Anaphylactic reaction

Several of the mediators stored or synthesized and released by the mast cells have an effect on capillary permeability. An increase in capillary permeability permits the influx of several blood proteins into the adjacent tissues, thereby causing disturbances in osmotic equilibrium and tissular edema. In the skin, this is manifested by the formation of an urticarial wheal and by erythema. In addition, contraction of the nonstriated muscle fibers wherever they occur and increase in the secretion from exocrine glands are common features. Since the major mediators present in tissue mast cells and blood basophils are either preformed (e.g., histamine) or arise within seconds following the triggering event, it is understandable that anaphylactic reactions develop very rapidly following contact with antigen they also have a relatively limited duration. 

In recent years, it has been shown that IgE antibodies may be bound not only to the mast cells and basophils mediating anaphylactic reactions, but also to mac- 

Interaction of antibodies, especially of the IgM and IgG type, with antigenic determinants present on the membrane of target cells, followed by classical activation of complement (Gell/Coombs type II). 

Complexing of antigen with antibody in free solution, followed by the attachment of immune complexes to a target cell and activation of complement. In this case, the damaged cell plays the role of an innocent bystander.  

Covering of antigenic determinants by specific antibodies on target cells, followed by deleterious effects brought about by cytotoxic T-lymphocytes (antibody-dependent cell cytotoxicity). 

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Histamine. Histamiae [51 -45-6] (200) is an inflammatory autacoid iavolved ia alleigic and anaphylactic reactions (3,39,59) (see... 

Epinephrine itself does find some use in clinical medicine. The drug is used in order to increase blood pressure in cases of circulatory collapse, and to relax the bronchial muscle in acute asthma and in anaphylactic reactions. These activities follow directly from the agent s physiologic role. The biogenetic precursor of epinephrine, norepinephrine, has activity in its own right as a mediator of sympathetic nerve action. (An apocryphal story has it that the term nor is derived from a label seen on a bottle of a key primary amine in a laboratory in Germany N ohne... 

Allergy. Figure 1 Type I Anaphylactic Reaction IgE-bearing mast cells are activated by allergens to release mediators of acute allergic reactions. 

Recombinant humanized monoclonal antibodies have been used recently to target antigens that are preferentially located on cancer cells. Examples include trastuzumab and rituximab which are used to treat HER2 positive breast cancer and B-cell type lymphomas, respectively. Unwanted side effects include anaphylactic reactions. 

Antineoplastic agents that cannot be grouped under subheadings 1-9 include miltefosine which is an alkylphosphocholine that is used to treat skin metastasis of breast cancer, and crispantase which breaks down asparagine to aspartic acid and ammonia. It is active against tumor cells that lack the enzyme asparaginase, such as acute lymphoblastic leukemia cells. Side effects include irritation of the skin in the case of miltefosine and anaphylactic reactions in the case of crispantase. Another recent development is the proteasome inhibitor bortezomib which is used to treat multiple myeloma. 

After administering penicillin IM in the outpatient setting, the nurse asks the client to wait in the area for at least 30 minutes Anaphylactic reactions are most likely to occur within 30 minutesafter injection. 

Protamine sulfate can result in severe hypotension and anaphylactic reaction. When administering protamine sulfate, the nurse should make sure that resuscitation equipment is readily available. 

The nurse must continually assess the patient for anaphylactic reactions (difficulty breathing, wheezing, fever, swelling around the eyes, hives, or itching) particularly with anistreplase or streptokinase Resuscitation equipment is immediately available... 

Iron salts occasionally cause gastrointestinal irritation, nausea, vomiting, constipation, diarrhea, headache, backache, and allergic reactions. The stools usually appear darker (black). Iron dextran is given by the parenteral route Hypersensitivity reactions, including fatal anaphylactic reactions, have been reported with the use of this form of iron. Additional adverse reactions include soreness, inflammation, and sterile abscesses at the intramuscular (IM) injection site Intravenous (IV) administration may result in phlebitis at the injection site When iron is administered via the IM route, a brownish discoloration of tlie skin may occur. Fhtients with rheumatoid arthritis may experience an acute exacerbation of joint pain, and swelling may occur when iron dextran is administered. 

