities, pulse cannot be felt, blood pressure cannot be determined. Severe collapse with anaphylactic shock can be combined with loss of consciousness, the development of a coma. In such cases, death may occur a few minutes after the onset of shock.
In addition to the described options for the development of anaphylactic shock, almost immediately after and administration of the drug, an equally severe picture of anaphylactic shock may develop 20-40 minutes after injection. A particular danger of the development of such a variant of anaphylactic shock is that in this time interval the patient’s well-being often remains good, the patient is not under the supervision of medical personnel and the possibility of providing timely assistance is reduced.
Treatment and care. The basic rule of therapy is that emergency care for anaphylactic shock should be provided without delay, with particular speed and precision in the implementation of prescriptions.
From medications, 0.5-1.0 ml of 0.1% adrenaline solution is injected subcutaneously or intramuscularly, and at the same time 125 mg of hydrocortisone or 60 mg of prednisolone is intramuscularly administered. Additionally, as a means of combating vascular collapse, you can enter subcutaneously 2 ml of cordiamine or 2 ml of 10% caffeine solution.
The patient should be laid down with his head turned to the side, and the lower jaw should be held in order to avoid asphyxiation by vomit. (If the patient has false dentures, they must be removed!) Above the injection site, it is necessary (if possible) to apply a tourniquet, and prick the place itself with 0.1% adrenaline solution (1.0-0.5 ml) and apply ice to it to reduce the absorption of the drug – the allergen. After that, you should put a dropper and start intravenous administration of 1-2 ml of a 0.2% solution of norepinephrine and 120 mg of prednisolone in 200 ml of isotonic sodium chloride solution or 400 ml of polyglucin.With severe bronchospasm, 10 ml of a 2.4% solution of aminophylline is added to the dropper, and with the development of left ventricular heart failure – 0.5 ml of a 0.05% solution of strophanthin.
If breathing is disturbed, 1 ml of 1% lobelin solution is injected into a vein, and with an increase in stridor breathing and asphyxia due to laryngeal edema, a tracheotomy is performed.
A patient in a state of anaphylactic shock with severe hemodynamic disorders should be covered with warmth, heated with heating pads and given oxygen.
When stopping anaphylactic shock, one should not forget that repeated administration of adrenaline should be carried out under the control of blood pressure and the state of cardiac activity, since a sharp overdose of the drug can cause ventricular fibrillation of the heart, which in itself can cause death of the patient.
After providing emergency care, the patient should be hospitalized.
It must be remembered that transportation of the patient is possible only after the relief of the main manifestations of shock and the normalization of blood pressure.When transporting a patient in case of insufficient intensive care, a drop in blood pressure or sharp agitation may again occur, therefore, during transportation, all the necessary drugs and syringes must be ready.
The outcome of anaphylactic shock is determined by timely and adequate therapy. Therefore, in the treatment rooms and at the posts of nurses, it is necessary to have special sets of medicines to combat anaphylactic shock and ready-to-use syringes and droppers (it is best to use single-use droppers and syringes in such cases).
Forecast. Mortality in anaphylactic shock ranges from 10 to 30%. It depends on the severity of concomitant diseases, the correctness and timeliness of shock treatment.
All patients who have suffered anaphylactic shock require dispensary supervision of an allergist.
Prevention. In the prevention of drug-induced anaphylactic shock, the role of the doctor is, first of all, not to prescribe medications without sufficient justification, and first of all those to which there is an allergy.
The most important preventive measure is the collection of a targeted allergic history.
It is always necessary to inform the patient about the upcoming administration of an antibiotic or other agent. In patients with suspected drug allergy, provocative sublingual test with 1/4 of a single therapeutic dose of the drug is of greatest practical importance. The absence of a systemic reaction (swelling of the frenum of the tongue, lips, itching, rashes) within 30 minutes eliminates the likelihood of an unexpected anaphylactic reaction.
In the case of the proposed parenteral administration of the antibiotic, the test consists in the introduction of small doses of the drug intradermally. The absence of a skin reaction indicates that the drug is well tolerated.