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Anaphylaxis

Definition:

Anaphylaxis is a rapidly progressing, life-threatening allergic reaction.It is a type of allergic reaction, in which the immune system responds to otherwise harmless substances from the environment. Unlike other allergic reactions, however, anaphylaxis can kill. Reaction may begin within minutes or even seconds of exposure, and rapidly progress to cause airway constriction, skin and intestinal irritation, and altered heart rhythms. In severe cases, it can result in complete airway obstruction, shock, and death.

Anaphylaxis is an acute systemic (multi-system) and severe Type I Hypersensitivity allergic reaction in humans and other mammals. The term comes from the Greek words ana (against) and phylaxis (protection). Minute amounts of allergens may cause a life-threatening anaphylactic reaction. Anaphylaxis may occur after ingestion, skin contact, injection of an allergen or, in rare cases, inhalation….CLICK & SEE

Anaphylactic shock, the most severe type of anaphylaxis, occurs when an allergic response triggers a quick release from mast cells of large quantities of immunological mediators (histamines, prostaglandins, leukotrienes) leading to systemic vasodilation (associated with a sudden drop in blood pressure) and edema of bronchial mucosa (resulting in bronchoconstriction and difficulty breathing). Anaphylactic shock can lead to death in a matter of minutes if left untreated.

An estimated 1.24% to 16.8% of the population of the United States is considered “at risk” for having an anaphylactic reaction if they are exposed to one or more allergens, especially penicillin and insect stings. Most of these people successfully avoid their allergens and will never experience anaphylaxis. Of those people who actually experience anaphylaxis, up to 1% may die as a result. Anaphylaxis results in approximately 18 deaths per year in the U.S. (compared to 2.4 million deaths from all causes each year in the U.S.). The most common presentation includes sudden cardiovascular collapse (88% of reported cases of severe anaphylaxis).

click to see the pictures

Researchers typically distinguish between “true anaphylaxis” and “pseudo-anaphylaxis or an “anaphylactoid reaction.” The symptoms, treatment, and risk of death are identical, but “true” anaphylaxis is always caused directly by degranulation of mast cells or basophils that is mediated by immunoglobulin E (IgE), and pseudo-anaphylaxis occurs due to all other causes. The distinction is primarily made by those studying mechanisms of allergic reactions.

Causes:-
Anaphylaxis is a severe, whole-body allergic reaction. After an initial exposure (“sensitizing dose”) to a substance like bee sting toxin, the person’s immune system becomes sensitized to that allergen. On a subsequent exposure (“shocking dose”), an allergic reaction occurs. This reaction is sudden, severe, and involves the whole body.

Hives and angioedema (hives on the lips, eyelids, throat, and/or tongue) often occur. Angioedema may be severe enough to block the airway. Prolonged anaphylaxis can cause heart arrhythmias.

Some drugs (polymyxin, morphine, x-ray dye, and others) may cause an “anaphylactoid” reaction (anaphylactic-like reaction) on the first exposure. This is usually due to a toxic reaction, rather than the immune system mechanism that occurs with “true” anaphylaxis. The symptoms, risk for complications without treatment, and treatment are the same, however, for both types of reactions. Some vaccinations are also known to cause “anaphylactoid” reactions. Antitoxins and antivenins may cause similar reactions.

Anaphylaxis can occur in response to any allergen. Common causes include insect bites/stings, food allergies (peanuts and tree nuts are the most common, though not the only), and drug allergies. Pollens and other inhaled allergens rarely cause anaphylaxis. In opthamology, the dye fluorescein used in some eye exams is a well known trigger. Some people have an anaphylactic reaction with no identifiable cause.
Symptoms:-
Symptoms of anaphylaxis are related to the action of Immunoglobulin E (IgE) and other anaphylatoxins, which act to release histamine and other mediator substances from mast cells (degranulation). In addition to other effects, histamine induces vasodilation of arterioles and constriction of bronchioles in the lungs, also known as bronchospasm (constriction of the airways).

Tissues in different parts of the body release histamine and other substances. This causes constriction of the airways, resulting in wheezing, difficulty breathing, and gastrointestinal symptoms such as abdominal pain, cramps, vomiting, and diarrhea. Histamine causes the blood vessels to dilate (which lowers blood pressure) and fluid to leak from the bloodstream into the tissues (which lowers the blood volume). These effects result in shock. Fluid can leak into the alveoli (air sacs) of the lungs, causing pulmonary edema.

