Anaphylaxis - Education
Summary
TLDRAnaphylaxis is a severe allergic reaction resulting from mast cell and basophil degranulation upon antigen exposure. It can manifest with life-threatening symptoms in respiratory, cardiovascular, and integumentary systems, varying in onset and severity. Common triggers during anesthesia include neuromuscular blockers and antibiotics. Immediate treatment involves calling for help, administering epinephrine, securing an airway, and providing fluids, with histamine blockers and steroids as adjunctive therapies.
Takeaways
- 🚨 Anaphylaxis is a severe allergic reaction resulting from the degranulation of sensitized mast cells and basophils upon antigen exposure.
- 🔬 Mast cells are found in the perivascular spaces of the skin and intestine, while basophils are in the blood.
- 🌟 Immunoglobulin E (IgE) is produced on initial exposure to an antigen and binds to the effector cells' surface, triggering a response on subsequent exposures.
- 💊 Physiologically active mediators like histamine, tryptase, and platelet-activating factor are released during anaphylaxis.
- 🌡 Histamine is a key inflammatory mediator stored in mast cells and basophils, causing vasodilation, increased vascular permeability, and other symptoms.
- 🚑 Symptoms of anaphylaxis can be life-threatening, affecting the respiratory, cardiovascular, and integumentary systems.
- 💉 An anaphylactic reaction can occur on first exposure to certain drugs, such as anaesthetics, due to cross-reactivity.
- 🕒 The onset and severity of anaphylactic symptoms can vary, complicating diagnosis, and may be masked by general anesthesia or surgical drapes.
- 📊 Neuromuscular blocking agents are the most common triggers for an anaphylactic reaction during anesthesia, accounting for over 50% of incidents.
- 🏥 Immediate treatment for anaphylaxis is critical and includes calling for help, administering epinephrine, securing an airway, and providing fluids.
- 🛡 Epinephrine is crucial in anaphylaxis treatment due to its hemodynamic effects and ability to stabilize mast cells, reducing mediator release.
Q & A
What is anaphylaxis?
-Anaphylaxis is a severe hypersensitivity reaction caused by the degranulation of sensitized mast cells and basophils after exposure to an antigen.
Where are mast cells and basophils typically located in the body?
-Mast cells are located in the perivascular spaces of the skin, long intestine, and other tissues, while basophils are found in the blood.
What is the role of immunoglobulin E (IgE) in anaphylaxis?
-IgE is produced upon initial exposure to an antigen and binds to the surface of effector cells, such as mast cells and basophils. Upon subsequent exposure, the antigen binds to the IgE, triggering the release of physiologically active mediators.
What are some of the physiologically active mediators released during an anaphylactic reaction?
-During an anaphylactic reaction, mediators such as histamine, tryptase, chemotactic factors, platelet-activating factor, prostaglandins, leukotrienes, and cytokines are synthesized and released.
How does histamine contribute to the clinical signs and symptoms of anaphylaxis?
-Histamine, stored in granules within mast cells and basophils, is a primary inflammatory mediator that works on receptors to cause vasodilation, increased vascular permeability, contraction of most smooth muscles, cardiac stimulation, and gastric secretions, leading to various symptoms of anaphylaxis.
Which systems of the body are most notably affected by an anaphylactic reaction?
-The respiratory, cardiovascular, and integumentary systems are most notably affected by an anaphylactic reaction.
Can an anaphylactic reaction occur on first exposure to certain substances?
-Yes, an anaphylactic reaction can occur on first exposure to certain substances, such as anaesthetic medications, due to cross-reactivity among many drugs and commercial household products.
What are some common triggering agents for an anaphylactic reaction during anesthesia?
-Neuromuscular blocking agents are the most common triggering agents, accounting for more than fifty percent of incidents. Other causative agents include latex, antibiotics, colloids, hypnotics, contrast media, protamine, and opioids.
What are the signs and symptoms of an anaphylactic reaction?
-Signs and symptoms include angioedema, laryngeal edema, hypotension, tachycardia, dysrhythmias, wheezing, bronchospasm, and a shock-like state secondary to severe hypotension.
