Anaphylaxis

Article Abstract:

A review is presented of the causes, epidemiology, diagnosis, and treatment of anaphylaxis, the potentially fatal response of the body to a stimulus to which it is hypersensitive. Anaphylaxis includes reactions ranging from itching and hives to shock and death and is precipitated by a variety of agents. As many as 1 in 3,000 hospital inpatients in the US experience this reaction. It is a systemic response that can affect almost any organ in the body, and may occur in response to an antigen to which the person has been previously exposed or to a substance that has not been previously encountered. Three principal causes of anaphylaxis have been identified: these are explained in detail. One involves the generation of an antibody response mediated by IgE; the second uses the complement cascade (part of the immune system); and the third involves an unidentified mechanism that is not, however, IgE- or complement-related. Epidemiologic studies have failed to identify those at risk for anaphylaxis. The most common causes of this reaction are antibiotics and radiographic contrast agents, solutions injected when certain X-ray studies are performed. The next most common cause is stings from insects of the order Hymenoptera (ants, bees, hornets, wasps); these reactions are associated with far fewer deaths than those related to antibiotics and contrast materials. The physiological events that occur in anaphylaxis are described. Obstruction of the upper airway and constriction of the lower airways (the smaller tubes that conduct air into the lungs) are the most serious respiratory events, and cardiovascular collapse and shock can also occur. Avoidance of the allergen is the main goal of treatment, but patients, for medical reasons, often need to receive drugs that could cause anaphylaxis. Careful monitoring and prompt action are essential if reactions occur. The drugs recommended for treating anaphylaxis are listed in a table. Patients who have undergone serious reactions should be hospitalized and observed for 24 hours in case of relapse. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment

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Rubber anaphylaxis

Article Abstract:

Natural rubber is known to cause allergic reaction in some patients. Contact with rubber on skin from gloves can worsen existing skin disorders such as atopic dermatitis. In a case report of two children undergoing surgery, a severe, life-threatening hypersensitivity, anaphylaxis, developed. It was found that the parents of these children had a history of rubber sensitivity. Exposure to the rubber products during surgery were traced to the use of surgical gloves, rubber anesthesia masks and bandages. In children requiring multiple surgeries, the risk of anaphylaxis is great. Avoidance of these products and the use of neoprene gloves may be beneficial. It is also suggested that individuals at risk be premedicated with corticosteroid, drugs to reduce the severity of potential reactions, before surgery. Premeasured injectable epinephrine, the drug used to treat anaphylactic reactions, can be used at home in the event exposure occurs at home.

Health aspects, Case studies, Allergy in children, Pediatric allergy, Rubber, column

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Anaphylaxis from the carboxymethylcellulose component of barium sulfate suspension

Article Abstract:

A case is reported of a 63-year-old woman who developed anaphylactic shock shortly after receiving an upper gastrointestinal exam using a barium sulfate solution. Within 30 minutes of the diagnostic exam, she developed hive-like wheals on her abdomen, arms and face and within minutes, she became unconscious. She was successfully resuscitated and the wheals disappeared within 24 hours. Skin tests revealed that she was sensitive to carboxymethylcellulose, which is a chemical added to barium sulfate to make it water-soluble.

Complications and side effects, Urticaria, Hives (Disease), Carboxymethylcellulose, Carboxymethyl cellulose, Barium sulfate

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