Final paper on: Anaphylaxis
Smith
29 November 2010
Anaphylaxis
Anaphylaxis is one of the most dangerous allergic reactions, which can be a life-threatening emergency. It comes from the Greek words: ava (against) and phylaxis (protection).
It is simply defined as an exaggerated allergic reaction to a foreign protein resulting from previous exposure to it. It can be described as ‘an acute allergic response resulting in respiratory failure, pump failure, vasodilation, capillary leakage, and tissue damage’ (Eaton 1999) Although severe cases of anaphylaxis can occur within seconds or even minutes of exposure and be fatal if untreated, many reactions are milder and can be treated with prompt medical therapy.
There are many types of anaphylactic allergic reactions. Anaphylaxis can be triggered by foods: milk, egg, peanut, tree nuts, fish, shellfish, soy, and wheat. Drugs: penicillin (being the number one in medications), non-steroidal anti-inflammatory drugs (including aspirin, ibuprofen and naproxen), cephalosporin, morphine, human papilloma-virus vaccination (HPV), local and general anesthesia, anti-arthritic drugs, IV contrast dye, and anti-seizure medications. Venom from stings/bites: honeybees, bumblebees, yellow jackets, hornets, wasps, and fire ants. Over exertion which is an ‘exercise-induced anaphylaxis (EIA) is a unique subset of anaphylactic reactions’ (Malde B., & Ditto A. 2004) and latex, studies show that some people with a latex allergy will also develop reactions when eating foods that cross-react with latex, such as bananas, kiwi, avocados, European chestnuts, and, less commonly, potatoes, tomatoes, and peaches, plums, cherries, and other pitted fruits. ‘Peanuts are a frequent cause of food allergy and the most common cause of fatal food-induced anaphylaxis in the U.S.’ (Finkelman FD 2010)
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The immune system plays a vital role in protecting the body from infection. Anaphylactic shock occurs as a result of the immune system’s lack or inability to fight off infection because of the severe allergic reaction. During an anaphylactic episode, the body’s immune system is severely compromised and affects multiple body systems including the skin: rash, hives, itching, flushing, and swelling of lips, tongue or throat (causing difficulty breathing).
Respiratory: bronchiole constriction, wheezing, strider, low oxygen. Gastrointestinal: cramping, pain, diarrhea and vomiting. Heart and vasculature: vasodilatation and low blood pressure, circulatory collapse, coronary artery spasm, myocardial infarction or dysrhythmia, and the Central Nervous System: loss of consciousness or coma, and death being the manifestation or indication of shock.
Michael, one of my best friends of nine years told me his near life taking story of him being bitten by fire ants. Michael said, living in Costa Rica most of his life he had been bitten by fire ants multiple times, but never had an allergic reaction to them before. He soon had joined the military and had to do a field exercise where they were low crawling on the grown when someone in front of him had kicked an ant hill. Michael was then bitten by about 8 or 10 fire ants. He brushed them off thinking nothing of it since he had been bitten by them before.
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The troops were told to sit and wait on instructions when he started to itch all over. One of his fellow soldiers looked at him and was in shock to see him all covered in hives. That’s when Michael started to feel his body temperature rise. He then informed his drill Sergeant of what he believed was going on with him. The Sergeant radioed in for the medics to pick him up and told him to have a seat and drink some water to try and reduce his body temperature. Mike said he then began to feel his chest get tight and started having hard time breathing and then passed out. He awoke in the military jeep when he opened his eyes, he was blind and all he could see was a white haze.
Michael became paralyzed and could not move his body. They carried him into the ER where he could hear but still not move. The doctor noticed that Mike could blink his eyes and told him to communicate with him by blinking once for yes and blinking twice for no. He was told he was going to be injected with several shots and would fall asleep within seconds and passed out immediately. He awoke 3 days later and was informed that he had flat lined and went into a coma. Michael recovered and was shipped out of Georgia where he believes he is very allergic to those fire ants and nowhere else. Since then, he has not had any encounter with fire ants or any other allergen.
A family pet also had an anaphylactic episode. Her name was Sarabi. At around 2 years old Sarabi suffered from an anaphylactic shock after receiving approximately four to five stings from bees. Her symptoms progressed quickly from being a rash with golf ball sized masses all over her body, to softball sized masses on either side of her neck. These bites quickly compromised her breathing to the point that she collapsed. She was presented to the emergency veterinarian in a semi-conscious state and received steroidal and non-steroidal anti-inflammatory drugs and epinephrine intravenously. She recovered after an evening under constant medical supervision and was released home the following day. Sarabi suffered three or four acute reactions but later became desensitized to the insect stings and no longer required medical attention. In fact, she never was deterred from biting bees despite the effect they had on her.
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Anaphylaxis is diagnosed based on the rapid development of symptoms in response to a suspect allergen. Identification of the allergen may be done with RAST testing, a blood test that identifies IgE reactions to specific allergens. Skin testing may be done for less severe anaphylactic reactions. As of today there is one universally accepted treatment for acute anaphylaxis, Epinephrine. Epinephrine is both an alpha and a beta agonist. Epinephrine will directly counteract the potentially life threatening aspects of anaphylaxis. Epinephrine can, and is, used in the both the pre-hospital environment as well as in definitive pre-hospital care. One of ‘the most important initial treatments, and one that can be overlooked in the rush to treat anaphylactic symptoms, is the need to remove the causative agent’. (Gavalas et al 1998) ‘When no cause can be identified, the patient is termed to have idiopathic anaphylaxis, which is a diagnosis of exclusion’. (McGrath KG 2002)
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References
Eaton CJ (1999) Immediate medical care. Second Edition. London, Churchill Livingstone
Malde, B., & Ditto, A. (2004). Anaphylaxis. Allergy And Asthma Proceedings: The Official
Journal Of Regional And State Allergy Societies, 25(4 Suppl 1), S52-S53. Retrieved from
MEDLINE with Full Text database.
Finkelman FD. Curr Opin Immunol. Peanut allergy and anaphylaxis.
(Nov 2, 2010) [Epub ahead of print]PMID: 21051210 [PubMed – as supplied by publisher]
(http://www.ncbi.nlm.nih.gov/pubmed)
Gavala M et al (1998) Guidelines for the management of anaphylaxis in the emergency
Department. Journal of Accident and Emergency Medicine. 15,2,96-98
McGrath KG. Anaphylaxis. In Patterson’s Allergic Diseases, 6th ed.
Grammer LC, and Greenberger PA (Eds).
Philadelphia: Lippincott,
Williams & Wilkins, 529–554, (2002).
