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Nuñez-Borque E, Fernandez-Bravo S, Yuste-Montalvo A, Esteban V. Pathophysiological, Cellular, and Molecular Events of the Vascular System in Anaphylaxis. Front Immunol 2022; 13:836222. [PMID: 35371072 PMCID: PMC8965328 DOI: 10.3389/fimmu.2022.836222] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 02/07/2022] [Indexed: 01/10/2023] Open
Abstract
Anaphylaxis is a systemic hypersensitivity reaction that can be life threatening. Mechanistically, it results from the immune activation and release of a variety of mediators that give rise to the signs and symptoms of this pathological event. For years, most of the research in anaphylaxis has focused on the contribution of the immune component. However, approaches that shed light on the participation of other cellular and molecular agents are necessary. Among them, the vascular niche receives the various signals (e.g., histamine) that elicit the range of anaphylactic events. Cardiovascular manifestations such as increased vascular permeability, vasodilation, hypotension, vasoconstriction, and cardiac alterations are crucial in the pathophysiology of anaphylaxis and are highly involved to the development of the most severe cases. Specifically, the endothelium, vascular smooth muscle cells, and their molecular signaling outcomes play an essential role downstream of the immune reaction. Therefore, in this review, we synthesized the vascular changes observed during anaphylaxis as well as its cellular and molecular components. As the risk of anaphylaxis exists both in clinical procedures and in routine life, increasing our knowledge of the vascular physiology and their molecular mechanism will enable us to improve the clinical management and how to treat or prevent anaphylaxis. Key Message Anaphylaxis, the most severe allergic reaction, involves a variety of immune and non-immune molecular signals that give rise to its pathophysiological manifestations. Importantly, the vascular system is engaged in processes relevant to anaphylactic events such as increased vascular permeability, vasodilation, hypotension, vasoconstriction, and decreased cardiac output. The novelty of this review focuses on the fact that new studies will greatly improve the understanding of anaphylaxis when viewed from a vascular molecular angle and specifically from the endothelium. This knowledge will improve therapeutic options to treat or prevent anaphylaxis.
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Affiliation(s)
- Emilio Nuñez-Borque
- Department of Allergy and Immunology, Instituto en Investigación Sanitaria - Fundación Jiménez Díaz (IIS-FJD), Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Sergio Fernandez-Bravo
- Department of Allergy and Immunology, Instituto en Investigación Sanitaria - Fundación Jiménez Díaz (IIS-FJD), Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Alma Yuste-Montalvo
- Department of Allergy and Immunology, Instituto en Investigación Sanitaria - Fundación Jiménez Díaz (IIS-FJD), Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Vanesa Esteban
- Department of Allergy and Immunology, Instituto en Investigación Sanitaria - Fundación Jiménez Díaz (IIS-FJD), Universidad Autónoma de Madrid (UAM), Madrid, Spain.,Faculty of Medicine and Biomedicine, Alfonso X El Sabio University, Madrid, Spain
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Zheng F, Copotoiu R, Tacquard C, Demoulin B, Malinovsky JM, Levy B, Longrois D, Barthel G, Mertes PM, Marchal F, Demoulin-Alexikova S, Collange O. Epinephrine but not vasopressin attenuates the airway response to anaphylactic shock in rats. Exp Lung Res 2017; 43:158-166. [DOI: 10.1080/01902148.2017.1323981] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Feng Zheng
- Department of Anesthesiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Ruxandra Copotoiu
- Service d'Anesthésie-Réanimation Chirurgicale, Pôle Anesthésie, Réanimations Chirurgicales, SAMU-SMUR, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- EA 3072, Institut de Physiologie, Faculté de Médecine de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France
| | - Charles Tacquard
- Service d'Anesthésie-Réanimation Chirurgicale, Pôle Anesthésie, Réanimations Chirurgicales, SAMU-SMUR, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- EA 3072, Institut de Physiologie, Faculté de Médecine de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France
