anaphylaxis · 2017-12-17 · 1. epinephrine i.m.- 0.01 mg/kg body weight in maximal single dose of...
TRANSCRIPT
MUDr. Mojmír Račanský Odd. Alergologie a klinické imunologie FNOL
Ústav Imunologie LF UPOL
Anaphylaxis
• ATOPY- personal or familiar predisposition to immunopatological reaction on
normally harmless antigen of environment that leads to allergen specific IgE
production • ALERGIE- phenotypical expression of atopy– excessively escalated reaction of
immune system on normally harmless antigens of environment
•ANAPHYLAXIS- Anaphylaxis is a severe life-threatening generalised or systemic
hypersensitivity reaction. It is commonly, but not always, mediated by an allergic mechanism, usually by IgE.
• Anaphylactoid or pseudo-allergic reactions
Basics
EPIDEMIOLOGY
• ACCURATE NUMBER NOT KNOWN- correct diagnose, mechanism of reaction • France – 70 person from 10 000 have allergic reaction which needs hospitalisation • Australia, GB, USA – 1% on anesthesiology dep. • ČR – cca 2000 person in hospital due to serious allergic reaction – approx. 5 + due to anaphylactic shock
ANAPHYLAXIS
PATOPHYSIOLOGY
Anaphylaxis
Anaphylaxis
Immunologic mechanism
IgE mediated
Another possibilities
Non-imunologic mechanism
–
PATOPHYSIOLOGY
•Gell-Coombsova classification
Anaphylaxis
Type I – Early IgE mediated
Type II – cytotoxic type
Type IV – Delayed, cell mediated
Type III – Immunocomplex type
Anaphylaxis on immunological base could be I., II., III. Imunopathogenic reaction. The most common is
IgE mediated!
PATOPHYSIOLOGY
Anaphylaxis
https://www.123rf.com/photo_27277872_stock-vector-allergy-and-anaphylaxis-anaphylactic-reaction-as-it-occurs-in-mast-cells-and-basophils-allergic-and-.html
Preformed mediators • histamine • tryptasa, chymase • other cytokins
De-novo syntetised mediators • leukotriens • prostaglandins • platelets activating factor A2
• PATOFYZIOLOGIE
Anafylaktická reakce
TRIGGERS
Anaphylaxis
Clinical signs • High variability- allergen, way of administration, senzitisation state, …
Anaphylaxis
• Skin: pruritus, erythema, exanthema, urticaria, swelling
• Airways: rhinitis, caught, wheezing, asthma
• GIT: nausea, stomach ache, vomitus, …
• Circulation: bluish face, tachycardia, hypotension, shock
• Urogenital: spasm of uterus, spasm of urinary bladder, …
• Neurological : anxiety, head ache, dissyness, consciousness
Local signs
• Escalation of local signs leads to shock reaction Systemic
signs
How to make a diagnose
Anaphylaxis
CLINICAL SIGNS + PERSONAL HISTORY
Ex-post laboratory examination
Ex-post examination
• Serum tryptase
• Allergen specific IgE
• Skin PRICK test
• Exposition test
ANAPHYLAXIS
THERAPY
Therapy
EPINEPHRINE THERE IS NO ABSOLUTE CONTRAINDICATION!!!
A + B + C + D
THERAPY
ANAPHYLAXIS
EPINEPHRINE 1. ⍺-adrenergic receptors –vazoconstriction = swelling, blod pressure 2. β1-adrenergic receptors – positive ionotropic + dromotropic = hypotension 3. β2-adrenergic receptors – against bronchoconstriction + anti inflamatory
THERAPY
Anaphylaxis
EPINEPHRINE Way of administration: i.m. (on bed-side monitor possible IV) Concentration: 1 mg/ml Dose: 0.01 mg/kg body weight in maximal single dose of 0.5mg (0.5 ml) for adult and 0,3mg (0,3ml) for child Next dose after 5 minut Autoinjectors: Children to 25kg- 0.15mg Adults and children up to 30kg- 0.3mg
1. EPINEPHRINE i.m.- 0.01 mg/kg body weight in maximal single dose of 0,5
mg for adult and 0,3mg for child, next dose administration after 5 minutes 2. Intravenous administration of medication is necessary • Antihistamines
• i.v. – bisulepine (Dithiaden®) • p.o. – 2. generation (levocetirisine (Zyrtec®), desloratadine (Aerius®),
bilastine (Xados®) • Corticosteroids
• i.v. – hydrocortison 200mg, methylprednison 40mg in single dose • Oxygenotherapy – O2 6-8l/min • Administration of bronchodilatans
• inhaled β2-mimetics – salbutamol (Ventolin®), or in combination with parasympatolytics= salbutamol+ipratropium (Berodual®)
• syntophyllin i.v. – 5 mg/kg
Anaphylaxis
Anaphylaxis- autoinjector
Thank you for your attention!