Drugs for the treatment of anaphylactic shock. Anaphylactic shock. Causes, symptoms, treatment of shock How anaphylactic shock develops

Anaphylactic shock is the most severe manifestation of an allergic reaction. Anaphylaxis develops rapidly, sometimes doctors do not have time to help the patient, and he dies from suffocation or cardiac arrest.

The outcome of shock depends on timely assistance provided and the correct actions of the doctor.

Anaphylaxis (anaphylactic shock)- this is an instantaneous type, which is expressed in a sharp increase in the body’s sensitivity to both the re-introduced allergen and the substance that first entered the body. The reaction develops at a speed from a few seconds to a couple of hours.

The concept was first defined at the beginning of the 20th century by the Russian scientist A.M. Bezredka. and the French immunologist Charles Richet, the latter receiving a Nobel Prize for his discovery.

The severity of anaphylaxis is not affected by either the route of entry of the allergen or its dose. Shock can develop from a minimal amount of a medicine or product.

Most often, anaphylaxis manifests itself as a reaction to drugs, in which case the fatal outcome is 15-20%. Due to the increase in the number of sufferers, there has been an increase in the number of cases of anaphylaxis in recent years.

How does pathology develop?

The body's reaction to anaphylaxis goes through three successive stages:

• immunological reaction;
• pathochemical reaction;
• pathophysiological reaction.

Immune cells come into contact with allergens, releasing antibodies (G.E.Ig). Due to the effects of antibodies, the body releases histamine, heparin and other inflammatory factors. These inflammatory mediators spread throughout all organs and tissues. As a result, blood thickening occurs and its circulation is disrupted.

First, the peripheral circulation is disrupted, then the central circulation. As a result of poor blood flow to the brain, hypoxia occurs. The blood clots, heart failure develops, and the heart stops.

Causes

The main cause of anaphylactic shock is the entry of an allergen into the body. There are several main groups of allergens.

Medicines. The following types of drugs usually trigger anaphylaxis:

• antibiotics;
• contrasts;
• hormonal agents;
• serums and vaccines;
• non-steroidal anti-inflammatory drugs;
• muscle relaxants;
• blood substitutes.

• Adrenaline solution. Administered intravenously using droppers, constantly monitoring the pressure. The product has a complex effect, normalizes blood pressure, and eliminates pulmonary spasm. Adrenaline suppresses the release of antibodies into the blood.
• Glucocorticosteroids(dexamethasone, prednisolone). They inhibit the development of immune reactions and reduce the intensity of the inflammatory process.
• Antihistamines(Claritin, Tavegil, Suprastin). First they are administered by injection, then switched to. These drugs suppress the action of free histamine, which blocks the effects it produces. Antihistamines should be administered after blood pressure has normalized, as they can lower it.
• If the patient develops respiratory failure, he is given methylxanthines(caffeine, theobromine, theophylline). These drugs have a pronounced antispasmodic effect, relax smooth muscles, reduce bronchospasm,
• To eliminate vascular insufficiency, administer crystalloid And colloidal solutions(ringer, gelofusin, riopolyglucin). They improve blood microcirculation and reduce its viscosity.
• Diuretic (diuretic) drugs(furosemide, minnitol) is used to prevent pulmonary and cerebral edema.
• Tranquilizers(Relanium, Seduxen) are used for severe convulsive syndrome. They eliminate feelings of anxiety and fear, relax muscles, and normalize the functioning of the autonomic nervous system.
• Local hormonal drugs(prednisolone ointment, hydrocortisone). They are used for skin manifestations of allergies.
• Absorbable ointments(heparin, troxevasin). Used to dissolve cones at bite sites.
• Inhalations humidified oxygen to normalize lung function and eliminate symptoms of hypoxia.

Treatment in the hospital lasts 8-10 days, then the patient is monitored to prevent complications.

Possible complications

Anaphylactic shock never goes away without a trace. The consequences of the disease can persist for a long time. Late complications may also occur.

The main complications of anaphylaxis:

• Pain in muscles, joints, stomach.
• Dizziness, nausea, weakness.
• Heart pain, shortness of breath.
• Long-term decrease in pressure.
• Deterioration of intellectual functions of the brain due to hypoxia.

To eliminate these consequences, the patient is prescribed:

• nootropic drugs (cinnarizine, piracetam);
• cardiovascular drugs (Mexidol, Riboxin).
• drugs that increase blood pressure (norepinephrine, dopamine).

Late complications of anaphylactic shock are very dangerous, they can lead to death or disability.

Late complications include:

• hepatitis;
• myocarditis;
• renal failure;
• glomerulonephritis (malignant degeneration of the kidneys);
• diffuse (extensive) damage to the nervous system;
• bronchial asthma;
• recurrent urticaria;
• systemic lupus erythematosus.

To prevent serious consequences during treatment, the functioning of the heart, kidneys, and liver is monitored. The patient is recommended to consult an immunologist and undergo immunotherapy.