Symptoms can include the following:

*polyuria
*respiratory distress
*hypotension (low blood pressure)
*encephalitis
*fainting
*unconsciousness
*urticaria (hives)
*flushed appearance
*angioedema (swelling of the lips, face, neck and throat): this can be life threatening
*tears (due to angioedema and stress)
*vomiting
*itching
*diarrhoea
*abdominal pain
*anxiety

The time between ingestion of the allergen and anaphylaxis symptoms can vary for some patients depending on the amount of allergen consumed and their reaction time. Symptoms can appear immediately, or can be delayed by half an hour to several hours after ingestion. However, symptoms of anaphylaxis usually appear very quickly once they do begin.

Diagnosis:-

Anaphylaxis is diagnosed based on the rapid development of symptoms in response to a suspect allergen. Identification of the culprit may be done with RAST testing, a blood test that identifies IgE reactions to specific allergens. Skin testing may be done for less severe anaphylactic reactions.

Apart from its clinical features, blood tests for tryptase (released from mast cells) might be useful in diagnosing anaphylaxis.

In some cases, it is unclear from the patient interview what triggered the anaphylaxis. In this setting, skin allergy testing (with or without patch testing) or RAST blood tests can sometimes identify the cause.

You may click to see:->Anaphylaxis Flow Chart

Treatment:-

Emergency Treatment
Anaphylaxis is a life-threatening medical emergency because of rapid constriction of the airway, often within minutes of onset, which can lead to respiratory failure and respiratory arrest. Brain and organ damage rapidly occurs if the patient cannot breathe. Due to the severe nature of the emergency, patients experiencing or about to experience anaphylaxis require the help of advanced medical personnel. First aid measures for anaphylaxis include rescue breathing (part of CPR). Rescue breathing may be hindered by the constricted airways, but if the patient stops breathing on his or her own, it is the only way to get oxygen to him or her until professional help is available.

.A woman being treated in an emergency department after going into anaphylactic shock

.The primary treatment for anaphylaxis is administration of epinephrine (adrenaline). Epinephrine prevents worsening of the airway constriction, stimulates the heart to continue beating, and may be life-saving. Epinephrine acts on Beta-2 adrenergic receptors in the lung as a powerful bronchodilator (i.e. it opens the airways), relieving allergic or histamine-induced acute asthmatic attack or anaphylaxis. If the patient has previously been diagnosed with anaphylaxis, he or she may be carrying an EpiPen or Twinject for immediate administration of epinephrine. However, use of an EpiPen or similar device only provides temporary and limited relief of symptoms.

Tachycardia (rapid heartbeat) results from stimulation of Beta-1 adrenergic receptors of the heart increasing contractility (positive inotropic effect) and frequency (chronotropic effect) and thus cardiac output.[10] Repetitive administration of epinephrine can cause tachycardia and occasionally ventricular tachycardia with heart rates potentially reaching 240 beats per minute, which itself can be fatal. Extra doses of epinephrine can sometimes cause cardiac arrest. This is why some protocols advise intramuscular injection of only 0.3–0.5mL of a 1:1,000 dilution.

Some patients with severe allergies routinely carry preloaded syringes containing epinephrine, diphenhydramine (Benadryl), and dexamethasone (Decadron) whenever they go to an unknown or uncontrolled environment.

You may click to see:->First Aid for Anaphylaxis
Clinical care
Paramedic treatment in the field includes administration of epinephrine IM; antihistamines IM (such as chlorphenamine or diphenhydramine); steroids, such as hydrocortisone or dexamethasone; IV Fluid administration and in severe cases, pressor agents (which cause the heart to increase its contraction strength) such as dopamine for hypotension, administration of oxygen, and intubation during transport to advanced medical care.

In severe situations with profuse laryngeal edema (swelling of the airway), cricothyrotomy or tracheotomy may be required to maintain oxygenation. In these procedures, an incision is made through the anterior portion of the neck, over the cricoid membrane, and an endotracheal tube is inserted to allow mechanical ventilation of the patient.

The clinical treatment of anaphylaxis by a doctor and in the hospital setting aims to treat the cellular hypersensitivity reaction as well as the symptoms. Antihistamine drugs such as diphenhydramine or chlorphenamine (which inhibit the effects of histamine at histamine receptors) are continued but are usually not sufficient in anaphylaxis, and high doses of intravenous corticosteroids such as dexamethasone or hydrocortisone are often required. Hypotension is treated with intravenous fluids and sometimes vasopressor drugs. For bronchospasm, bronchodilator drugs (e.g. salbutamol, known as Albuterol in the United States) are used. In severe cases, immediate treatment with epinephrine can be lifesaving. Supportive care with mechanical ventilation may be required.

