Anaphylaxis - Definition, Symptoms, Treatment, Causes, Management
Anaphylaxis is a severe multi-organ system reaction to allergy that is potentially life-threatening and with rapid onset that usually occurs in a matter of seconds or minutes from initial exposure to allergen. There are however, many allergic reactions that can be milder and can be controlled with prompt medical treatment.
Anaphylaxis was first documented during 2641 BC with the mysterious death of an Egyptian Pharaoh named Menes after he was stung by a wasp. The same incidence occurred during the Babylonian time with two deaths mentioned due to wasp sting. The term anaphylaxis on the other hand was coined by two Parisian scientists named Charles Richet and Paul Portier during their study of toxin from the tentacles of local jellyfish. The two scientist vaccinated dogs with the toxins from the tentacles of jellyfish with anticipation of acquiring protection. However, the vaccinated dogs died within 30 minutes from vaccination which was believed to be the result of rapid breathing as an effect of allergic reaction. Thus, the term anaphylaxis was coined to mean “against protection” as observed by Richet and Portier.
Anaphylaxis is not rare yet less frequent in occurrence although modern day has it increasing in frequency mainly as a result of increase in the number of potential allergens people nowadays are exposed to. The accuracy on the incidence of anaphylaxis otherwise remains unidentified while its occurrence is at any age level with some studies revealing insignificant predominance in female gender.
There are three main classifications of anaphylaxis:
This is a life-threatening type of allergic reaction that is involved with systemic vasodilatation that leads to low blood pressure which is defined as much lower than the below standard value or baseline of the person. Severe decrease in blood pressure can deprive the brain of sufficient amount of oxygen supply subsequently leading to brain damage.
This is the type of allergic reaction with symptoms recurring usually within an hour to 72 hours after the initial symptoms of anaphylaxis have subsided even without further exposure to the allergen. This type of anaphylaxis is treacherous and requires monitoring for a period of 24 hours or more from initial recovery for recurrence of symptoms.
Pseudoanaphylaxis or anaphylactoid reaction is a type which does not resulted from an allergen but from direct result of mast cell degranulation or this type is not directly mediated by the antibodies. This type however, produces mild irritating symptoms yet should not be disregarded as it may shoot up rapidly into whole-body reaction.
Anaphylaxis involves a systemic reaction which can occur within seconds to minutes from exposure to allergen. The severity of reaction varies from one person to another while the risk may lessen over a period of time if there is no replication of exposures.
The early symptoms of anaphylaxis initially manifests in the skin which include the following:
- Skin is warm to touch and with redness
- Burning itchiness that is usually located in the armpits and the groin
- Lips swelling
- Tongue and throat swelling
The early symptoms may be followed by symptoms affecting the respiratory with which the manifestation is the result of swelling in the throat and tongue as the inflammation have resulted to restriction in the air passage. The symptoms include the following:
- Impaired swallowing ability
- Difficulty and shortness o0f breath
- Hoarseness of voice
The manifestation of anaphylaxis may also be associated with symptoms of asthma and rhinitis such as:
- Onset of runny nose
- Sneezing and wheezing which can only aggravate the difficulty in breathing
- Stomach cramps
- Diarrhea and vomiting
Anaphylaxis can be at its severe when the mediators have reached the bloodstream, the capillaries or the tiny blood vessels will open causing symptoms such as:
- Feeling of lightheadedness
- Sudden drop in the blood pressure
- Possible loss of consciousness
Blood pressure decrease that is much lower than the below level of standard normal value will leave the brain deprived of oxygen. This allergic reaction is potentially life-threatening that immediate medical attention is required. Signs and symptoms leading to anaphylactic shock are the following:
- Pale color of the skin
- Shortness and difficulty in breathing
- Air gasping
- Inability to utter a word or two
- Patient would prefer to sit up straight or hands on knees in effort to grasp for air
- Neck muscles are used for breathing in
- Loss of consciousness
After the symptoms have set in, possible outcomes may be expected and in which close monitoring must be applied to observe for danger signs as there can be a recurrence of the symptoms. The symptoms and signs can be mild and resolve spontaneously if prompt medication is administered. Initial improvement of symptoms must not be disregarded and should be monitored within 24 hours or more as symptoms may recur and additional treatment may be required and if allergic reaction is unrelenting and severe, intensive care and hospitalization may be necessary.
Anaphylaxis occurs when mediators from certain type of white blood cells are being released and prompted by mechanism of allergic reaction either immunologic or non-immunologic. Allergic reaction sets in when the immune system discharges chemical reactions. Exposure to allergens can trigger and aggravate anaphylaxis while its common triggers include the following:
- Food is the most common trigger of anaphylaxis in both children and adults and which is immediately recognized during the first ingestion.
- Medication usually with penicillin and aspirin.
- Bites and stings from insects.
Anaphylaxis calls for an emergency treatment to immediately address airway and oxygen supply to prevent deprivation in the brain which can be fatal or severely damaging to patient.
Management of anaphylaxis includes the following:
- Epinephrine administration is initially given to reduce the allergic response while this medication has no contraindication and is given intramuscularly.
- Antihistamines and corticosteroids are given intravenously to reduce swelling in the air passages to allow breathing.
- Oxygen is applied to facilitate breathing.
- Epinephrine auto-injector is prescribed to people at risk for anaphylaxis just in case allergic reaction attacks.