Causes of death from anaphylaxis

With anaphylactic shock, conditions develop that directly threaten the patient’s life. Death occurs in 2% of cases due to untimely assistance.

Causes of death due to anaphylaxis:

• cerebral edema;
• pulmonary edema;
• obstruction of the respiratory tract.

Prevention

Prevention of anaphylactic shock can be primary and secondary. The primary one is aimed at preventing the development of any allergy, the secondary one is aimed at preventing the recurrence of shock.

Primary prevention methods:

• giving up bad habits (alcohol and smoking);
• caution in taking medications, any medications are taken as prescribed by a doctor, you cannot take several medications at the same time;
• reducing consumption of foods with preservatives;
• strengthening the immune system;
• timely treatment of any types of allergies;
• avoiding snake and insect bites;
• indication of the drugs that caused the allergy on the title page of the medical record.

If you are prone to allergies, it is advisable before taking medications.

To prevent recurrence of shock, the patient must observe the following safety measures:

• regularly clean the premises to remove dust and mites;
• do not have pets or have contact with them on the street;
• remove soft toys and unnecessary objects from the apartment so that dust does not collect on them;
• during the flowering period of plants, wear sunglasses, take antihistamines, avoid visiting places with a large number of allergenic plants;
• follow a diet, exclude foods that cause allergies;
• do not take medications that cause a pathological reaction;
• Do not swim in cold water if you have a cold allergy.
• The medical card must contain a note indicating that the patient experienced anaphylactic shock.

Anaphylactic shock is a deadly condition. It occurs unexpectedly and develops rapidly. The prognosis depends on timely provision of assistance and correctly selected therapy. The patient’s general health and the absence of chronic diseases are of great importance for recovery.

- this is, as a rule, an acute systemic allergic reaction, which is characterized by rapid development with signs and sharp decrease in pressure . Severe cardiovascular disease and is life-threatening for the patient.

The cause of anaphylactic shock is due to repeated contact with the allergen. The development of the reaction depends on the sensitivity of the body. So, in some cases, the reaction occurs within two minutes after contact, but it can develop within several hours. Very often, anaphylactic shock occurs when , when taking protein foods or administering medications that were previously observed .

The differences between anaphylactic shock and similar allergic reactions are its systemic nature, that is, the involvement of several organs, and the severity of the disease. Without timely help, such reactions end in death. Anaphylactic shock as a complication of drug allergy occurs on , anesthetics, non-steroidal anti-inflammatory drugs, vaccines, radiocontrast agents. Illness may occur even when testing these medications for a reaction.

Symptoms of anaphylactic shock

Typically, anaphylactic shock is characterized by the fact that its symptoms appear alternately. Typically, the first visual symptoms are hives , although in some cases there may be no urticaria. Next, hoarse “asthmatic” breathing and cough appear, as a consequence of the rapidly developing broncho - And laryngospasm , development and progression is possible. Also, blood pressure drops sharply and suddenly.

Very often, such general symptoms of anaphylactic shock as a feeling of heat, difficulty breathing, pain in the head and in the chest area appear. During a reaction, a person is excited and restless, but in rare cases he may also be lethargic and depressed. It is worth noting that depending on how this pathological condition develops, the patient may experience muscle cramps.

Emergency care for anaphylactic shock

The first thing to do, in view of the possibility, is to urgently stop the flow of allergen into the body. For example, if an allergy develops due to an insect bite, then it would be advisable to apply a tourniquet just above the bite site 1-2 cm and apply ice to the entry point of the insect sting. This significantly stops the flow of the allergen into the general blood stream and slows down the process of development of anaphylactic shock. An ambulance team is urgently called, and in the meantime the patient is placed in a supine position and freed from oppressive and constrictive clothing (tie, collars), thereby ensuring access to oxygen. If vomiting is possible, the patient's head should be turned to one side to prevent aspiration due to recessed tongue or vomit.

Treatment of anaphylactic shock

Treatment for anaphylactic shock, just like other allergic conditions, is symptomatic. To the patient parenterally , that is, subcutaneously, and best of all, from 0.2 ml to 0.5 ml of 0.1% in the form of hydrochloride (adrenaline solution) is administered intravenously. This is the first emergency aid for anaphylactic shock, so people prone to allergies should have this medicine with them. If necessary, you can repeat the injections, but be sure to monitor your heart rate and breathing.

Following the above drug, glucocorticoids , for example at a dosage of 150 mg. Also necessary in such a process as adequate treatment of anaphylactic shock is the use of antihistamines, that is, those that reduce the allergic reaction. The list of these drugs includes

Anaphylactic shock(from the Greek “reverse protection”) is a generalized rapid allergic reaction that poses a threat to human life, because it can develop within a few minutes. The term has been used since 1902, when it was first described in dogs.

The presented pathology occurs in women and men,

old people and children with the same frequency.

Death may occur

in approximately 1% of all patients.

Development of anaphylactic shock: causes

Various factors can cause anaphylactic shock: animals, medications, food.

