Anaphylaxis: clinical presentation, immunologic mechanisms, and treatment

Approaches to otolaryngic allergy emergencies

The otolaryngic allergist should take every measure possible to prevent reactions during testing and treatment of the allergic patient. Because the risk of this rare complication cannot be completely eliminated, however, it is essential to be prepared for prompt recognition and proper treatment of an anaphylactic emergency. An emergency set, including airway management tools, oxygen, intravenous materials, and proper medication, is essential. The entire office staff should be educated to cope with the emergency. Finally, a medication history must be repeated at intervals to detect patients who are receiving beta blockers to either remove them from the patients' treatment regimen or to prepare for the special treatment of the patients on beta blockers.

Anaphylactic shock: mechanisms and treatment

This paper reviews the mechanisms of anaphylactic shock in terms of the immunoglobulin and non-immunoglobulin triggering events, and the cellular events based on the rise in intracellular cyclic AMP and calcium that release preformed granule-associated mediators and the rapidly formed, newly synthesized mediators predominantly based on arachidonic acid metabolism. These primary mediators recruit other cells with the release of secondary mediators that either potentiate or ultimately curtail the anaphylactic reaction. The roles of these mediators in the various causes of cardiovascular collapse are examined. The treatment of anaphylactic shock involves oxygen, adrenaline and fluids. The importance and safety of intravenous adrenaline are discussed. Combined H1 and H2 blocking antihistamines and steroids have a limited role. Glucagon and other adrenergic drugs are occasionally used, and several new experimental drugs are being developed.

An experimental model of death from anaphylactic shock with compound 48/80 and postmortem changes in levels of histamine in blood

The present study was made on an experimental animal model of a death from anaphylaxis, in which postmortem changes in levels of histamine and 1-methylhistamine, in whole blood were measured. Instead of the usual immunological method administering compound 48/80, a degranulating agent of mast cell and the effect closely resembling the immuno-reaction, resulted in reliable death in a short time. The animals that died rapidly after the injection of compound 48/80, were found to have large increases in levels of histamine and 1-methylhistamine soon after the administration. These results were similar to the results of injecting histamine exogenously. On the other hand, the animals that died after a longer time showed no increases in levels of those amines within about 24 h, but 24 hours after death histamine levels were only increased tremendously without rise in 1-MHA levels. These phenomena closely resembled those in the control animals that were treated with overdoses of Nembutal.

Anaphylactic shock. Guidelines for immediate diagnosis and treatment

With the pathophysiology of anaphylaxis firmly in mind, the primary care physician can accurately diagnose and effectively treat this acute, life-threatening condition. The necessary drugs and equipment must be present in the office of any physician who performs skin testing, administers immunotherapy or intramuscular antibiotics, or uses local anesthetics. The drug of choice, epinephrine, must be administered as soon as the diagnosis is made, and hospitalization is necessary to guard against recurrent anaphylaxis. Preventive measures, including identification of the offending antigen, avoidance instructions, epinephrine for self-administration, and immunotherapy should be considered for all patients.