Pavel Suk



}serious allergic reaction with rapid onset (minutes to hours)
}diagnosis is mainly clinical
}
}trigger - local anestetics
◦esters (high allergenic potential)
◦amids (safer)

}massive release of histamine (+other mediators)  from mast cells and basophils
}activation:
◦specific IgE depenent = true anaphylactic reaction
◦other immunologic pathways
◦non-immunologic (opiods, exercise, …)
◦idiopathic
}histamin effects
◦contraction of smooth muscles
◦vasodilation, capillary leakage (oedema)
◦myocardial depression
◦
◦

http://www.nhs.uk/Conditions/Nettle-rash/PublishingImages/urticaria_342x198_ADNYDN.jpg
http://img.webmd.com/dtmcms/live/webmd/consumer_assets/site_images/articles/health_tools/adult_skin
_problems_slideshow/phototake-rm-hives_urticaria_skin_rash.jpg
https://www.nlm.nih.gov/medlineplus/ency/images/ency/fullsize/2482.jpg
absent in 20 % cases
Hives (utricaria)
Flushing
Itching

http://media.tumblr.com/6f4490a7b47baf4d5c5687ee3adc91aa/tumblr_inline_mqvogdOcXM1qd5s1b.jpg
http://jeffreysterlingmd.files.wordpress.com/2013/10/angioedema_250x.jpg
eyelids / lips /
tongue / uvula

}respiratory (up to 70 %)
◦tachypnoea
◦wheezes
◦stridor
◦hypoxia
◦nasal discharge
◦voice change
◦throat closure

}cardiovascular (up to 50% cases)
◦tachycardia
◦hypotension
◦dizziness
◦syncope (hypotonia)
◦incontinence
}gastrointestinal (up to 50% cases)
◦crampy abdominal pain
◦nausea/vomiting
◦diarhoea

}Biphasis course
◦reccurence of symptoms within 10 (up to 72) hours


}concomitant medication
◦alpha and beta-blocker – resistence to treatment
◦ACE-I – more severe hypotension
◦antihistamines – mimicked symptoms
◦
}comorbidities
◦astma – increased incidence
◦COPD, severe pulmonary desease
◦cardiovascular disease  - severe course
◦acute infection (respiratory)
◦

}remove antigen
}call for help
}oxygen
}supine/semi-recumbent postion with eleveted lower limbs
◦
Výsledek obrázku pro semi-recumbent

}decreases histaminerelease from mast cells
}intramuscular (thigh)
}dose 0.3 to 0.5 mg
}0.01 mg/kg for children
}may be repeated in 10-15 min intervals
}
http://www.thailandsnakes.com/wp-content/uploads/2015/09/Epipen-Thailand.jpg Skeletal formula of
adrenaline

}H1/H2 antihistamines
◦relieve itching and hives
◦do not improve other symptoms
}glucocorticoids
◦effects onset in hours
◦methylprednisone 1-2 mg/kg IV
}bronchodilators (salbutamol, …)
◦adrenaline has strong BDL effect
}IV fluids

}observation 4-8 hours
◦with risk factors longer (> 12 hours)
}lab diagnostics - serum tryptase
◦ideally within 3 hours from symptoms onset
}pathogen identification
◦specific IgE
◦skin testing
}Epipen for high-risk patients