The main causes of anaphylactic shock

State of anaphylactic shock in the body

The pathogenesis of the disease is quite complex and includes three successive stages:

immunological;

pathochemical;

pathophysiological.

The pathology is based on the contact of a specific allergen with immune cells, resulting in the release of specific antibodies (Ig E, Ig G). These antibodies provoke a large release of inflammatory factors (leukotrienes, prostaglandins, heparin, histamine, etc.). Then the factors of the inflammatory process penetrate into all tissues and organs, causing disruption of blood clotting and circulation in them to such serious complications as acute heart failure and cardiac arrest. Typically, the manifestation of any allergic reaction is possible only with repeated exposure to the allergen on the body. The danger of anaphylactic shock is that it can develop even if the allergen first enters the body.

Symptoms of anaphylactic shock

Variations in the course of the disease:

Abortion is the easiest option, in which there is no threat to the patient’s condition worsening. Anaphylactic shock does not provoke residual effects and is easily relieved.

Protracted – develops when using long-acting drugs (bicillin, etc.), so patient monitoring and intensive therapy need to be extended for several days.

Malignant (fulminant) - has a very rapid development of acute respiratory and cardiovascular failure in the patient. Regardless of the operation performed, it is characterized by mortality in 90% of cases.

Recurrent - has the character of repeated episodes of a pathological condition for the reason that, without the knowledge of the patient, the allergen continues to enter the body.

During the development of symptoms of the disease, doctors distinguish 3 periods:

Precursor period

At first, patients feel headache, nausea, dizziness, general weakness, and rashes on the mucous membranes and skin in the form of urticaria blisters may occur.

The patient complains of a feeling of discomfort and anxiety, numbness of the hands and face, lack of air, deterioration of hearing and vision.

High period

It is characterized by loss of consciousness, a drop in blood pressure, general pallor, increased heart rate (tachycardia), noisy breathing, cyanosis of the limbs and lips, cold sticky sweat, itching, urinary incontinence, or, conversely, cessation of urinary excretion.

Period of recovery from shock

May continue for several days. Lack of appetite, dizziness, and weakness in patients persist.

Severity of the condition

For mild flow

In mild cases of anaphylactic shock, warning signs usually develop within 10-15 minutes:

Quincke's edema of diverse localization;

burning and feeling of heat throughout the body;

rash, urticaria, erythema, itching.

The patient manages to tell others about his feelings during mild anaphylactic shock:

Feeling of lower back pain, headache, numbness of fingers, lips, tongue, dizziness, fear of death, lack of air, general weakness, decreased vision, pain in the abdomen, chest.

There is pallor or cyanosis of the facial skin.

Some patients may experience bronchospasm, characterized by difficulty in exhaling and loud wheezing that can be heard from a distance.

In most cases, abdominal pain, diarrhea, vomiting, defecation or involuntary urination are observed. But at the same time, the patients remain conscious.

Tachycardia, muffled heart sounds, thready pulse, sharply reduced blood pressure.

For moderate cases

Harbingers:

Involuntary urination and defecation, dilated pupils, pale skin, cold sticky sweat, cyanosis of the lips, urticaria, general weakness, Quincke's edema - as with mild cases.

Often – clonic and tonic convulsions, after which the person loses consciousness.

The pressure is not detectable or very low, bradycardia or tachycardia, muffled heart sounds, threadlike pulse.

Rarely - nosebleeds, gastrointestinal, uterine bleeding.

Severe course

There are five clinical forms of the disease:

Asphyxial - with this form of pathology, patients are dominated by signs of bronchospasm (hoarseness, difficulty breathing, shortness of breath) and respiratory failure; Quincke's edema often occurs (severe swelling of the larynx, the development of which can stop a person's breathing).

Abdominal - the predominant symptom is abdominal pain, which mimics the symptoms of a perforated gastric ulcer (due to spasm of intestinal smooth muscles) or acute appendicitis, diarrhea, vomiting.

Cerebral - this form is characterized by the development of edema of the brain and meninges, which manifests itself in the form of a state of coma or stupor, nausea and vomiting that does not provide relief, and convulsions.

Hemodynamic - the diagnostic symptom of this form is a rapid drop in blood pressure and pain in the heart region, which is similar to myocardial infarction.

Generalized (typical) is the most common clinical form of anaphylactic shock, which includes general manifestations of the disease.

Diagnosis of anaphylactic shock

It is necessary to diagnose pathology as quickly as possible,

After all, in many ways the patient’s life depends on the doctor’s experience.

The state of anaphylactic shock can easily be confused with other diseases; the main factor in making a diagnosis is the correct history taking!

Plain chest x-ray can detect inversial pulmonary edema.

A biochemical blood test determines an increase in kidney tests (urea, keratin), liver enzymes (bilirubin, alkaline phosphatase, ALT, AST).

A complete blood count may indicate anemia (decreased red blood cell count) and leukocytosis (increased white blood cell count) with eosinophilia (increased eosinophil count).