It is also possible to undergo a second reaction prior to medical attention or using an Epipen. It is suggested to seek one to two days of medical care.

The possibility of biphasic reactions (recurrence of anaphylaxis) requires that patients be monitored for four hours after being transported to medical care for anaphylaxis.

Many anaphylactic patients will be sent home or released after the initial reaction is declared over. Yet, rebound reactions are almost always bound to happen. Most people with anaphylaxis have a rebound a few hours after the initial reaction, yet there are cases where a rebound would occur after as much time as a week.
Planning for emergency treatment:-
The Asthma and Allergy Foundation of America advises patients prone to anaphylaxis to have an “allergy action plan” on file at school, home, or in their office to aid others in case of an anaphylactic emergency, and provides a free “plan” form. Action plans are considered essential to quality emergency care. Many authorities advocate immunotherapy to prevent future episodes of anaphylaxis.

Beta-blockers may aggravate anaphylactic reactions and interfere with treatment.

Prognosis:
The rapidity of symptom development is an indication of the likely severity of reaction: the faster symptoms develop, the more severe the ultimate reaction. Prompt emergency medical attention and close monitoring reduces the likelihood of death. Nonetheless, death is possible from severe anaphylaxis. For most people who receive rapid treatment, recovery is complete.

Prevention:-
Immunotherapy with Hymenoptera venoms is especially effective and widely used throughout the world and is accepted as an effective treatment for most patients with allergy to bees, wasps, hornets, yellow jackets, white faced hornets, and fire ants.

Avoidance of the allergic trigger is the only reliable method of preventing anaphylaxis. For insect allergies, this requires recognizing likely nest sites. Preventing food allergies requires knowledge of the prepared foods or dishes in which the allergen is likely to occur, and careful questioning about ingredients when dining out. Use of a Medic-Alert tag detailing drug allergies is vital to prevent inadvertent administration during a medical emergency.

People prone to anaphylaxis should carry an “Epipen” or “Ana-kit,” which contain an adrenaline dose ready for injection.

The greatest success with prevention of anaphylaxis has been the use of allergy injections to prevent recurrence of sting allergy. The risk to an individual from a particular species of insect depends on complex interactions between likelihood of human contact, insect aggression, efficiency of the venom delivery apparatus, and venom allergenicity. According to most authorities, venom immunotherapy has been demonstrated to reduce the risk of systemic reactions below 1% to 3%. One simple method of venom extraction has been electrical stimulation to obtain venom, instead of dissecting the venom sac. An allergist will then provide venom immunotherapy which is highly efficacious in preventing future episodes of anaphylaxis.

A vaccine has been in the works to prevent anaphylaxis from peanuts and tree nuts. Despite showing significant promise to prevent individuals with the allergy from developing anaphylaxis if eating a small amount of the food, the FDA has not yet approved the vaccine.

You may click to see:->

Mast Cell Disorder

Allergy

Slow reacting substance of anaphylaxis

Exercise-induced anaphylaxis

.Paediatric Allergy – anaphylaxis

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Tags Allergy, American Academy of Family Physicians, American College of Allergy, Anaphylaxis, Asthma & Immunology, Chicago, Chicago Public Schools, Conditions and Diseases, Elementary school, Epinephrine, EpiPen, Food allergy, Health, Immunoglobulin E, Twinject coupon, United States

Ailmemts & Remedies

Drug Allergy

Synonyms and Keywords:-
drug allergy, allergen, allergic reaction, anaphylactic shock, anaphylaxis, antibodies, antibody, hypersensitivity, medication allergies, medication reactions, immune system, immunoglobulin E, IgE, serum sickness

Description:
A drug allergy is an allergy to a drug, most commonly a medication. Medical attention should be sought immediately if an allergic reaction is suspected....CLICK & SEE

An allergic reaction will not occur on the first exposure to a substance. The first exposure allows the body to create antibodies and memory lymphocyte cells for the antigen. However, drugs often contain many different substances, including dyes, which could cause allergic reactions. This can cause an allergic reaction on the first administration of a drug. For example, a person who developed an allergy to a red dye will be allergic to any new drug which contains that red dye.

A drug allergy is different from an intolerance. A drug intolerance, which is often a milder, non-immune-mediated reaction, does not depend on prior exposure. Most people who believe they are allergic to aspirin are actually suffering from a drug intolerance.

Both over-the-counter and prescription drugs can cause various problems. Most symptoms, such as nausea and diarrhea, are not allergies but side effects that can affect anyone. A drug allergy occurs when the immune system produces an abnormal reaction to a specific drug. Often the reactions are mild, but some can be life-threatening.

