Anaphylaxis

The term anaphylaxis was introduced by Paul Portier and Charles Richet in 1902 (in Greek ana- reverse, phyl- protection). 

It is a potentially lethal immediate hypersensitivity reaction, in whose pathomech-anism the main role is played by IgE antibodies. Mediators released in the process are responsible for tissue reactions, which may involve the respiratory system, gastrointestinal system, and the skin or cardiovascular system. 

The probability of occurrence of sudden death due to the food anaphylaxis has been calculated over 10 years retrospective research at 0.06 deaths in 1,000,000 in children aged 0-15 per year based on results of 10 years retrospective studies. The most frequent allergen was cow s milk accounting for approximately 50% of deaths. Also, severe anaphylactic reactions were observed following the consumption of nuts. That estimated probability of death occurrence is 1 in 800,000 children per year, assuming that 5% of the population exhibits symptoms of food allergy (Macdougall et al., 2002). 

In the submucosal layer of the gastrointestinal tract, there are numerous MCX mucosal cells. They are equipped with granules and contain biogenic amines, chemotactic factors, and as far as proteases are concerned, tryptase. 

MCX cells are sensitive to cromoglycates. The cytokines, they secrete include, mainly IL 5 and IL 6 in considerable concentrations, when stroma contains IL 4 as well as IL 1, 3, 8, 10, 13, 16, MIP-la, MIP-2a, and TGFp. 

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Cobalamin should be adininistered parenteraHy by the intramuscular or subcutaneous route. Isolated cases of anaphylaxis have been reported with intravenous administration. 

Although immediate reactions of anaphylaxis, bronchospasm, and urticaria have been reported, most commonly patients exhibiting an adverse reaction develop a maculopapular rash, usually after several days of therapy. They may also develop fever and eosinophilia (80,219). Cefoperazone (34) and ceftriaxone (39), having greater biUary excretion than other cephalosporins, are associated with an increased risk of diarrhea, which may be caused by selection of cytotoxin producing stains of Clostridium difficile (219). 

After these reports there were many attempts to administer hemoglobin solutions to humans. Many of these patients did well, but others demonstrated hypertension, bradycardia, oliguria, and even anaphylaxis. These untoward effects were not correlated with specific biochemical properties of the solutions themselves. 

The mortahty is usually reduced from 12% in the control group to 9—10% in the streptokinase group. Side effects are bleeding and hemorrhage, fever, and in rare occasions, anaphylaxis. 

Horie and coworkers synthesized a series of flavones that showed promising inhibitory activity against archidonate 5-lipooxygenase. This enzyme is responsible for the initiation of bioactive leukotrienes that are chemical mediators of anaphylaxis and inflammation. Under standard K-R conditions o-hydroxyarylketone 66 and anhydride 67 in presence of the corresponding anhydride 68 delivered flavones 69 in yields of 42-65%. Subsequent hydrogenation of 69 afforded the flavone inhibitors 70. 

Chloro-oxazolo[4,5-/i]quinoline-2-carboxylic acid methyl ester was the most active compound in tests for inhibitors of antigen-induced release of histamine in vitro from rat peritoneal mast cells (IC50 of 0.3 p,M) and as inhibitors of IgE-mediated passive cutaneous anaphylaxis in the rat (ED50 (intraperitoneal) of 0.1 mg/kg in dose 0.5 mg/kg as an inhibitor of the test)—10 times and 60 times more potent, respectively, than the disodium salt of cromoglycic acid (85JMC1255). 

Reaction of 2-aminoquinoline derivatives with BrCH2C0C02Et gave imidazoquinoline-2-carboxylate 473 which upon hydrolysis with sodium hydroxide gave the corresponding acid which had been tested against the passive cutaneous anaphylaxis (78GEP2802493, 78BEP858605) (Scheme 79). 

The attractive properties of cromolyn as an inhibitor of the release of mediators of anaphylaxis has inspired many attempts to improve on the antiasthmatic characteristics of that substance. One such agent is cromitrile (6). In this case, a tetrazolyl unit is introduced as a carboxy group... 

Anaphylaze, Anaphylazie, /. anaphylaxis, anarbeiten, v.t. join, attach. 

Other causes of shock include anaphylaxis, hypoglycemia, hypothyroidism, or Addison s disease. 

Hypersensitivity reactions (rash, urticaria, arthralgia, respiratory distress, acute anaphylaxis), depression, somnolence, fatigue, coma, anorexia, nausea, vomiting... 

Chamomile Matricaria chamomilla As a tea for gastrointestinal disturbances, as a sedative, and as an anti-inflammatory agent Fbssible contact dermatitis and, in rare instances, anaphylaxis Chamomile is a member of the ragweed family and those allergic to ragweed should not take the herb. 

Adrenalin Medihalcr (Kettelhack-Riker) Anaphylaxie-Besteck Losung Z.J. (SmithKline Beecham)... 

Ring J (ed) Anaphylaxis. Chem Immunol Allergy. Basel, Karger, 2010, vol 95, pp 1-11... 

Fig. 2. Stamp from the Principality of Monaco celebrating 100 years anaphylaxis discovery. 

There are also other immimological mechanisms, especially via IgG or IgM antibodies with immune complex formation, which can lead to similar clinical conditions [20, 34, 42] as has been shown in dextran anaphylaxis (table 1). Triggering of mast cells and basophils leads to release of various vasoactive mediators, among which histamine was the first recognized in 1908 (fig. 3,4) [6]. 

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... 

Anaphylaxis most commonly starts with symptoms on the skin or the respiratory tract (table 2). The symptomatology is variable there is no obligatory involvement of all organ systems. A major characteristic of anaphylaxis is the rather rapid onset of symptoms after contact with the elicitor. The interval varies between a few seconds or minutes until 1 or 2 h, partly dependent upon the route of application (rapid onset after intravenous allergen exposure) and degree of sensitization. Experience in insect sting anaphylaxis in... 

According to the different intensity of clinical symptoms, several attempts have been made to classify anaphylaxis according to severity, the most common scales have been published by Mueller [26] and Ring and Messmer [35] (table 3). 

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