Enzyme immunoassay is used to determine specific antibodies (Ig E, Ig G).

If the patient is unable to name the cause of the allergic reaction, he is recommended to conduct allergy tests with consultation with an allergist.

First aid for anaphylactic shock: algorithm of actions

Lay the person on a flat surface, slightly raise his legs (for example, place a pillow or a rolled-up blanket under his feet).

Turn your head to the side to prevent aspiration of vomit, and pull dentures out of your mouth.

Open a door or window to allow fresh air to enter the room.

Carry out measures aimed at stopping the entry of the allergen into the patient’s body - remove the sting with poison, apply a cold compress to the injection or bite site, apply a pressure bandage above the bite site and other actions.

Feel the victim’s pulse: first on the wrist, and if absent, on the femoral or carotid arteries. If the pulse cannot be detected, an indirect cardiac massage should be performed - clasp your hands, place them in the middle of the sternum and perform rhythmic shocks up to 5 cm deep.

Check whether the patient is breathing: monitor the movements of the chest, place a mirror against the victim’s mouth. If there is no breathing, it is recommended to start artificial respiration using the “mouth to mouth” or “mouth to nose” technology, directing the air flow through a scarf or napkin.

Transport the person to the hospital yourself or immediately call an ambulance.

Emergency medical care algorithm for anaphylactic shock:

Monitoring vital functions - electrocardiography, determining oxygen saturation, measuring pulse and blood pressure.

Ensure airway patency - remove vomit from the mouth, remove the lower jaw using the triple Safar maneuver, and perform tracheal intubation. In case of angioedema or spasm of the glottis, it is recommended to perform conitocomy (performed by a doctor or paramedic in emergency cases, the essence of this manipulation is to cut the larynx between the cricoid and thyroid cartilages to ensure the flow of fresh air) or tracheotomy (performed only in medical institutions, doctor performs an incision of tracheal rings).

Administration of adrenaline in the proportion of 1 ml of 0.1% solution of adrenaline hydrochloride per 10 ml of physiological solution. If there is a specific place through which the allergen entered the body (injection site, bite site), it is advisable to inject it subcutaneously with a diluted solution of adrenaline. Next, 3 to 5 ml of solution should be administered sublingually (under the root of the tongue, since it is well supplied with blood) or intravenously. The remainder of the adrenaline solution should be diluted in 200 ml of saline and continued intravenous drip administration, while monitoring blood pressure levels.

Administration of glucocorticosteroids (adrenal hormones) - most often prednisolone (dosage 9-12 mg) or dexamethasone (dosage 12-16 mg) is used.

Administration of antihistamine drugs - first by injection, then with a transition to tablet forms (tavegil, suprasin, diphenhydramine).

Inhalation of humidified oxygen (40%) at a rate of 4 to 7 liters per minute.

When determining respiratory failure, it is recommended to administer aminophylline (5-10 ml) and methylxanthines - 2.4%.

As a result of blood redistribution, acute vascular failure develops. In this case, it is recommended to administer colloidal neoplasmazhel (gelofusin) and crystalloid (sterofundin, plasmalit, ringer-lactate, ringer) solutions.

In order to prevent pulmonary and cerebral edema, diuretics are prescribed - minnitol, torasemide, furosemide.

For the cerebral form of anaphylactic shock, tranquilizers (Seduxen, Relanium, Sibazon), anticonvulsants are prescribed - 25% magnesium sulfate (10-15 ml), 20% sodium hydroxybutyrate (GHB) 10 ml.

Anaphylactic shock: How not to die from allergies? video:

Consequences of anaphylactic shock

No disease goes away without a trace, and anaphylactic shock is one of them. After elimination of respiratory and cardiovascular failure, the patient may continue to have the following symptoms:

Abdominal pain, vomiting, nausea, heart pain, shortness of breath, chills, fever, muscle and joint pain, weakness, lethargy, lethargy.

Prolonged hypotension (low blood pressure) is treated with long-term administration of vasopressors: norepinephrine, dopamine, mesaton, adrenaline.

Pain in the hearts as a result of ischemia of the heart muscle - administration of cardiotrophs (ATP, riboxin), antihypoxants (Mexidol, thiotriazoline), nitrates (nitroglycerin, isoket) is recommended.

Decreased intellectual function due to prolonged cerebral hypoxia, headache - vasoactive substances (cinnarizine, ginko biloba, Cavinton), nootropic drugs (citicoline, piracetam) are used.

If infiltrates occur at the site of injection or bite, local treatment is recommended - ointments and gels with a resolving effect (lyoton, troxevasin, heparin ointment).

Sometimes late complications occur after anaphylactic shock:

Diffuse damage to the nervous system, vestibulopathy, glomerulonephritis, neuritis, allergic myocarditis, hepatitis are often the cause of death.

Approximately 2 weeks after shock, angioedema, recurrent urticaria and the development of bronchial asthma may appear.

