Anaphylactic shock

Anaphylactic shock is an acutely developing process. It poses a great threat to human life and can lead to death. Much depends on the degree of the allergic attack and the disorders it provoked. More detailed information about all the symptoms, causes and treatment will be described below.

ICD-10 code

Anaphylactic shock is classified in group T78-T80. This includes both primary codes for identification and those due to an unidentified cause. In multiple coding, this category can be used as an additional code to identify the effects of conditions classified elsewhere.

• T78.0 Anaphylactic shock due to pathological reaction to food.
• T78.1 Other manifestations of pathological reaction to food.
• T78.2 Anaphylactic shock, unspecified.
• T78.3 Angioedema

Giant urticaria Quincke's edema. Excludes: urticaria (D50.-). serum (T80.6).

• T78.4 Allergy, unspecified

Allergic reaction NEC Hypersensitivity NEC Idiosyncrasy NEC Excludes: allergic reaction NEC to a medicinal product (T88.7) properly prescribed and correctly administered. T78.8 Other adverse reactions, not elsewhere classified.

• T78.9 Unspecified adverse reaction.

Excludes: adverse reaction due to surgical or medical intervention NOS (T88.9).

Statistics

Fortunately, situations where anaphylactic shock develops are not very common. According to statistics, a reaction to taking certain medications develops in only one person out of 2,700 hospitalized. This is a very small figure. Fatal outcomes are not very common. Usually, the mortality rate is 1-2 cases out of a million. These statistics are relevant for insect bites.

Statistics on this pathology vary significantly in different countries. As for Russia, the problem occurs in no more than one person out of 70 thousand per year. Basically, it is a reaction to an insect bite, this is the most common reason for its appearance. In Canada, this figure is lower, 4 cases per 10 million, in Germany 79 cases per 100 thousand (high figure). In the USA, the problem is very widespread. Thus, in 2003, the pathology affected 1,500 thousand people per year.

Causes of anaphylactic shock

The main reason is the penetration of poison into the body, this can happen due to a snake or insect bite. In recent years, the problem has begun to appear against the background of taking medications. Penicillin, Vitamin B1, Streptomycin can lead to this. A similar effect is caused by Analgin, Novocaine, immune serums.

• Poisons. Bites from bedbugs, wasps and bees can cause pathology. This causes anaphylactic shock in people who are particularly susceptible to it.
• Medicines. The above medicines can cause shock. To ease the person's condition, it is worth introducing Prednisolone and Adrenaline. They can relieve allergic reactions and swelling.
• Food. Most products can cause the problem. It is enough to simply eat the allergen. These are mainly milk, eggs, peanuts, nuts, and corn seeds.
• Risk factors. People suffering from asthma, eczema, allergic rhinitis are more susceptible to developing shock. An allergic reaction can develop to latex, contrast agents.

[ 1 ], [ 2 ], [ 3 ], [ 4 ], [ 5 ]

Pathophysiology

The key moment of anaphylactic shock is a sharp drop in blood pressure. Like any allergic reaction, this pathology begins with an allergen-antibody reaction. There is no exact definition of why the disease occurs. This is a common allergic reaction that can occur to anything.

True, it has been proven that when an allergen enters the body, its active reaction with antibodies begins. This triggers a whole series of cascade actions. As a result, capillaries and arteriovenous shunts expand.

Because of this negative effect, most of the blood begins to move from the main vessels to the periphery. As a result, a critical decrease in blood pressure occurs. This action occurs so quickly that the circulatory center simply does not have time to quickly react to this process. As a result, the brain does not receive enough blood and the person loses consciousness. True, this measure is extreme, as a rule, it leads to a fatal outcome. Not in all cases, but half of them definitely end unfavorably.

Symptoms of anaphylactic shock

The clinical picture of the disease is "famous" for its speed. Thus, the symptoms develop within a few seconds after contact with the allergen. First of all, there is depression of consciousness, after which the blood pressure drops sharply. The person is plagued by convulsions, and involuntary urination occurs.

Many patients begin to feel a sharp rush of heat and skin hyperemia before the main symptoms. In addition, the fear of death is oppressive, headaches and pain behind the breastbone appear. Then the pressure drops and the pulse becomes threadlike.

There are other variants of anaphylactic shock development. Thus, skin lesions are possible. A person feels increasing itching, which is typical for Quincke's edema. After that, a severe headache and nausea develop. Then convulsions occur, accompanied by involuntary urination and defecation. Then the person loses consciousness.