What is the role of tryptase in an anaphylactic reaction?
-Tryptase is an enzyme released from mast cells along with histamine and serves as a positive indicator for an immunologically mediated event when levels are greater than 25 micrograms per liter.
What is the immediate treatment for an anaphylactic reaction?
-Immediate treatment includes calling for help, removing potential causative agents, increasing FIO2 to 100%, administering epinephrine, establishing a secure airway, ensuring adequate IV access, and providing a fluid bolus. An epinephrine infusion may be considered if there is no response to initial interventions.
Why is epinephrine a crucial part of anaphylaxis treatment?
-Epinephrine is crucial due to its positive hemodynamic effects and its ability to stabilize mast cells and reduce the amount of inflammatory mediator release.
What are some other treatment options for anaphylaxis besides epinephrine?
-Other treatment options include vasopressors, beta-2 agonists, histamine blockers, and steroids to counteract the effects of histamine and assist in reversing hypotension refractory to epinephrine and intravascular fluid replacement.
Outlines
🚨 Anaphylaxis: Causes and Symptoms
Anaphylaxis is a severe allergic reaction triggered by antigen exposure to sensitized mast cells and basophils. These cells release inflammatory mediators like histamine, tryptase, and leukotrienes upon antigen binding to IgE antibodies. This leads to various symptoms, notably affecting the respiratory, cardiovascular, and integumentary systems. Symptoms can range from angioedema to hypotension and bronchospasm, and it can be life-threatening. The reaction can occur with the first exposure to certain drugs, including anesthetics, and diagnosis can be complicated by variable onset times and masked symptoms under general anesthesia. Common triggers during anesthesia are neuromuscular blocking agents, latex, antibiotics, and others, accounting for over 50% of incidents.
💡 Anaphylaxis Treatment and Management
Immediate treatment for anaphylaxis is crucial and involves calling for help, removing the causative agent, administering 100% oxygen, and giving epinephrine. Establishing a secure airway and ensuring IV access are also critical. If there's no response, an epinephrine infusion may be necessary. Additional treatments may include vasopressors, beta-2 agonists, histamine blockers, and steroids. Tryptase levels can indicate an immunologically mediated event and are useful for diagnosis, but normal levels do not rule out anaphylaxis. Glucocorticoids may help prevent recurring or prolonged reactions, and H1 and H2 receptor antagonists can counteract histamine effects, aiding in the management of symptoms like urticaria and angioedema.
Mindmap
Keywords
💡Anaphylaxis
💡Mast Cells
💡Basophils
💡Immunoglobulin E (IgE)
💡Histamine
💡Tryptase
💡Neuromuscular Blocking Agents
💡Epinephrine
💡Vasopressors
💡Beta-2 Agonists
💡Glucocorticoids
Highlights
Anaphylaxis is a severe hypersensitivity reaction caused by degranulation of sensitized mast cells and basophils after exposure to an antigen.
Mast cells are located in the perivascular spaces of the skin, long intestine, while basophils are in the blood.
Immunoglobulin E (IgE) is produced upon initial exposure to an antigen and binds to the surface of effector cells.
Subsequent exposure to the antigen leads to the release of physiologically active mediators, including histamine.
Histamine is a primary inflammatory mediator stored in granules within mast cells and basophils.
Histamine causes vasodilation, increased vascular permeability, and smooth muscle contraction, leading to anaphylactic symptoms.
Anaphylactic reactions can occur in the respiratory, cardiovascular, and integumentary systems.
An anaphylactic reaction can occur on first exposure to certain medications due to cross-reactivity.
The onset and degree of clinical manifestations can vary greatly, complicating diagnosis.
Neuromuscular blocking agents are the most common triggering agents for an anaphylactic reaction during anesthesia.
Signs and symptoms of an anaphylactic reaction include angioedema, laryngeal edema, hypotension, and tachycardia.
A shock-like state can develop due to severe hypotension caused by vasodilation and fluid extravasation.
Tryptase is an enzyme released from mast cells and can be a positive indicator for an immunologically mediated event.
Anaphylactic reactions are life-threatening and require prompt identification and immediate treatment.