Repeated contact with allergenic drugs leads to the development of diseases such as systemic lupus erythematosus and periarteritis nodosa.

Anaphylactic shock, what it is and how to deal with it, video:

Primary prevention of shock

It is based on preventing the body from contacting the allergen:

control over the quality production of medical devices and medicines;

elimination of bad habits (substance abuse, drug addiction, smoking);

combating chemical products that pollute the environment;

combating the simultaneous prescribing of huge amounts of medical drugs by doctors;

ban on the use of certain food additives (glumanate, agar-agar, bisulfites, tartrazine).

Secondary prevention of shock

Promotes early detection and timely treatment of the disease:

conducting allergy tests to determine a specific allergen;

timely treatment of eczema, hay fever, atopic dermatitis, allergic rhinitis;

indication in red ink on the outpatient card or the front page of the medical history of intolerable medications;

careful collection of allergy history;

monitoring patients for at least half an hour after injection;

conducting sensitivity tests of the body in relation to drugs administered intramuscularly or intravenously.

Tertiary prevention of shock

Prevents relapses of the disease:

use of a mask and sunglasses during the flowering period of plants;

careful control of food intake;

removing unnecessary upholstered furniture and toys from the apartment;

ventilation of premises;

frequent cleaning of rooms to remove insects, mites, and house dust;

compliance with personal hygiene rules.

Photos of the consequences:

How can doctors minimize the risk of anaphylactic shock in a patient?

In order to prevent illness, the main aspect is a carefully collected history of the patient’s diseases and life. To minimize the risk of its development from taking medications, you must:

Prescribe any drugs strictly according to indications, in the optimal dosage, taking into account compatibility and tolerability.

The age of the patient must be taken into account. Single and daily doses of antihypertensive, sedative, neuroplegic, and cardiac drugs for elderly people should be reduced by 2 times compared to doses for middle-aged people.

Do not administer multiple medications at the same time, only one medication. You can prescribe a new drug only after testing for its tolerability.

When prescribing several medications that are identical in chemical composition to pharmacological action, the risk of allergic cross-reactions should be taken into account. For example, if you are intolerant to promethazine, it is prohibited to prescribe its antihistamine derivatives (pipolene and diprazine); if you are allergic to anesthesin and procaine, there is a high probability of intolerance to sulfonamides.

Antibiotics must be prescribed taking into account the data of microbiological studies and determining sensitivity to microorganisms.

It is better to use distilled water or saline as a solvent for antibiotics, since the use of procaine often causes allergic reactions.

When treating, take into account the functional state of the kidneys and liver.

Monitor the content of eosinophils and leukocytes in the patient’s blood.

Before drug therapy, patients who have a tendency to develop anaphylactic shock 3-5 days and 30 minutes before the administration of the drug should be prescribed second and third generation antihistamines (Telfast, Semprex, Claritin), calcium supplements and corticosteroids - according to indications.

To be able to apply a tourniquet in case of shock above the injection, you need to administer the first injection of medication (1/10 of the dose, antibiotics in a dose of less than 10,000 units) into the upper third of the shoulder. If signs of intolerance appear, it is necessary to tightly apply a tourniquet above the injection site until the pulse stops below the application site, inject the injection site with an adrenaline solution (calculating 1 ml of 0.1% adrenaline along with 9 ml of saline), cover the area with ice or apply a cloth soaked cold water.

Treatment rooms should contain anti-shock first aid kits and tables containing a list of medications with common antigenic determinants that cause cross-allergic reactions.

Rooms for patients with anaphylactic shock should not be located near manipulation rooms. It is prohibited to place patients who have repeatedly experienced anaphylactic shock in the same ward together with those who are being administered drugs that cause allergies in the former.

To prevent the occurrence of the Arthus-Sakharov phenomenon, the injection site should be monitored (redness, swelling, itching of the skin; when injections are repeated in one area, skin necrosis).

For patients who have suffered anaphylactic shock upon discharge from the hospital, “anaphylactic shock” or “drug allergy” is marked in red ink on the title page of the medical history.

After discharge, patients who have suffered anaphylactic shock are referred to doctors at their place of residence to register at a dispensary and receive hyposensitizing and immunocorrective treatment.

Anaphylactic shock is an acute allergic process that develops in a sensitized body in response to repeated contact with an allergen and is accompanied by impaired hemodynamics, leading to circulatory failure and, as a consequence, acute oxygen starvation of vital organs.

Bronchospasm is one of the signs of anaphylactic shock

A sensitized organism is an organism that has previously been in contact with a provocateur and has increased sensitivity to it. In other words, anaphylactic shock, like any other allergic reaction, develops not on the first exposure to an allergen, but on the second or subsequent ones.

Shock is an immediate hypersensitivity reaction and is a life-threatening condition. The full clinical picture of shock develops in a period from a few seconds to 30 minutes.

Anaphylactic shock was first mentioned in documents dating back to 2641 BC. e. According to records, the Egyptian pharaoh Menes died from an insect bite.