The respiratory organs are affected, the person hears suffocation caused by swelling of the mucous membrane. Acute myocarditis or myocardial infarction is observed from the heart. The diagnosis is made based on clinical manifestations.

Precursors of anaphylactic shock

After interaction with the allergen, the precursor stage develops. It is characterized by the appearance of a feeling of approaching death. The person begins to be bothered by discomfort, fear and anxiety. He cannot describe his condition. After all, it is really strange.

After which, noise in the ears begins to appear. A sharp decrease in vision is possible, which brings a lot of discomfort. The person is in a pre-fainting state. Then pain in the lower back develops, fingers and toes begin to go numb. All these symptoms indicate that the person is developing anaphylactic shock. It is also characterized by the development of urticaria, Quincke's edema and severe itching.

It is important to understand that things are bad and it is necessary to provide emergency assistance to the person. If symptoms appear, it is worth contacting a medical institution. Without special preparation and the use of the necessary drugs, it is impossible to help a person.

[ 6 ], [ 7 ]

Drug-induced anaphylactic shock

Drug anaphylactic shock is an acute allergic reaction that occurs immediately. It all occurs against the background of taking medications. They squeeze out mediators and lead to disruption of the activity of important organs and systems. Which can lead to death.

The problem arises due to a history of drug allergy. It may develop against the background of long-term use of drugs, especially if they are characterized by repeated use. Depot preparations, polypharmacy, and increased sensitizing activity of the drug can lead to shock. The risk is professional contact with drugs, the presence of an allergic disease in the anamnesis, and the presence of dermatomycosis.

This pathology is not very common. It mainly occurs due to self-treatment, without consulting a doctor, or the use of a medication that can cause an allergy.

[ 8 ], [ 9 ]

Anaphylactic shock in pregnant women

This phenomenon begins to gain momentum over time. Pregnancy itself makes a woman vulnerable to many factors, including allergic reactions. Often, this condition is caused by taking certain medications.

The clinical picture of manifestations does not differ at all from the symptoms of anaphylactic shock in other people. However, such a phenomenon in pregnant women can lead to spontaneous abortion or the onset of premature labor. This process can lead to premature placental abruption, which entails the death of the fetus. The development of disseminated intravascular coagulation syndrome is not excluded. It is the cause of fatal uterine bleeding.

The reaction that occurs together with the loss of consciousness is especially severe. The woman can simply die within 30 minutes. Sometimes this "process" is extended for 2 days or even 12 days. It entails failures in the functioning of vital organs and systems.

Treatment in this case is extremely difficult. After all, the fetus itself is the allergen. If the woman's condition is severe, it is recommended to terminate the pregnancy. In general, a pregnant girl should take medications with caution, so as not to provoke such a reaction in the body.

[ 10 ], [ 11 ], [ 12 ], [ 13 ], [ 14 ], [ 15 ], [ 16 ], [ 17 ]

Anaphylactic shock in newborns

Anaphylactic shock is an allergic reaction that is immediate. That is, the condition worsens immediately after contact with the allergen. This can happen due to taking medications, as well as using radiopaque substances. Very rarely, the process occurs against the background of an insect bite. There were cases when the "problem" was provoked by cold. Most often, the problem occurs due to the negative effects of antibiotics. Usually, the reaction occurs to Penicillin. If the mother took such a drug and then breastfed her baby, the reaction will be immediate.

The baby begins to be bothered by a feeling of fear and anxiety. The child is capricious, cries. The face turns blue and pale. Shortness of breath often begins, accompanied by vomiting and a rash. The child's blood pressure rises, but it is impossible to understand this without measuring it. After which there is a loss of consciousness, convulsions appear. Naturally, a fatal outcome is not excluded.

If the condition is accompanied by acute respiratory failure, the baby becomes suddenly weak, lacks air, and is plagued by a painful cough. The skin turns pale, sometimes foam appears at the mouth, and wheezing. In babies, everything manifests itself very quickly. Weakness, tinnitus, and profuse sweating are the first sudden signs. The skin becomes pale, the pressure drops. Within a few minutes, loss of consciousness, convulsions, and death may develop. Therefore, it is important to identify the problem in time and begin emergency care.

