Anaphylactic Shock: Pathophysiology and Implications for Treatment

Risk for Anaphylactic Reaction from Cardiac Catheterization in Patients Receiving β-Adrenergic Blockers or Angiotensin-Converting Enzyme-Inhibitors

BACKGROUND

β-Adrenergic blockers (BBs) have been associated with increased risk for severe anaphylactic reaction (AR) from contrast media; however, this was shown with intravenous contrast media, before widespread use of low osmolar contrast media, angiotensin-converting enzyme-inhibitors (ACE-Is), and cardioselective BBs.

OBJECTIVE

To assess the risk for AR during cardiac catheterization (CC) associated with BB or ACE-I exposure.

METHODS

Patients who experienced adverse reactions during CC from January 2004 to December 2013 were identified; 1 to 2 matched controls were assigned for each case. We analyzed AR rates in association with demographic variables, medication exposures (BBs, ACE-Is, angiotensin-receptor blockers, aspirin), and comorbidities: cardiovascular disorders, asthma, and atopy.

RESULTS

We analyzed 71,782 CCs. Of these, severe 70 reactors were identified-46 (0.06%) fulfilled AR criteria. There were 35 cases of mild to moderate AR and 11 cases of severe AR (0.015%). There were no significant differences in age (61.3% vs 61.5%), sex (63% vs 64% males), cardiovascular disorder rate (78% vs 93%), and exposure to BBs (46% vs 51%; cardioselective: 77% vs 80%) and ACE-Is (37.0% vs 37.2%) in cases versus controls. Via multivariate logistic regression, BB exposure was not associated with greater AR frequency (P = .35) or severity (P = .40). Neither cardioselective BBs (P = 0.2) nor noncardioselective BBs (P = .5) influenced AR severity. ACE-Is had no effect on AR frequency (P = .35) or severity (P = .14). Lower AR frequency was associated with cardiovascular disorder (P = .01).

CONCLUSIONS

In this case-control study, severe AR was rarely observed. Exposure to BBs or ACE-Is did not significantly influence AR frequency or severity; however, most BBs were cardioselective. Our findings imply that cardioselective BB or ACE-I suspension is not warranted in association with CC.

Post-mortem diagnosis of anaphylaxis: A difficult task in forensic medicine

The lack of reliable laboratory biomarkers and common standard definitions of signs and symptoms represents the main problem for clinicians when a suspected anaphylactic event must be diagnosed, while a post-mortem diagnosis of anaphylaxis is often a very difficult task in forensic medicine. Significant necroscopic signs as well as the data reported from witnesses or medical records may be absent, biological fluids as blood or urine may be unavailable or under thanatological modifications. The aim of this review is to focus on the diagnostic difficulties with which coroners and forensic pathologists have to cope when a confirmation of anaphylactic death is required by judicial authorities. Investigation methods for a prudent forensic diagnosis of anaphylactic death as well as the need of new potential laboratory or histological investigation techniques coming from immunological research are discussed too.

Anaphylaxis in the elderly

Anaphylaxis is a potentially fatal generalized hypersensitivity reaction leading to multiorgan dysfunction. It involves multiple mediators using several different pathways for the development of a systemic response. The elderly differ from other age groups in terms of the risk factors, causative agents and the development of compensatory mechanisms. The presence of comorbidities and polypharmacy has a marked influence on treatment and outcome in the elderly. This article aims at a general understanding of anaphylaxis with special reference to the elderly.

Anaphylaxis: office management and prevention

Anaphylaxis, an acute and potentially lethal multisystem allergic reaction, is almost unavoidable in medical practice. Health care professionals must be able to recognize the signs of anaphylaxis, treat an episode promptly and appropriately, and be able to provide preventive recommendations. Epinephrine, which should be administered immediately, is the drug of choice for acute anaphylaxis.

Acute hypersensitivity reactions to chemotherapy

OBJECTIVES

To provide a review of the immune system response involved in acute hypersensitivity reactions (HSRs) and anaphylactic reactions to chemotherapy.

DATA SOURCES

Professional experience, published articles, and book chapters.

CONCLUSIONS

Acute HSRs from chemotherapy administration can be a rare to moderate occurrence, depending on the chemotherapy agents involved. It is of vital importance for nurses caring for patients receiving chemotherapy to take steps to prevent HSRs when possible and/or to minimize the potentially fatal effects of those reactions.

IMPLICATIONS FOR NURSING PRACTICE

Nurses caring for patients receiving chemotherapy should understand the risk of HSRs as well as the pathophysiology involved to ensure utilization of preventive measures when appropriate and early recognition and intervention in the event of an acute HSR.