Several different types of allergic reactions to medications can occur. Reactions to drugs range from a mild localized rash to serious effects on vital systems. The body’s response can affect many organ systems, but the skin is the organ most frequently involved.

It is important to recognize the symptoms of a drug allergy, because they can be life-threatening. Death from an allergic reaction to a medication is extremely rare, however.

An allergic reaction does not often happen the first time you take a medication. A reaction is much more likely to occur the next time you take that medication. If you have a reaction the first time, you probably were exposed to the medication before without being aware of it.

Causes:
An allergic reaction is caused by the body’s immune system overreacting to the drug, which is viewed as a chemical “invader,” or antigen. This overreaction is often called a hypersensitivity reaction.

*The body produces antibodies to the antigen and stores the antibodies on special cells.
*The antibody in an allergic reaction is called immunoglobulin E, or IgE.
*When the body is exposed to the drug again, the antibodies signal the cells to release chemicals called “mediators.” Histamine is an example of a mediator.
*The effects of these mediators on organs and other cells cause the symptoms of the reaction.

The most common triggers of drug allergies are the following:
*Painkillers (called analgesics) such as codeine, morphine, nonsteroidal antiinflammatory drugs (NSAIDs, such as ibuprofen or indomethacin), and aspirin
*Antibiotics such as penicillin, sulfa drugs, and tetracycline
*Antiseizure medications such as phenytoin (Dilantin) or carbamazepine (Tegretol)

Symptoms:
Drug allergies may cause many different types of symptoms depending on the drug and the degree of exposure to the drug (how often you have taken it). These are the most common reactions:

Skin reactions:
A measles-like rash
Hivesâ€”Slightly red, itchy, and raised swellings on the skin, which have an irregular shape
Photoallergyâ€”Sensitivity to sunlight, an itchy and scaly rash that occurs following sun exposure
Erythema multiformeâ€”Red, raised and itchy patches on the skin that sometimes look like bull’s-eye targets and which may occur together with swelling of the face or tongue

Fever
Muscle and joint aches
Lymph node swelling
Inflammation of the kidney

Unlike most allergic reactions, which occur fairly quickly after exposure to the allergen, allergic reactions to drugs tend to occur days or weeks after the first dose of the drug.

Anaphylaxis or anaphylactic reactionâ€”This is a serious allergic reaction that can be life threatening. A person with anaphylaxis must be treated in a hospital emergency department. Characteristics of anaphylaxis (sometimes referred to as anaphylactic shock) include:

Skin reactionâ€”Hives, redness/flushing, sense of warmth, itching

Difficulty breathingâ€”Chest tightness, wheezing, throat tightness

Faintingâ€”Light-headedness or loss of consciousness due to drastic decrease in blood pressure (“shock”)

Rapid or irregular heart beat

Swelling of face, tongue, lips, throat, joints, hands, or feet

Almost all anaphylactic reactions occur within four hours of the first dose of the drug. Most occur within one hour of taking the drug, and many occur within minutes or even seconds.
An allergic reaction to a drug may give rise to the following symptoms:

If you develop the symptoms and suspect they may be due to a prescription, or over-the-counter drug, contact your doctor at once before taking the next dose. Rarely, a drug allergy may lead to a severe and potentially fatal reaction called anaphylaxis.

Risk factors for drug allergies include the following:-

*Frequent exposure to the drug

*Large doses of the drug

*Drug given by injection rather than pill

*Family tendency to develop allergies and asthma

*Certain food allergies such as to eggs, soybeans, or shellfish

When to Seek Medical Care:-

Always contact the health-care provider who prescribed the medication for advice.

*If the symptoms are mild, such as itching and localized hives, the provider may switch you to a different type of medication, recommend that you stop the medication, or, if appropriate, prescribe antihistamines to relieve your symptoms.

*If you cannot reach this provider for advice quickly, play it safe and go to a hospital emergency department.

*If you are having any “systemic” symptoms such as fever or vomiting, you should stop taking the medication and be seen immediately by a medical professional.

*If you are having difficulty breathing, your throat is swelling, or you are feeling faint, you may be having an anaphylactic reaction. Go immediately to a hospital emergency department. Do not attempt to drive yourself. If no one is available to drive you right away, call 911 for an ambulance. While waiting for the ambulance, start self-treatment.

Diagnosis:-
Generally a drug allergy is identified by signs and symptoms. Medical professionals are trained to recognize hives, swelling patterns, and rashes associated with allergic reactions. You will be asked questions about your medical history and possible triggers of the reaction.Blood tests and other tests are needed only under very unusual circumstances.