The first qualified description of the pathological condition was made in 1902 by the French physiologists P. Portier and C. Richet. In the experiment, after repeated immunization, a dog that previously tolerated the administration of serum well, instead of having a preventive effect, developed acute shock with a fatal outcome. To describe this phenomenon, the term anaphylaxis was introduced (from the Greek words ana - “reverse” and phylaxis - “protection”). In 1913, these physiologists were awarded the Nobel Prize in Medicine and Physiology.

Diagnosis of anaphylactic shock is not difficult, since the connection between characteristic clinical manifestations and a previous insect bite, consumption of an allergenic product, or use of a drug is usually obvious.

Data from epidemiological studies indicate that the incidence of anaphylactic shock in the Russian Federation is 1 per 70,000 population per year. In patients with acute allergic diseases it occurs in 4.5% of cases.

Synonym: anaphylaxis.

Causes and risk factors

The cause of anaphylaxis can be various substances, most often of a protein or polysaccharide nature. The development of a pathological condition can also be provoked by low-molecular compounds (haptens or incomplete antigens), which acquire allergenic properties when bound to the host protein.

The main provocateurs of anaphylaxis are as follows.

Medicines (up to 50% of all cases):

• antibacterial drugs (most often natural and semi-synthetic penicillins, sulfonamides, Streptomycin, Levomycetin, tetracyclines);
• protein and polypeptide preparations (vaccines and toxoids, enzyme and hormonal agents, plasma preparations and plasma-substituting solutions);
• some aromatic amines (hypothiazide, para-aminosalicylic acid, para-aminobenzoic acid, a number of dyes);
• non-steroidal anti-inflammatory drugs (NSAIDs);
• anesthetics (Novocaine, Lidocaine, Trimecaine, etc.);
• radiopaque agents;
• preparations containing iodine;
• vitamins (mostly group B).

The second place in the ability to cause anaphylaxis is occupied by the bites of hymenoptera insects (about 40%).

The third group is food products (approximately 10% of cases):

• fish, canned fish, caviar;
• crustaceans;
• cow's milk;
• egg white;
• legumes;
• nuts;
• food additives (sulfites, antioxidants, preservatives, etc.).

The incidence of anaphylactic shock in the Russian Federation is 1 per 70,000 population per year.

The main provocateurs also include medicinal allergens, physical factors and latex products.

Factors that increase the severity of anaphylaxis:

• bronchial asthma;
• diseases of the cardiovascular system;
• therapy with beta-blockers, MAO inhibitors, ACE inhibitors;
• allergy vaccination (specific immunotherapy).

Forms

Anaphylactic shock is classified depending on the clinical manifestations and the nature of the pathological process.

In accordance with clinical symptoms, the following variants are distinguished:

• typical (mild, moderate and severe);
• hemodynamic (manifestations of circulatory disorders predominate);
• asphyxial (symptoms of acute respiratory failure come to the fore);
• cerebral (the leading ones are neurological manifestations);
• abdominal (symptoms of damage to the abdominal organs predominate);
• fulminant.

According to the nature of the course, anaphylactic shock occurs:

• acute malignant;
• acute benign;
• protracted;
• recurrent;
• abortive.

The International Classification of Diseases, 10th revision (ICD-10) offers a separate gradation:

• anaphylactic shock, unspecified;
• anaphylactic shock caused by a pathological reaction to food;
• anaphylactic shock associated with the administration of serum;
• anaphylactic shock caused by a pathological reaction to an adequately prescribed and correctly administered drug.

Stages

There are 3 stages in the formation and course of anaphylaxis:

1. Immunological – changes in the immune system that occur when an allergen first enters the body, the formation of antibodies and sensitization itself.
2. Pathochemical – release of mediators of an allergic reaction into the systemic circulation.
3. Pathophysiological – detailed clinical manifestations.

Symptoms

The time for clinical signs of shock to appear depends on the method of introducing the allergen into the body: with intravenous administration, the reaction can develop within 10-15 seconds, intramuscular - after 1-2 minutes, orally - after 20-30 minutes.

The symptoms of anaphylaxis are very diverse, however, a number of leading symptoms are identified:

• hypotension, up to vascular collapse;
• bronchospasm;
• spasm of smooth muscles of the gastrointestinal tract;
• blood stagnation in both the arterial and venous parts of the circulatory system;
• increased permeability of the vascular wall.

Mild anaphylactic shock

A mild degree of typical anaphylactic shock is characterized by:

• itchy skin;
• headache, dizziness;
• feeling of heat, hot flashes, chills;
• sneezing and mucus from the nose;
• sore throat;
• bronchospasm with difficulty exhaling;
• vomiting, cramping pain in the umbilical region;
• progressive weakness.

Anaphylactic shock is an immediate hypersensitivity reaction and is a life-threatening condition. The full clinical picture of shock develops in a period from a few seconds to 30 minutes.