| | - Bruno Demoulin
- EA 3450, Laboratoire de Physiologie, Université de Lorraine, Vandoeuvre les Nancy, France
- Explorations fonctionnelles pédiatriques, CHU de Nancy, Vandoeuvre les Nancy, France
| | - Jean Marc Malinovsky
- Service d'Anesthésie-réanimation, Pôle URAD (Urgences – Réanimation- Anesthésie- Douleur), Hôpital Maison Blanche, CHU de Reims, Reims, France
| | - Bruno Levy
- Service de Réanimation Médicale Brabois, Pole Cardiovasculaire et Réanimation Médicale, Hôpital Brabois, CHU Nancy, Vandoeuvre les Nancy, France
- Inserm U 1116, Groupe Choc, Equipe 2, Faculté de Médecine, Université de Lorraine, Nancy, France
| | - Dan Longrois
- Département d'Anesthésie-Réanimation, Hôpital Bichat Claude Bernard, Assistance Publique Hôpitaux de Paris, Paris, France
- Inserm U1148, Université Paris 7, Paris, France
| | - Grégoire Barthel
- Département d'Anesthésie-Réanimation, CHU Nancy, Vandoeuvre les Nancy, France
| | - Paul Michel Mertes
- Service d'Anesthésie-Réanimation Chirurgicale, Pôle Anesthésie, Réanimations Chirurgicales, SAMU-SMUR, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- EA 3072, Institut de Physiologie, Faculté de Médecine de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France
| | - François Marchal
- EA 3450, Laboratoire de Physiologie, Université de Lorraine, Vandoeuvre les Nancy, France
- Explorations fonctionnelles pédiatriques, CHU de Nancy, Vandoeuvre les Nancy, France
| | - Silvia Demoulin-Alexikova
- EA 3450, Laboratoire de Physiologie, Université de Lorraine, Vandoeuvre les Nancy, France
- Explorations fonctionnelles pédiatriques, CHU de Nancy, Vandoeuvre les Nancy, France
| | - Olivier Collange
- Service d'Anesthésie-Réanimation Chirurgicale, Pôle Anesthésie, Réanimations Chirurgicales, SAMU-SMUR, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- EA 3072, Institut de Physiologie, Faculté de Médecine de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France
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Kounis NG, Soufras GD, Hahalis G. Anaphylactic Shock: Kounis Hypersensitivity-Associated Syndrome Seems to be the Primary Cause. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2014; 5:631-6. [PMID: 24404540 PMCID: PMC3877435 DOI: 10.4103/1947-2714.122304] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Experiments have shown that anaphylaxis decreases cardiac output; increases left ventricular end diastolic pressure; induces severe early acute increase in respiratory resistance with pulmonary interstitial edema; and decreases splanchnic, cerebral, and myocardial blood flow more than what would be expected from severe arterial dilation and hypotension. This is attributed to the constrictive action of inflammatory mediators released during anaphylactic shock. Inflammatory mediators such as histamine, neutral proteases, arachidonic acid products, platelet-activating factor (PAF), and a variety of cytokines and chemokines constitute the pathophysiologic basis of Kounis hypersensitivity-associated acute coronary syndrome. Although the mechanisms of anaphylactic shock still remain to be elucidated, myocardial involvement due to vasospasm-induced coronary blood flow reduction manifesting as Kounis syndrome should be always considered. Searching current experimental and clinical literature on anaphylactic shock pathophysiology, causality, clinical appearance, and treatment via PubMed showed that differentiating global hypoperfusion from primary tissue suppression due to mast cell mediator constrictive action on systemic arterial vasculature is a challenging procedure. Combined tissue suppression from arterial involvement and peripheral vasodilatation, perhaps, occur simultaneously. In cases of anaphylactic shock treatment targeting the primary cause of anaphylaxis together with protection of coronary vasculature and subsequently the cardiac tissue seems to be of paramount importance.
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Affiliation(s)
- Nicholas G Kounis
- Department of Medical Sciences, Patras Highest Institute of Education and Technology, Patras, Greece
| | - George D Soufras
- Department of Cardiology, 'Saint Andrews' State General Hospital, Patras, Greece
| | - George Hahalis
- Department of Cardiology, University of Patras Medical School, Rio, Patras, Greece
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