Anaphylactic reactions treatment

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. 

Soar J, Pumphrey R, Cant A, Clarke S, Corbett A, Dawson P> et al Emergency treatment of anaphylactic reactions - guidelines for healthcare providers. Resuscitation 2008 77 157-169. 

Some types of allergic reaction, for example immediate or delayed-type skin allergies, serum-sickness-like reactions and anaphylactic reactions, may occur in a proportion of patients given penicillin treatment. There is some, but not complete, cross-allergy with cephalosporins. 

Clinical evaluation entailed administration to 45 MPS I patients in a randomized, placebo-controlled clinical trial. The primary efficacy outcomes assessed were forced vital capacity and distance walked in 6 min, both of which were statistically higher relative to placebo after 26 weeks of treatment. The most serious adverse reaction noted was that of a severe anaphylactic reaction in one patient. The most common adverse effects reported were respiratory tract infection, rash and injection-site reactions. The product is manufactured by BioMarin Inc. and is distributed by Genzyme Corporation. 

It is intended for symptomatic treatment of seasonal allergies and allergic reactions as well as an adjuvant drug in anaphylactic reaction therapy. Synonyms of this drag are arbid, timpil, histryl, hispril, and others. 

The parenteral use of complexes of iron and carbohydrates has resulted in anaphylactic-type reactions. Deaths associated with such administration have been reported therefore, use iron dextran injection only in those patients in whom the indications have been clearly established and laboratory investigations confirm an iron-deficient state not amenable to oral iron therapy. Because fatal anaphylactic reactions have been reported after administration of iron dextran injection, administer the drug only when resuscitation techniques and treatment of anaphylactic and anaphylactoid shock are readily available. 

Acute asthma Cromolyn has no role in the treatment of acute asthma, especially status asthmaticus it is a prophylactic drug with no benefit for acute situations. Hypersensitivity reactions Severe anaphylactic reactions may occur rarely. Renal/Hepatic function Impairment. Decrease the dose or discontinue the drug in these patients. 

Brompheniramine VaZol also is indicated for the temporary relief of runny nose and sneezing caused by the common cold treatment of allergic and nonallergic pruritic symptoms temporary relief of mild, uncomplicated urticaria and angioedema amelioration of allergic reactions to blood or plasma adjunctive therapy in anaphylactic reactions. 

Cyclosporin is usually given orally, although absorption is often unpredictable. The intravenous route is usually restricted to patients who cannot take the drug orally, because of the risk of anaphylactic reactions. Other uses of cyclosporin include psoriasis and severe, active rheumatoid arthritis when these do not respond to conventional treatment, and steroid-resistant nephrotic syndrome. 

Diphtheria Diphtheria antitoxin, equine 20,000-120,000 units IV or IM depending on the severity and duration of illness. Early treatment of respiratory diphtheria. Available from the CDC.3 Anaphylactic reactions in 7% of adults and serum reactions in 5-10% of adults. 

During administration, patients vital signs should be monitored closely and epinephrine should be available for treatment of an acute anaphylactic reaction... 

Acute anaphylaxis occurred in an 18-year-old man after the third course of intradermal injections of triamcinolone suspension ( Kenalog 10 mg per treatment) for alopecia areata (446). Subsequent rechallenge with intradermal triamcinolone 1 ml resulted in the same anaphylactic reaction as before and his serum IgE concentration was increased. 

Bacitracin is indicated in prophylaxis and treatment of local infections, treatment of secondary pyodermas, as an adjunct in burn treatment, and as prophylaxis in operative wounds. However, it is not indicated in the treatment of chronic ulcers because of the increased risk of allergic reactions. There are several reports of delayed hypersensitivity, acute IgE-mediated allergic reactions, and anaphylactic reactions to bacitracin.51-53... 

ACE inhibitors are used in the treatment of hypertension, heart failure, and diabetic neuropathy. These drugs should not be used in patients with renovascular disease. Anaphylactic reactions may occur in patients. It has been reported that ACE inhibitors affect the fetus when administered to pregnant animals.52 ACE inhibitors can cause injury and even death to the developing fetus in the second and third trimesters of pregnancy.53 55... 

The reaction may be either local or systemic. Symptoms vary from mild irritation to sudden death from anaphylactic shock. Treatment usually involves intramuscular injection of adrenaline (epinephrine), antihistamines and corticosteroids. 

An anaphylactic reaction has been reported in a 75-year-old woman who was given adenosine 12 mg for a supraventricular tachycardia. She developed bronchospasm and profound inspiratory stridor, her arterial blood pressure fell to 50/30 mmHg from an arterial systolic pressure of 70 mmHg, and she recovered with appropriate treatment (41). 

Antimuromonab IgE antibodies have been identified after 10-25 days of treatment in six of 181 patients, and only in those with high titers of antimuromonab IgG antibodies (34). Immediate IgE-mediated anaphylactic reactions, namely anaphylactic shock, bronchospasm, urticaria, have been rarely reported and have sometimes been difficult to differentiate from the cytokine-release syndrome (35,36). Late-onset reactions after the first week of treatment, including cutaneous erythema, a fall in blood pressure, or serum sickness-hke reactions, are infrequent (37). 

In an extension study in 225 children there were no anaphylactic reactions or adverse events suggestive of serum sickness or immune complex formation anti-omalizumab antibodies were not detected (9). In cases of re-treatment there were no severe adverse events related to omalizumab (10). 

An HIV-infected patient who developed an anaphylactic reaction to rifampicin tolerated treatment with rifabutin without any adverse event. 

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