Objectively determined are hyperemia (less commonly, cyanosis) of the skin, rashes of varying severity, hoarseness, wheezing, audible at a distance, decreased blood pressure (up to 60/30–50/0 mm Hg), threadlike pulse and tachycardia up to 120– 150 beats/min.

Moderate anaphylactic shock

Symptoms of moderate anaphylactic shock:

• anxiety, fear of death;
• dizziness;
• heartache;
• diffuse pain in the abdominal cavity;
• uncontrollable vomiting;
• feeling of lack of air, suffocation.

Objectively: consciousness is depressed, cold sticky sweat, the skin is pale, the nasolabial triangle is cyanotic, the pupils are dilated. The heart sounds are muffled, the pulse is threadlike, arrhythmic, rapid, blood pressure is not determined. Involuntary urination and defecation, tonic and clonic convulsions, and rarely bleeding of various locations are possible.

Severe anaphylactic shock

Severe anaphylactic shock is characterized by:

• lightning-fast deployment of the clinic (from a few seconds to several minutes);
• lack of consciousness.

Marked cyanosis of the skin and visible mucous membranes, profuse sweat, persistent dilation of the pupils, tonic-clonic convulsions, wheezing difficulty breathing with prolonged exhalation, and foamy sputum are noted. Heart sounds are not heard, blood pressure and pulsation of peripheral arteries are not determined. The victim, as a rule, does not have time to make complaints due to a sudden loss of consciousness; If medical attention is not provided immediately, there is a high probability of death.

Severity of anaphylactic shock:

When recovering from anaphylactic shock, victims experience weakness, lethargy, lethargy, severe chills, sometimes fever, muscle and joint pain, headache, stabbing pain and discomfort in the heart area.

Diagnostics

Diagnosis of anaphylactic shock is not difficult, since the connection between characteristic clinical manifestations and a previous insect bite, consumption of an allergenic product, or use of a drug is usually obvious.

Treatment

Treatment of shock begins directly at the site of its occurrence, without waiting for the victim to be transported to a specialized department. The outcome of shock is determined by the timeliness and adequacy of first aid measures. The patient should be placed with his legs elevated and his head turned to the side.

Careful monitoring of vital signs is necessary throughout the entire period of treatment and several hours after relief of shock, since clinical symptoms may recur within 24 hours.

In 50% of cases, anaphylactic shock is caused by taking medications.

Principles of therapy for anaphylactic shock:

• immediately stopping the allergen (for example, removing the insect sting or stopping the administration of the drug);
• relief of acute respiratory and hemodynamic disorders;
• compensation for developed adrenocortical insufficiency;
• neutralization of allergic mediators of anaphylaxis in the systemic circulation and antigen-antibody connections;
• maintaining vital functions or performing resuscitation measures if necessary;
• normalization of acid-base balance;
• increased total peripheral vascular resistance;
• replenishment of circulating blood volume.

Admission to the intensive care unit and 24-hour monitoring is indicated for patients with moderate to severe anaphylaxis and those living away from medical facilities (as comprehensive treatment continues for 72 hours).

After discharge, patients with anaphylaxis from insect bites are prescribed specific immunotherapy - a set of measures that reduce the body's sensitivity to the allergen by preventing the development or inhibition of sensitization (developing tolerance to the allergen by sequentially administering its microdoses in increasing concentrations).

Consequences and complications

Possible complications (may develop delayed, up to several weeks):

• allergic myocarditis;
• Quincke's edema;
• recurrent urticaria;
• pulmonary edema;
• myocardial infarction;
• heart failure;
• development of chronic allergic reactions;
• bronchial asthma;
• hepatitis;
• glomerulonephritis;
• “shock kidney”, “shock lung”, “shock liver”;
• bleeding of various locations;
• neuritis, diffuse damage to the nervous system, vestibulopathy;
• epilepsy;
• autoimmune diseases.

Up to 40% of patients experience a relapse of anaphylaxis over the next 2-3 years.

Forecast

With timely emergency care and adequate complex therapy, the prognosis is favorable. It worsens significantly when anti-shock measures are started 30 or more minutes after the development of anaphylactic shock.

Anaphylactic shock was first mentioned in documents dating back to 2641 BC. e. According to records, the Egyptian pharaoh Menes died from an insect bite.

Prevention

1. Avoid taking medications that have a history of causing allergic reactions or others that are cross-allergic to them.
2. Avoid treatment with drugs that have a high risk of developing anaphylaxis, especially in patients suffering from allergic diseases.
3. Avoid places with a high likelihood of contact with insects.
4. Avoid perfumes and cosmetics with intense odors.
5. Persons suffering from allergies should have a document with them indicating the diagnosis.
6. When conducting an X-ray examination using a radiopaque contrast agent, you must warn the doctor about your existing allergy history.
7. Patients with a history of allergies are recommended to give preference to oral forms of medications.
8. All patients who have experienced anaphylactic shock should have an epinephrine emergency kit and know how to use it.

