ACUTE ANAPHYLAXIS

From Big Medical Encyclopedia

ACUTE ANAPHYLAXIS (Greek ana-again and aphylaxis — vulnerability) — one of heavy displays of an anaphylaxis which is characterized by excitement and the subsequent oppression of function of c. N of page, bronchospasm, sharp falling of arterial pressure. For the first time similar reaction under the name of an anaphylaxis was described in 1902 by Richet and the Porter (Page R. Richet, P. Portier) at dogs. Further such reactions were observed at different types of animals and at the person and were called A. M. Bezredka an acute anaphylaxis.

An etiology

Allocate And. highway medicinal, serumal, vaccinal, food, from stings of insects, at skin diagnostic tests and specific desensitization. In most cases And. highways cause medicinal substances: penicillin (is more often than other drugs), streptomycin, novocaine, vaccines and serums, oryzamin, acetilsalicylic to - that, sulfanamide drugs, AKTG, and also extracts of pollen of plants. Heavy And. highway can develop at the use even is insignificant small doses of drugs. Cases are known And. highway at a diagnostic intracutaneous test from 10 PIECES of penicillin or at use of the syringe and needles which were sterilized with the syringes which were earlier used to an injection of penicillin. And. highway develops irrespective of a route of administration of medicines, but is more often at their parenteral administration. Usually And. highway develops at the people having any allergic reactions in the anamnesis.

The pathogeny

the Pathogeny does not differ from a pathogeny of an active anaphylaxis (see) since. And. highway — one of its manifestations. At primary hit in an organism of allergen there is a sensitization caused by formation of allergic antibodies. A part of these antibodies is fixed on various cells of fabrics, especially on labrocytes, other antibodies circulate in blood.

Repeated hit in an organism of allergen causes formation of a complex allergen + an antibody. Formation of such complex on labrocytes leads to escaping them various biologically active agents (a histamine, bradikinin, serotonin, etc.). Formation of a complex with the circulating antibodies leads to complement activation and formation of anaphylatoxin.

Biologically active agents, including anaphylatoxin, cause numerous pathophysiological effects. Among them are main: spasm of smooth muscles and increase in vascular permeability. Selective effect of biologically active agents on vascular system leads to deposition of blood in a venous bed, to reduction of cordial emission and disturbance of utilization of oxygen by fabrics.

At an atopy (see) development And. highway is possible at primary hit of allergen in an organism.

Pathological anatomy

Pathological anatomy And. highway is characterized by sharply expressed perivascular hypostases in various bodies and fabrics, a spasm and hypostasis of small bronchial tubes and bronchioles, considerable accumulation of atsidofilatsit (eosinophils) in the thickness of a wall of bronchial tubes, the phenomena of acute emphysema of lungs. Hypostasis and swelling of a brain is in certain cases observed.

The clinical picture

the Clinical picture is quite variable. To the most frequent manifestations And. highway should refer disturbances from respiratory organs and blood circulation (an acute bronchospasm and heavy hypotonia). Time of development And. highway fluctuates of several seconds before half an hour, and than quicker develops And. highway, is more adverse than subjects its outcome.

The first symptoms beginning And. highways are concern, sensation of fear, the pulsing headache, dizziness, a sonitus, cold sweat. In certain cases a harbinger developing And. highway can be sharply expressed skin itch with the subsequent very bystry emergence of urtikarny rashes and allergic hypostasis like Quincke. An asthma, feeling of constraint in breasts, cough is quite often noted that is a consequence of either a bronchospasm, or allergic hypostasis of a throat, and also symptoms of dysfunction went. - kish. a path in the form of pristupoobrazny abdominal pains, nausea, vomiting, a diarrhea. The mydriasis, foam from a mouth, spasms, involuntary defecation and an urination, bloody allocations from a vagina are possible.

At inspection of the patient pallor of skin and mucous membranes comes to light, it is frequent with a tsianotichesky shade (as a result of acute pulmonary insufficiency). Besides, allergic hypostases of various parts bodies, and also a small tortoiseshell can be found. In lungs the bandbox percussion sound is noted and rigid breath with dry rattles is listened. Cardiac sounds deaf. Owing to hypertensia of a small circle of blood circulation the emphasis of the II tone on a pulmonary artery can appear. Depending on expressiveness of shock bigger or smaller falling of arterial pressure is noted. Parallel to a lowering of arterial pressure also character of pulse changes: from rare and good filling to frequent and threadlike.

Especially hard proceeds And. highway with a loss of consciousness. The patient can die in one cases within 5 — 30 min. at the phenomena of asphyxia, in others — in 24 — 48 hours and more in connection with heavy irreversible changes in vitals. The lethal outcome can sometimes come and much later (even in 12 days) in connection with changes in kidneys (glomerulonephritis), in went. - kish. a path (profuse intestinal bleedings), in heart (myocarditis), a brain (hypostasis, hemorrhages) or other bodies. Therefore the patients who transferred And. highways, shall be during, at least, 12 days in a hospital.