[ 18 ], [ 19 ], [ 20 ], [ 21 ]

Stages

There are four stages of shock development. The first of them is the cardiogenic variant. This stage is the most common. It is characterized by symptoms of cardiovascular failure. Thus, tachycardia is noted, a person feels a sharp drop in pressure, a threadlike pulse. There is a disorder of external respiration. This variant does not lead to death.

• Asthmoid (asphyxial) variant. It is characterized by the manifestation of bronchiolospasm, all this leads to the development of acute respiratory failure. Suffocation occurs, it is associated with laryngeal edema.
• Cerebral variant. It is characterized by damage to the central nervous system. This occurs due to acute cerebral edema. Hemorrhages and dysfunctions of the brain are possible. This condition is characterized by psychomotor impairment. Loss of consciousness and tonic-clonic seizures often occur.
• Abdominal variant. It is characterized by the development of symptoms as a result of taking antibiotics. This may be Bicillin and Streptomycin. A fatal outcome may occur due to the development of cardiovascular failure, as well as cerebral edema.

Forms

There are several forms of development of the pathology. The lightning form is the fastest, this is clear from the name itself. It develops within 2 minutes after the allergen enters the body. It is characterized by rapid development of symptoms, as well as cardiac arrest. The signs are very scanty, there is a sharp pallor, symptoms of clinical death appear. Sometimes patients simply do not have time to describe their condition.

• Severe form. It develops within 5-10 minutes after contact with the allergen. The patient begins to complain of an acute shortage of air. He is suppressed by a sharp feeling of heat, headache, and pain syndrome develops in the heart area. Heart failure develops very quickly. If qualified assistance is not provided in time, a fatal outcome occurs.
• Moderately severe form. Development occurs within 30 minutes after the allergen enters the body. Many patients complain of fever, reddening of the skin. They are plagued by headaches, fear of death and strong agitation.
• The fulminant form is characterized by an acute onset and rapid progression. Blood pressure drops very quickly, the person loses consciousness and suffers from increasing respiratory failure. A distinctive feature of the form is resistance to intensive anti-shock therapy. In addition, the development of the pathology progresses strongly, a comatose state is possible. Death can occur for the first time in minutes or hours, as a result of damage to vital organs.

There are variants of lightning-fast progression. They completely depend on the clinical syndrome. It can be acute respiratory or vascular failure.

In shock accompanied by acute respiratory failure, a feeling of tightness in the chest develops, the person does not have enough air, a painful cough, shortness of breath, headache begins. Angioedema of the face and other parts of the body is possible. If the syndrome progresses, a fatal outcome is possible.

An allergic reaction with acute vascular insufficiency is characterized by its sudden onset. The person feels weak, there is a noise in the ears, and profuse sweating appears. The skin becomes pale, the pressure drops, and the heart is weakened. A fatal outcome can occur due to the increase in symptoms.

[ 22 ], [ 23 ], [ 24 ], [ 25 ]

Consequences and complications

As for the consequences, they are affected by the severity of anaphylactic shock, as well as its duration. The whole danger is that the process can negatively affect the entire body as a whole. That is, lead to the failure of many vital organs and systems.

The less time there was between contact with the allergen and the development of shock, the more severe the consequences. For some time, any symptoms are completely absent. However, repeated contact can become more dangerous than the first.

Often the problem leads to the development of very dangerous diseases. These include non-infectious jaundice, as well as glomerulonephritis. There are severe disruptions in the functioning of the vestibular apparatus, the central nervous system. The consequences are really aggravating. Therefore, the faster a person receives emergency care, the higher the chance of preventing a fatal outcome and the development of problems with many organs and systems.

As for complications, they should be divided into two types. After all, they can arise both after contact with the allergen and during the recommended treatment. Thus, complications caused by contact with the allergen include respiratory arrest, DIC syndrome, bradycardia, which entails cardiac arrest. The development of cerebral ischemia, renal failure, as well as general hypoxia and hypoxemia is possible.

Complications after incorrect therapy are also aggravating. They can occur in almost 14% of all cases. This may be due to the use of adrenaline. Against this background, tachycardia of various types occurs, arrhythmia and myocardial ischemia are possible.

During treatment, it is necessary to understand that cardiopulmonary resuscitation may be required at any time. It is necessary to know how it is done. After all, the process must be carried out according to standard ALS/ACLS algorithms.