Monitoring and Managing Adverse Reactions When tiie patient is receiving iron dextran, the nurse monitors closely for a hypersensitivity reaction. Epinephrine is kept on standby in tiie event of severe anaphylactic reaction. 

Administration of oxytocin may result in fetal bradycardia, uterine rupture, uterine hypertonicity, nausea, vomiting, cardiac arrhythmias, and anaphylactic reactions. Serious water intoxication (fluid overload, fluid volume excess) may occur, particularly when the drug is administered by continuous infusion and the patient is receiving fluids by mouth. When used as a nasal spray, adverse reactions are rare. 

The immune globulins are contraindicated in patients with a history of allergic reactions after administration of human immunoglobulin preparations and individuals with isolated immunoglobulin A (IgA) deficiency (individuals could have an anaphylactic reaction to subsequent administration of blood products that contain IgA). 

Table 2. Prevalence of symptoms in anaphylactic reactions according to Przybilla and Rueff [see 18]. A meta-analysis of 1,865 cases from 14 publications (Liebermann) and 865 own patients with insect venom anaphylaxis... 

Tables. Classification of anaphylactic reactions according to severity of clinical symptoms [35]... 

Table 4. Differential diagnosis of anaphylactic reactions (according to Przybilla)... 

Fatal anaphylaxis occurs mostly due to bronchial obstruction or cardiac arrest, but also disseminated intervascular coagulation as well as adrenalin overdose [2, 7, 21, 31]. When anaphylactic reactions are survived, long-lasting sequels are rare. However,... 

Regarding the management of anaphylaxis, differentiation should be made between the acute treatment of an anaphylactic reaction [see chapter by Ring et al, section Treatment and Prevention, p. 201] and the management of a patient who has undergone an anaphylactic episode. 

Another way to classify anaphylactic reactions regards the eliciting agents the most common elicitors of anaphylaxis are drugs, insect venoms, foods, additives,... 

De Week AL Immunochemical particularities of anaphylactic reactions to compounds used in anesthesia. Ann Fr Anesth Reanim 1993 12 126-130. 

Hermann K, Ring J The renin-angiotensin system in patients with repeated anaphylactic reactions during Hymenoptera venom hyposensitization and sting challenge. Int Arch Allergy Immunol 1997 11 251-256. 

Finally, patients suffering from mastocytosis have a higher risk of developing severe anaphylaxis after an insect sting [34]. In venom-allergic patients with mastocytosis, elevated baseline serum tryptase levels were foimd to be associated with severe anaphylactic reactions to stings [35]. 

Anaphylactic reactions may exhibit a biphasic pattern. Different studies indicated a wide variation regarding the incidence of biphasic reactions. These range from 3 to 20% regarding the incidence of biphasic reactions. The time from the initial symptoms to the onset of the secondary reaction varied from >1 up to 47 h [36]. 

Areas with a higher socioeconomic status seem to be related to an increased number of anaphylactic reactions [44-46]. Data from Canada and Wales indicate that prescriptions for epinephrine autoinjectors were higher in populations of relative wealth, whereas these findings could not be explained by access to medical care or other factors. 

Sampson HA, Mendelson L, Rosen JP Fatal and near-fatal anaphylactic reactions to food in children and adolescents. N Engl J Med 1992 327 380-384. De Bilderling G, Mathot M, Agustsson S, Tuerlinckx D. Jamart J. Bodart E Early skin sensitization to aeroallergens. Clin Exp Allergy 2008 38 643-648. 

Schulman G. Hakim R. Arias R, Silverberg M, Kaplan AP. Arbeit L Bradykinin generation by dialysis membranes possible role in anaphylactic reaction. J Am Soc Nephrol 1993 3 1563-1569. 

Systemic anaphylaxis in man is frequently accompanied by electrocardiographic alterations ischemic ST waves, arrhythmias and atrial fibrillation [6-11]. Anaphylactic reactions after insect stings can lead to coronary spasm or acute myocardial infarction [12, 13]. Myocardial infarction can also occur as a consequence of idiopathic... 

In this article we will describe the possible roles of cardiac mast cells and their mediators during anaphylactic reactions in man and will briefly review the cardiovascular effects of mast cell-derived mediators in vivo. 

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