Shock, anaphylactic

Clinical Forms of Allergic Reactions to Drugs I. Anaphylactic Shock 

Only a few studies (Hanashiro and Weil 1967 Bernreiter 1959 Booth and Patterson 1970 Wegmann and Renker 1976) have described the pathophysiological changes occurring during anaphylactic shock in man, obviously because 

Early recognition of anaphylactic shock and the immediate use of epinephrine and other supportive measures (see Chap. 8) may be life-saving. The critical time is usually the first 30-60 min after this initial phase, symptoms often subside completely, even in the absence of continuing therapy. However, patients with severe reactions may require treatment and medical observation for at least 24 h delayed fatality can occur due to severe hypotension or hypoxemia leading to infarction of parenchymatous organs such as the brain, heart, kidney, or liver. Symptoms of urticaria or serum sickness may occur in the aftermath of anaphylactic reactions and last for several days. 

Aside from the severe cardiovascular collapse observed in major anaphylactic shock, all symptoms may occur in a milder form such as generalized urticaria, angioneurotic edema, and asthmatic attacks. In general, the faster the symptoms appear after injection or ingestion of the drug, the more severe the reaction. 

Venoms Streptokinase Hormones (ACTH, insulin, calcitonin) 

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L-Tyrosine metabohsm and catecholamine biosynthesis occur largely in the brain, central nervous tissue, and endocrine system, which have large pools of L-ascorbic acid (128). Catecholamine, a neurotransmitter, is the precursor in the formation of dopamine, which is converted to noradrenaline and adrenaline. The precise role of ascorbic acid has not been completely understood. Ascorbic acid has important biochemical functions with various hydroxylase enzymes in steroid, dmg, andhpid metabohsm. The cytochrome P-450 oxidase catalyzes the conversion of cholesterol to bUe acids and the detoxification process of aromatic dmgs and other xenobiotics, eg, carcinogens, poUutants, and pesticides, in the body (129). The effects of L-ascorbic acid on histamine metabohsm related to scurvy and anaphylactic shock have been investigated (130). Another ceUular reaction involving ascorbic acid is the conversion of folate to tetrahydrofolate. Ascorbic acid has many biochemical functions which affect the immune system of the body (131). 

The penicillins in general, ate renowned for their lack of toxicity. The most common adverse effect of the use of penicillins is an allergic reaction which can change from a mild rash to fatal anaphylactic shock in rate cases. AH penicillins cross the placenta and ate excreted in maternal milk. However, the relative freedom from toxicity tenders these compounds valuable agents during pregnancy and lactation. 

For enzymes intended for parenteral use, the manufacturer must assure that the enzyme preparation is essentially pure and free of endotoxins. Electrophoretic and immunologic tests provide the requisite evidence of purity and homogeneity. Most importandy, the manufacturer must remove toxic impurities, eg, bacterial hpopolysacchati.de (endotoxins) which might cause severe toxic reactions such as anaphylactic shock, fever, and vascular coUapse. 

Histamine is the biological amine, playing an important role in living systems, but it can also cause unnatural or toxic effects when it is consumed in lai ge amounts. It can occur with some diseases and with the intake of histamine-contaminated food, such as spoiled fish or fish products, and can lead to undesirable effects as headache, nausea, hypo- or hypertension, cai diac palpitations, and anaphylactic shock syndrome. So, there is a need to determine histamine in biological fluids and food. 

Anaphylactic shock. A systemic hypersensitivity response resulting in dramatic decrease in blood pressure. 

The most serious acute Type I reaction is the generalized reaction, the anaphylactic shock. Anaphylactic shock results from a generalized release of mediators from mast cells and basophils. The clinical symptoms are manifested predominantly in... 

The fate of the patient largely depends on the first 30 min of an anaphylactic shock reaction. Thus persons with a known history of hypersensitivity reactions towards bee or wasp poison should always carry an emergency set during the insect season (see below). 

The term anaphylactic shock describes a severe generalized type I allergic reaction associated with cardiovascular shock, airway constriction and heart arrhythmias, which, if left untreated, may cause death. 

The human histamine Hi-receptor is a 487 amino acid protein that is widely distributed within the body. Histamine potently stimulates smooth muscle contraction via Hi-receptors in blood vessels, airways and in the gastrointestinal tract. In vascular endothelial cells, Hi-receptor activation increases vascular permeability and the synthesis and release of prostacyclin, plateletactivating factor, Von Willebrand factor and nitric oxide thus causing inflammation and the characteristic wheal response observed in the skin. Circulating histamine in the bloodstream (from, e.g. exposure to antigens or allergens) can, via the Hi-receptor, release sufficient nitric oxide from endothelial cells to cause a profound vasodilatation and drop in blood pressure (septic and anaphylactic shock). Activation of... 

Anaphylactic shock is an extremely serious allergic drug reaction that usually occurs shortly after the administration of a drug to which the individual is sensitive This type of allergic reaction requires immediate medical attention. Symptoms of anaphylactic shock are listed in Table 1-2. 

All or only some of these symptoms may be present. Anaphylactic shock can be fatal if the symptoms are not identified and treated immediately. Treatment is to raise the blood pressure improve breathing, restore cardiac function, and treat other symptoms as they occur. 

Anaphylactic shock, which is a severe form of hypersensitivity reaction, also can occur (see Chap. 1). Anaphylactic shock occurs more frequently after parenteral administration but can occur with oral use This reaction is likely to be immediate and severe in susceptible... 

Allergic reactions (anaphylactic shock, angioneurotic edema) ... 

Other—urticaria, anaphylactic shock, other skin manifestations... 

Although these drug s are sometimes used to treat allergies, a drug allergy can occur with the use of an antihistamine Symptoms that may indicate an allergy to these drugs include skin rash, urticaria, and anaphylactic shock. 

Fig. 4. Microcirculatory stasis in the rabbit omentum during anaphylactic shock (from [11]).

Dybendal X Guttormsen AB, Elsayed S, Askeland 48 B, Harboe T, Florvaag E Screening for mast cell tryptase and serum IgE antibodies in 18 patients with anaphylactic shock during general anaesthesia. 

Hanashiro PK, Weil MH Anaphylactic shock in man. Report of two cases with detailed hemodynamic and metabolic studies. Arch Intern Med 1967 119 129. 

Clinical manifestations show striking variations of intensity in different patients, ranging from mild hypersensitivity reactions to severe anaphylactic shock and death (table 3). However, IgE-mediated reactions are usually more severe than non-IgE-medi-ated reactions [9]. In addition, IgE-mediated reactions to NMBAs have been shown to be more severe than reactions to other substances like latex in some series [9]. 

Duda D. Dick W, Lorenz W Anaphylactic shock. Resuscitation 1998. 4th Congress of the European Resuscitation Council. Bologna, Monduzzi, 1998, pp 15-19. 

Zaloga GP, Delacey W Holmboe E, Chernow B Glucagon reversal of hypotension in a case of anaphylactoid shock. Ann Intern Med 1986 105 65-66. Kill C, Wranze E, Wulf H Successful treatment of severe anaphylactic shock with vasopressin. Two case reports. Int Arch Allergy Immunol 2004 134 260-261. 

In an anesthetized, ventilated canine model of anaphylactic shock defined as hypotension with blood pressure maintained at 50% of baseline, epinephrine infusion produces an improvement in blood pressure, associated with positive inotropy [21]. 

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