[ 26 ], [ 27 ], [ 28 ], [ 29 ], [ 30 ], [ 31 ]

Diagnosis of anaphylactic shock

Diagnostics should begin with questioning the victim. Naturally, this is done in cases where the manifestation of shock does not take the form of lightning. It is worth clarifying with the patient whether he had previously had allergic reactions, what caused them and how they manifested themselves. It is necessary to find out information regarding the medications used. These can be glucocorticoids, antihistamines or adrenaline. They are the ones that can lead to the development of a negative process.

After the interview, the patient is examined. The first step is to assess the person's condition. Then the skin is examined, sometimes it takes on a bluish tint or, on the contrary, becomes pale. Next, the skin is assessed for erythema, edema, rash or conjunctivitis. The oropharynx is examined. Anaphylactic shock often causes swelling of the tongue and soft palate. The victim's pulse should be measured. The patency of the airways, the presence of shortness of breath or apnea are assessed. It is imperative to measure the blood pressure, if the condition is severe, it is not determined at all. In addition, it is necessary to clarify the presence of such symptoms as vomiting, vaginal discharge (bloody type), involuntary urination and / or defecation.

[ 32 ], [ 33 ], [ 34 ], [ 35 ]

Tests for anaphylactic shock

This process is characterized by a very specific manifestation, which may differ depending on the affected organs and systems. It is characterized by a sharp decrease in pressure, a disorder of the central nervous system, and a spasm of smooth muscles. This is far from a complete list of manifestations.

When diagnosing anaphylactic shock, laboratory tests are not performed at all. Because they will not be able to find out anything. However, stopping an acute reaction does not always mean that everything has ended well and the process has retreated. In 2-3% of cases, manifestations begin after a while. Moreover, these may not be ordinary symptoms, but real complications. Thus, a person can "get" nephritis, damage to the nervous system, allergic myocarditis. The manifestations of immune disorders have many similar features.

Thus, the number of T-lymphocytes decreases significantly, and changes occur in its activity. The level of T-suppressors decreases. As for immunoglobulins, they increase sharply. The reaction of lymphocyte blast transformation increases sharply. Autoantibodies appear in the body.

[ 36 ], [ 37 ], [ 38 ], [ 39 ], [ 40 ], [ 41 ], [ 42 ], [ 43 ], [ 44 ]

Instrumental diagnostics

It should be noted that the diagnosis of the process is clinical. There are no instrumental methods that could confirm the presence of this process. After all, everything is visible anyway. However, despite this, there are still some research methods that are carried out along with first aid. These include ECG, Pulse Oximetry and Chest X-ray, CT and MRI.

So, ECG monitoring is performed in 3 leads. Recording in 12 leads is indicated only for those patients who have been diagnosed with specific cardiac rhythm disturbances characteristic of ischemia. This procedure should not interfere with emergency care. It is necessary to take into account the fact that any changes in the ECG can be caused by hypoxemia or hypoperfusion. Myocardial diseases caused by the use of adrenaline can provoke such a course.

• Pulse oximetry. If the SpO2 values are low, then the person has hypoxemia. Usually, in the case of anaphylactic shock, this process precedes cardiac arrest. The process can be observed in two conditions. Thus, with bronchial asthma or stenosing laryngitis. Therefore, everything should be assessed in a complex.
• General chest radiography. It is performed only after the patient's condition has stabilized and if there are signs of lung pathologies. It is advisable to take pictures immediately. CT and MRI are auxiliary methods. They are performed only in cases where there is a suspicion of pulmonary embolism.

Differential diagnostics

Laboratory tests are not carried out during the development of the reaction. After all, you need to act quickly, there is no time to take tests and wait for the answer. The person needs urgent help.

Increased levels of some enzymes in the blood indicate that a person has developed a critical condition. Thus, histamine usually begins to rise sharply, this happens literally within 10 minutes. However, such a method of determination is not generally available. Tryptase. Peak values are observed within an hour and a half after the start of the process itself, they persist for 5 hours. Patients may experience an increase in both two indicators, and one.

To determine the level of these enzymes, it is necessary to take a blood sample. For this, 5-10 ml of the sample is taken. It is worth noting that the collection of tests should be carried out in parallel with the emergency care! Repeated collection is carried out 2 hours after the symptoms began to manifest themselves.

5-hydroxyindoleacetic acid. Serves for laboratory differential diagnostics of carcinoid syndrome and is measured in daily urine. LGE does not play a special role. Only confirmation of the diagnosis is possible.