Option A. highways consider exceptional cases of so-called death in a cradle of babies that connect with an allergy of the child to cow's milk (according to other point of view death comes in connection with aspiration of cow's milk in a lung of the sleeping child).

The diagnosis

At the sudden falling of arterial pressure which is followed by a loss of consciousness when other manifestations of allergic reactions are absent there are difficulties in diagnosis And. highway. If development of a shock symptom complex is connected with introduction to an organism of allergen (medicinal substances, foodstuff etc.), then anaphylactic genesis is most probable. Specification of the diagnosis is recommended only after rendering acute management to the patient.

The forecast

the Forecast substantially depends on timeliness of medical actions and on weight of shock. Short-term increase in arterial pressure to datum level is not a reliable sign of removal of the patient from state of shock. Vigorous antishock actions should be continued to a complete recovery of efficiency of a fabric blood-groove.

Treatment

At And. highway is required the acute qualified medical assistance. The first that needs to be made, is to stop further intake of allergen in a blood stream. E.g., if And. highway developed from sting or an injection of medicine, it is necessary to impose immediately a plait if it is possible, proksimalny places of an injection or a sting. Into the place of an injection or sting it is necessary to enter immediately 0,5 ml of 0,1% of solution of adrenaline (subcutaneously or intramusculary) and the same dose subcutaneously into other place.

In all cases And. highway should give preference to adrenaline as the means combining vasopressor action with broncholitic and reducing exudation in bronchial tubes.

In hard cases it is necessary to enter 0,5 ml of 0,1% of solution of adrenaline from 20 ml of 40% of solution of glucose intravenously. In the absence of medical effect it is recommended to repeat in 10 — 15 min. an injection of 0,5 ml of 0,1% of solution of adrenaline subcutaneously or intramusculary. If thus nevertheless it is not possible to increase arterial pressure, then it is necessary to use drop intravenous injection of noradrenaline (5 ml of 0,2% of solution of a noradrenalpn dissolve 5% of solution of glucose in 500 ml and enter with a speed of 40 — 50 thaws of 1 min.). In addition enter Cordiaminum, caffeine, camphor, and at the expressed bronchospasm, besides, intravenously of 10 ml of 2,4% of solution of an Euphyllinum (an aminofpllin, Diaphyllinum) from 10 — 20 ml of 40% of solution of glucose.

At the same time administer the antihistaminic drugs (1 — 2 ml of 2% of solution of Suprastinum carefully intravenously or better than 1 — 2 ml of 2,5% of solution of Pipolphenum intramusculary). Antihistaminic drugs are especially shown in the presence of urtikarny rashes and hypostasis like Quincke. The favorable medical effect is rendered by inhalation of oxygen. It is also recommended to apply intravenously glucocorticoid hormones possessing the expressed antiallergenic and anti-inflammatory action (1 — 2 ml of 3% of solution of Prednisolonum from 5% solution of glucose).

If shock arises from use of penicillin, after emergence of the first symptoms of reaction it is necessary to enter intramusculary, and in hard cases — intravenously a penicillinase in the form of a single dose of 250000 — 800000 PIECES. The penicillinase is most effective at its early use since it is capable to destroy free penicillin, and no effect on the allergen which is already formed a complex — the antibody has. However it is necessary to remember that the penicillinase at repeated introduction itself can cause allergic reactions.

In case of hypostasis of a throat and stidor breath against the background of use of adrenaline and antihistaminic drugs according to vital indications the intubation of a trachea or a tracheostomy is necessary. If, despite the held events, the condition of the patient does not improve, it is necessary to pass to resuscitation (see).

Prevention

to Predict development And. highway is still impossible. Skin sensitivity tests to medicinal substances are insufficiently exact. Besides, this test can sometimes cause allergic reaction in the patient.

Considering suddenness of emergence, precipitancy of development and weight of effects And. highway, paramount attention it is necessary to pay to measures of prevention: 1) to carefully ask the patient on allergic reactions to the medicines applied in the past (even easy reaction of allergic type in the anamnesis shall form the basis for failure from purpose of this drug since the repeated contact can cause heavier reaction, up to development And. highway); 2) with extra care to appoint medicines with the expressed antigenic properties; 3) with risk factors (the allergic constitution, fungal infections of skin, professional contact with antibiotics) it is recommended to make the first injection of an antibiotic in the lower third of a shoulder in case of emergence And. highway could impose a plait above an injection site; 4) to have the set of medicines and tools necessary for rendering immediate medical aid the first minutes of danger.

An acute anaphylaxis experimental — see. Anaphylaxis , active.


Bibliography: Adrianova N. V. and Samushiya Yu. A. Acute management at allergic diseases, M., 1968, bibliogr.; Allergic diseases at children, under the editorship of M. Ya. Studenikin and T. S. Sokolova, M., 1971, bibliogr.; Ivanov F. K. A serum disease and collateral complications at treatment by antibiotics, M., 1967, bibliogr.; Krayn L. Clinical immunology and an allergy, the lane with English, M., 1966, bibliogr.

S. M. Orlov.

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