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Anaphylactic shock always develops suddenly and lightning fast. Therefore, it requires equally lightning-fast actions.

What is anaphylactic shock and why is it dangerous?

Anaphylactic shock is an extremely severe form of allergy.

As with any allergy, the body, when faced with a substance that seems to be poison, begins to defend itself. And he does it so actively that he harms himself.

But in the case of anaphylaxis, the situation is special: the immune response to the irritant is so strong that not only the skin and mucous membranes are affected, but also the digestive tract, lungs, and cardiovascular system. The consequences can be extremely unpleasant:

• Blood pressure drops sharply.
• Swelling of tissues, including the larynx, quickly develops - breathing problems begin.
• The brain begins to experience acute oxygen starvation, which can lead to fainting and further disruption of vital functions.
• Due to swelling and lack of oxygen, other internal organs also suffer.

This combination of symptoms has serious complications and can be fatal. Therefore, it is important to quickly recognize anaphylaxis and provide first aid.

How to recognize anaphylactic shock

The first and one of the most important points when making a diagnosis is contact with the allergen. Be especially careful if the symptoms listed below develop after an insect attack, medication, or food. Even seemingly harmless cookies with peanuts can be an allergen.

Shock develops in two stages. The main warning signs of anaphylaxis look like this:

• The obvious skin reaction is redness or, on the contrary, pallor.
• Tingling in the arms, legs, near the mouth or all over the head.
• , itchy nose, desire to sneeze.
• Difficulty and/or wheezing.
• A lump in the throat that prevents you from swallowing normally.
• Abdominal pain, nausea, vomiting, diarrhea.
• Swollen lips and tongue.
• A clear feeling that something is wrong with the body.

Already at this stage it is necessary to take urgent measures (more on them below). And even more so, emergency assistance is necessary if anaphylaxis reaches the second, shock stage. Its symptoms:

• Dizziness.
• Sharp weakness.
• Paleness (the person literally turns white).
• The appearance of cold sweat.
• Severe shortness of breath (hoarse, noisy breathing).
• Sometimes .
• Loss of consciousness.

3 main rules of first aid for anaphylactic shock

1. Call an ambulance

This needs to be done as soon as possible. From a mobile phone call 103 or 112.

2. Administer adrenaline promptly.

Adrenaline (epinephrine) is injected intramuscularly to raise low blood pressure. This drug is sold in pharmacies in the format of auto-injectors - automatic syringes that already contain the required dose of medication. Even a child can give an injection with such a device.

As a rule, the injection is made in the thigh - the largest muscle is located here, it is difficult to miss.

Don't be afraid: adrenaline won't harm you Severe Allergic Reaction Treatment in case of a false alarm. But if done correctly it can save a life.

People who have already experienced anaphylactic reactions often carry epinephrine auto-injectors with them. If the victim is still conscious, be sure to ask if he has the medicine. Eat? Follow the instructions above.

There is no point in taking antihistamines: anaphylactic shock develops very quickly and they simply do not have time to act.

If the victim does not have adrenaline, and there are no pharmacies nearby, all that remains is to wait for the ambulance to arrive.

3. Try to make the person feel better

• Lay the victim on his back with his legs elevated.
• If possible, isolate the person from the allergen. If you notice that an allergic reaction has begun to develop after an insect bite or injection of any drug, apply a bandage above the bite or injection site to slow down the spread of the allergen throughout the body.
• Do not give the victim anything to drink.
• If vomiting is present, turn the head to the side to prevent the person from choking.
• If a person has lost consciousness and stopped breathing, start (if you have the appropriate skills) and continue until paramedics arrive.
• If the victim’s condition has improved, still make sure that he waits for an ambulance. Anaphylactic shock requires additional examination. In addition, the attack may recur.

Fortunately, in most cases, with timely medical assistance, anaphylaxis subsides. According to American statistics, deaths are recorded Fatal Anaphylaxis: Mortality Rate and Risk Factors only 1% of those who were hospitalized with a diagnosis of anaphylactic shock.

What can cause anaphylactic shock

There is no particular point in listing the reasons. Allergy is an individual reaction of the body; it can develop to factors that are completely harmless to other people.

But for the literalists, we will still provide a list of the most common triggers Allergy Attacks and Anaphylaxis: Symptoms and Treatment, in response to which anaphylactic shock occurs.

• Food. Most often - nuts (especially peanuts and forest), seafood, eggs, wheat, milk.
• Insect bites - bees, wasps, hornets, ants, even mosquitoes.
• Dust mites.
• Mold.
• Latex.
• Some medications.

Who is susceptible to anaphylactic shock?

The risk of developing anaphylactic shock is high in those Anaphylactic Shock: Symptoms, Causes, and Treatment, Who:

• I have already experienced a similar allergic reaction.
• Has any type of allergy or.
• Has relatives who had anaphylaxis.

If you belong to one of these risk groups, consult your physician. You may need to buy an epinephrine auto-injector and carry it with you.