Anaphylactic shock: how to recognize it, symptoms, treatments


Inside hell suddenly. Characterized by an unexpected and sudden onset, lo anaphylactic shock (or anaphylaxis) is one severe allergic reactiongeneralized and life-threatening: “It starts quickly affecting two or more systems, for example the skin and respiratory system or the circulatory and gastrointestinal system”, explains Dr. Max Vote, in charge of the First Intervention Point at the Cortina Hospital in Cortina d’Ampezzo, Belluno. «In patients who are affected, a mortality rate of 0.6-2 per cent is estimated: therefore the Timing of intervention is crucial and it can really make a difference ».

What is anaphylactic shock

Most anaphylactic shocks are allergic origin and it depends on a particular mechanism that is triggered in the body. «Each allergen is harmless when it comes into contact with the body for the first time. Some people, however, mistakenly perceive it as a threat and begin to produce special antibodies, immunoglobulins E, which attach themselves to the surface of certain cells, such as basophils present in the blood and mast cells present in tissues “, says Dr. Vota.

“When the same allergen comes into contact with the organism of these subjects for the second time, basophils and mast cells release large amounts of histamine and other mediators of inflammation, which lead to dilation of blood vessels and trigger the process of symptoms typical of allergies. The reaction can be mild, moderate or severe: here, within this scale, anaphylactic shock represents the most serious and dangerous occurrence ».

When it occurs

As we know, allergies are more frequent in people who are familiar with this type of reaction, but each time it is impossible to predict their severity based on past episodes. “This means that anaphylactic shock is always a unexpected eventbecause the intensity of an attack does not allow us to presume what will be the course of subsequent ones ».

In general, however, the substances which can most easily lead to anaphylaxis are some foods (eggs, hazelnuts, peanuts, milk, shellfish, fish), venom of the hymenoptera (bee, wasp or hornet stings), medicines (penicillin, anti-inflammatories and some biologics).

“They also exist idiopathic anaphylactic shocks, that is, of unknown origin », Dr. Vota is keen to specify. «The symptoms are always the same, but this time we do not observe the presence of immunoglobulin E on the surface of basophils and mast cells. This is the case of anaphylaxis triggered in some patients by iodinated contrast media that are injected during various radiographic examinations: here it is not an allergy, so it is impossible to predict the reaction“.

Even more complex to beat on time is theexercise anaphylaxis, which can once again be idiopathic (physical activity is enough to trigger it) or food-dependent (in this case, it occurs during or after a physical effort that has been preceded, even for a few hours, by the ingestion of a certain food ). “In the latter case, the link is not entirely clear, but it could be due to exercise-induced vasodilation, which increases intestinal permeability making the allergen more ‘aggressive’, otherwise tolerated”.

How to know you are having a severe allergic reaction

But how does anaphylactic shock manifest itself? We have said that two or more apparatuses are involved in this type of reaction, so they can be added together different symptomssuch as hives, rhinitis, asthma, diarrhea or stomach cramps, which appear about 20-30 minutes (maximum one hour) after contact with a certain allergen.

“We have to suspect the problem when we realize that things are evolving rapidly and that general malaise gets worse quickly: the skin becomes pale and sweaty, the heartbeat is weak and rapid, it is difficult to breathe, there is agitation and mental confusion ».

In this phase, all the medicines normally used to counteract allergies (such as antihistamines and cortisones) have no effect, because the only life-saving drug is adrenaline. «Sometimes, however, anaphylaxis can be biphasic: after a few hours from its apparent resolution, there is a resumption of symptoms without the subject having been exposed to the allergen again. At other times, the anaphylactic shock is even protracted, ie its clinical manifestations last for 24-36 hours, forcing the adrenaline treatment to be repeated several times ».

What to do now and what not to do

All allergy sufferers should always keep an adrenaline injector with you, using it if threatening symptoms appear and without waiting for the situation to be too serious. «These preparations, similar to ‘pens’, are injected intramuscularly into the thigh, even through the clothing: just hold them down for about ten seconds and then release. These are prepackaged and pre-dosed formulations, convenient because they can be stored at room temperature, even in summer, and last up to eighteen months.

After administration, it is anyway need to go to the hospital closer to be properly monitored. On the other hand, those who do not have adrenaline with them must immediately contact 118 for a quick intervention ». What not to do instead? First, get excited. It’s important keep calm, as far as possible, in order to remain lucid and find a correlation between the symptoms and the last substances ingested or with which one has come into contact. “Even running to a medical center is not a good idea, because in this critical phase any physical effort could aggravate the situation”, explains the expert.

What treatments are available

There are no therapies capable of preventing the problem, but there are rules of conduct effective. For example, those suffering from a food allergy must avoid coming into contact with the “offending” foods, which may be contained in unsuspected preparations: “We read product labels well before consuming them, carefully consulting the list of ingredients, and eat as simple as possible, avoiding too elaborate preparations », recommends Dr. Vota.

«We pay maximum attention even when we hire a drugFor example, there are ibuprofen-based formulations containing soy lecithin, which in turn may contain peanut proteins. Therefore, in allergic patients, even pharmacological treatments should always be recommended by a specialist, avoiding any risk ».

If, on the other hand, the allergy depends on the venom of the hymenoptera, they can be used outdoor precautions (wear long pants and long sleeves during walks, avoid walking barefoot, do not camp near ponds and swamps, use insect repellent products) or maybe you can evaluate the allergy vaccine, but not always possible: “The specific immunotherapy for this form of allergy is available only for those who have already experienced medium-severe reactions. Otherwise, in addition to not being effective, desensitization could even exacerbate the problem “, concludes the expert.

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