Treatment for anaphylaxis includes calling for help, removing causative agents, and administering epinephrine.
Epinephrine has positive hemodynamic effects and stabilizes mast cells, reducing inflammatory mediator release.
H1 and H2 receptor antagonists are used to counteract the effects of histamine and may assist in reversing hypotension.
Glucocorticoids may reduce the risk of recurring or prolonged anaphylaxis.
Transcripts
anaphylaxis is a severe hypersensitivity
reaction caused by the degranulation of
sensitized mast cells and basophils
after exposure to an antigen mast cells
are located in the perivascular spaces
of the skin long and intestine while
basophils are located in the blood upon
initial exposure to an antigen
immunoglobulin E is produced and binds
to the surface of the effector cell with
subsequent exposure the antigen binds to
the IgE antibodies releasing
physiologically active mediators that
include histamine tryptase chemotactic
factors and platelet-activating factor
furthermore metabolites such as
prostaglandins kinase leukotrienes and
cytokines are synthesized and released
histamine is a primary inflammatory
mediator which is stored in granules
within the mast cells and basophils
histamine has an important role in the
clinical signs and symptoms manifested
in anaphylaxis and works on receptors to
cause vasodilation increased vascular
permeability contraction of most smooth
muscle other than blood vessels cardiac
stimulation and stimulation of gastric
secretions this results in a series of
potentially life-threatening symptoms
occurring most notably in the
respiratory cardiovascular and
integumentary systems it is possible for
an anaphylactic reaction to occur on
first exposure to anaesthetic
medications due to cross reactivity
among many drugs and commercial
household products the time of onset and
the degree of clinical manifestations
can vary greatly making diagnosis
complicated in addition many symptoms
may be masked by general anesthesia and
the use of surgical drapes which conceal
the cutaneous signs the most common
triggering agents for an anaphylactic
reaction during anesthesia are
neuromuscular blocking agents they
account for more than fifty percent of
the total incidents other causative
agents include latex antibiotics
colloids hypnotics contrast media
protamine and opioids there are also
several other medications medication
classes and substances that have the
potential to trigger anaphylaxis the
signs and symptoms of an anaphylactic
reaction are the consequence of the
antigen-antibody reaction and the body's
massive immune response that includes
the release of histamine as a result /
itís or tocaria angioedema especially
laryngeal edema hypotension tachycardia
dysrhythmias wheezing and bronchospasm
may occur a shock like state can develop
that is secondary to severe hypotension
caused by vasodilation and the
extravasated of protein and fluids out
of the vascular compartment the clinical
appearance of anaphylaxis may present in
various combinations and usually occurs
within minutes of exposure to the
offending antigen however in some cases
the onset of signs and symptoms may be
delayed for an hour or longer trip taste
is an enzyme released from mast cells
along with histamine and has a half-life
of several hours it has been shown to be
a positive indicator for an
immunologically mediated event at levels
greater than 25 micrograms per liter
however the presence of normal trip
taste levels should not rule out an
anaphylactic reaction since normal
levels have been found in up to
one-third of anaphylactic cases
anaphylactic reactions are
life-threatening and require prompt
identification and immediate treatment
treatment includes calling for help
removing potential causative agents
increasing fio2 to 100% administering
epinephrine establishing a secure airway
and ensuring adequate IV access
providing a fluid bolus if there's no
response to these interventions an
epinephrine infusion should be
considered other treatment options to
consider include vasopressors
beta-2 agonists histamine blockers and
steroids airway patency must be
accomplished by means of intubation and
maintained since a demon the airway is a
common complication of anaphylaxis
epinephrine should not be delayed due to
its positive hemodynamic effects as well
as its ability to stabilize mast cells
and reduce the amount of inflammatory
mediator release epinephrine can be
administered intravenously or
subcutaneously and the dose should be
titrated according to the severity of
symptoms and histamines may be useful
particularly for symptoms of ERDA keria
and angioedema h1 and h2 receptor
antagonists are frequently administered
to counteract the effects of histamine
and may assist in reversing hypotension
refractory to epinephrine and
intravascular fluid replacement
glucocorticoids may reduce the risk of
recurring or prolonged anaphylaxis
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