Treatment:-
After getting advice from your health-care provider, some mild allergic reactions may be treated at home.In very serious cases only , Hospitalization may be required.

Self Home Care:-

For hives or localized skin reactions, perform the following:

*Take cool showers or apply cool compresses.
*Wear light clothing that doesn’t irritate your skin.
*Take it easy. Keep your activity level low.

To relieve the itching, apply calamine lotion or take nonprescription antihistamines, such as diphenhydramine (Benadryl) or chlorpheniramine maleate (Chlor-Trimeton).

For more severe reactions, self-treatment is not recommended. Call your health-care provider or 911, depending on the severity of your symptoms. If you have symptoms of anaphylaxis, here’s what you can do while waiting for the ambulance:

Try to stay calm.

*If you can identify the cause of the reaction, prevent further exposure.
Take an antihistamine (one to two tablets or capsules of diphenhydramine [Benadryl]) if you can swallow without difficulty.
*If you are wheezing or having difficulty breathing, use an inhaled bronchodilator such as albuterol (Proventil) or epinephrine (Primatene Mist) if one is available. These inhaled medications dilate the airway.
*If you are feeling light-headed or faint, lie down and raise your legs higher than your head to help blood flow to your brain.
*If you have been given an epinephrine kit, inject yourself as you have been instructed. The kit provides a premeasured dose of epinephrine, a prescription drug that rapidly reverses the most serious symptoms.

Bystanders should administer CPR to a person who becomes unconscious and stops breathing or does not have a pulse.

If at all possible, you or your companion should be prepared to tell medical personnel what medications you take and any known allergies.

Modern Medical Treatment:-

Generally, treatment of a drug allergy falls into three categories:

Mild allergy (localized hives and itching)
Treatment is aimed at caring for the symptoms and stopping the reaction caused by the drug.
Medications prescribed may include antihistamines, such as diphenhydramine (Benadryl)
You may be advised to stop taking the medication that caused the allergy.
Moderately severe allergy (all-over hives and itching)
Treatment is aimed at caring for the symptoms and stopping the reaction.

Usually the offending medication is stopped.
Medications prescribed may include antihistamines such as diphenhydramine (Benadryl)), oral steroids (prednisone), or histamine blockers such as cimetidine (Tagamet), famotidine (Pepcid), or ranitidine (Zantac).

Severe allergy (shortness of breath, throat tightness, faintness, severe hives, involvement of many organ systems)
Treatment includes strong medications to quickly reverse the dangerous chain of events.
The offending medication is stopped immediately.

Medications prescribed may include antihistamines such as diphenhydramine (Benadryl), oral or IV steroids such as prednisone or methylprednisolone (Solu-Medrol), or histamine blockers such as cimetidine (Tagamet), famotidine (Pepcid), or ranitidine (Zantac).

Depending on the severity of other symptoms, other medications may be used including epinephrine (also called adrenaline), which is inhaled, given by IV, or injected under the skin.

If your reaction is severe, you may need to be admitted to the hospital for continued therapy and observation.

Follow-up:-
Follow up with your health-care provider after an allergic reaction to a drug. At this follow-up appointment, he or she can evaluate your recovery from the reaction and adjust any medications.
If you do not respond to the treatment prescribed for your drug allergy, it is important that you see a medical professional for re-evaluation.

Ayurvedic Treastment : VIRECHAN

Prevention:-
There is no known way to prevent drug allergies. You can reduce your risk by taking as few medications as possible. The more exposure your body has to medications, the greater the likelihood of a drug allergy.

Always tell any new health-care provider you see about your allergies and the types of reactions you have had. Talk to your doctor about the possibility or necessity of having a portable epinephrine kit to treat severe reactions.

Do not take a drug that you have reacted to in the past. Once you have a reaction to a drug, your risk of having a more severe reaction next time increases dramatically.

Consider wearing a medical alert ID bracelet or necklace. These devices are worn on the wrist or neck and can alert medical personnel and others about the risk for an allergic reaction.

Adults might carry a card with pertinent medical information in a wallet or purse. Tell your health-care provider about any adverse reactions to medications in the past before he or she prescribes medications to you.

Tell your health-care provider about any medications, prescription or over-the-counter, that you are taking.

Click for->Practice Guidelines: Drug Allergy

Resources:
http://en.wikipedia.org/wiki/Drug_allergy
http://www.emedicinehealth.com/drug_allergy/page15_em.htm
http://www.charak.com/DiseasePage.asp?thx=1&id=246