Skin tests are performed to determine the trigger that may have caused the process. This could be an allergic reaction to food or a drug.

In addition, tests are performed for markers of IgE-independent reactions, metanephrines, vanillylmandelic acid, blood serotonin levels, as well as a test panel for the determination of vasointestinal polypeptides.

All of the above are only auxiliary studies. The presence of a problem can be determined even by visual examination of the patient.

[ 45 ], [ 46 ]

Treatment of anaphylactic shock

This stage depends entirely on the etiology. First of all, it is necessary to stop the parenteral administration of drugs, a tourniquet is applied to the injection site (slightly above it) for 25 minutes. After 10 minutes, it can be loosened, but not more than 2 minutes. This is done if the problem was caused by the administration of a drug.

If the problem arose due to an insect bite, the sting should be immediately removed using an injection needle. Removing it manually or with tweezers is not advisable. This can lead to the poison being squeezed out of the sting.

Ice or a heating pad with cold water should be applied to the injection site for about 15 minutes. After that, the injection site is injected in 5-6 places, thus infiltration occurs. For this, 0.5 ml of 0.1% adrenaline solution with 5 ml of isotonic sodium chloride solution is used.

Anti-shock therapy is performed. The person's airways are kept clear. The patient must be laid down, but his head must be lowered to prevent aspiration of vomit. The lower jaw must be extended; if there are removable dentures, they must be removed. Then 0.3-0.5 ml of 0.1% adrenaline solution is administered intramuscularly into the shoulder or thigh. It can be administered through clothing. If necessary, the procedure is repeated for 5-20 minutes, while the pressure level must be monitored. Then access is provided for intravenous administration. The person is administered 0.9% sodium chloride solution. For an adult, at least one liter, and for a child, 20 ml per kilogram of weight.

Antiallergic therapy. It is necessary to use glucocorticoids. Prednisolone is mainly used. It is administered in a dosage of 90-150 mg. For children under one year, the dosage is 2-3 mg per kilogram of weight. At the age of 1-14 years - 1-2 mg per kilogram of body weight. Intravenous, jet injection.

Symptomatic therapy. To increase the pressure, Dopamine is administered intravenously at a rate of 4-10 mcg/kg/min. If bradycardia begins to develop, then Atropine is administered subcutaneously at a dosage of 0.5 mg. If necessary, the procedure is repeated after 10 minutes. In case of bronchospasm, Salbumatol should be administered by inhalation, preferably 2.5-5 mg. If cyanosis begins to develop, oxygen therapy should be administered. It is also necessary to monitor respiratory functions and always have the skill of rapid response. After all, resuscitation measures may be needed at any time.

Prevention

It is almost impossible to predict the development of this condition. After all, the problem can arise at any time and for no apparent reason. Therefore, it is necessary to use drugs that have pronounced antigenic properties with caution. If a person has a reaction to Penicillin, then it is impossible to prescribe drugs from this category.

The introduction of complementary foods to babies is carried out with caution. Especially if allergies are hereditary. One product should be introduced within 7 days, not faster. If a person develops a persistent reaction to cold, then he should refuse to swim in ponds. Children should not be outdoors for a long time in winter (naturally, if there is a cold problem). You cannot be in places with a large accumulation of insects, near an apiary. This will help to avoid an insect bite and thereby cause a shock state of the body.

If a person has an allergic reaction to any allergen, it is worth taking special medications in order not to provoke its strong development.

Forecast

It should be noted that the fatality rate is 10-30% of the total. In this case, much depends on the severity of the patient's condition. Fatalities in drug allergies are caused by gross errors in choosing a medication. Incorrect selection of contraception can also contribute to this process.

People with a persistent allergic reaction to penicillin are especially dangerous. Using a syringe with its residue can cause an unexpected reaction in the body, which is a real danger. Therefore, only a sterile syringe should be used. All people who are in direct contact with medications, while having a risk of developing shock, should change their place of work. If special rules are followed, the prognosis will be favorable.

It is important to understand that no sanatorium conditions will help get rid of a possible allergy. It is necessary to simply limit contact with the main allergen. If there is a strange reaction to being in cold water or to the cold in general, you need to limit contact with it. This is the only way to save the situation. Naturally, the speed of reaction also affects the favorable prognosis when an acute form of shock develops. It is necessary to provide the person with emergency assistance and call an ambulance. Joint actions will help save the life of the victim.

[ 47 ], [ 48 ]