Anaphylactoid reaction: symptoms, diagnosis and classification
The occurrence of an allergic( anaphylactic) reaction is caused by exogenous agents, and its course is characterized by immediate type hypersensitivity. As a rule, it is possible to characterize the response of the organism by the life-threatening pathological condition of the skin, respiratory and cardiovascular functions. After the first contact with the antigen, the development of antibodies IgE, specific for its intended purpose, begins. They merge with the cells responsible for the immunological processes in the body, and sensitization to the antigen occurs.
How are allergic reactions manifested?
Another ingress of the allergen promotes the release of bioactive substances, in particular histamine, responsible for the immune forces of cells. At the moment of transition from abnormal chemical processes to unnatural physiology, changes are primarily reflected on blood vessels, lymph nodes, smooth bronchial muscles, which contributes to the development and the earliest manifestation of the following syndromes:
- decrease in vascular tone;
- sudden contraction of smooth muscle tissue of the intestines, bronchi, uterus;
- infringement of blood circulation;
- inflammation and swelling of blood vessels.
Unlike allergic, anaphylactoid reaction, which physicians often call pseudoallergic, IgE antibodies are not mediated with basophils. Despite the similarity of the manifestation of the response processes, both manifestations are a generalized response of the hypersensitivity of the organism.
Drug allergens that cause the anaphylactoid reaction
Anaphylactoid reaction is also the release of histamine, often already at the first contact with the stimulus. Pseudoallergens at the moment are a fairly wide range. Paradoxically, this reaction of the body often happens during the reception of drugs that stop allergies.
Anaphylactic and anaphylactoid reactions of an immediate type occur quite often after the administration of muscle relaxants, antibiotics, anesthetic drugs, opioids, local anesthetics, vaccination, hormone therapy, atropine and B vitamins. Allergens are also referred to as sera, antigens used in medical diagnosticpurposes for the detection of cutaneous, venereal diseases. Cases of allergy to latex products have become more frequent. An anaphylactoid reaction to lidocaine is considered a common occurrence, as the drug is often used in local anesthesia, but its complex chemical composition can cause side effects even in a healthy organism for which the allergy to the components of the medication is not characteristic.
If we consider the cases of the body's response to stimuli of a non-medicinal nature, then basically food can be "problematic":
- fish of some varieties;
- citrus fruits.
Anaphylactoid reaction may occur when an insect or invertebrate species of a fauna is bitten. Patients who are constantly experiencing allergic manifestations of a non-drug character have huge risks of developing anaphylaxis in the case of surgical intervention under general anesthesia.
Classification of anaphylaxis
Hence the classification of allergic reactions also occurs. The first block includes a variety of anaphylactic reactions that are divided into IgE mediated IgG mediated and IgE mediated and physically loaded. Anaphylactoid pseudoallergic reactions are mediated by simple excretion of mediators, then one should call the drugs provoked by the action, the effect of food and physical factors. Anaphylactoid reactions in mastocytosis are a separate category;mediated by immune complexes, immunoglobulin aggregates upon administration of immune sera and mediated by cytotoxic antibodies, radiopaque substances.
How does anaphylaxis?
Morphine and many barbiturates, muscle relaxants, pethidine can affect mast cells, causing a release of histamine. At the same time, the clinical picture depends on the dosage and the rate at which the active substances enter the body. Practice shows that mainly the reaction is benign, limited only to manifestations on the skin.
Anaphylactoid reaction( ICD 10 assigned to this pathological syndrome) is characterized by unpredictability of further development and, possibly, a complete lack of information on previous allergic responses of the body to antigens. Since the consequences of anaphylaxis to the crane are dangerous to health and life, it is important to detect the course of the complications in a timely manner and take appropriate measures. Regardless of the mechanism of the anaphylactic or pseudoallergic stimulus, the symptomatology can vary significantly. Bearing a purely individual character, manifestations can range from a slight jump in blood pressure and skin eruptions to severe bronchospasm and a collapse in the functioning of the cardiovascular system.
At this stage, it is easy to note one more difference in the action of pseudoallergenes on the body. Meanwhile, anaphylactoid reaction, the symptoms of which can be detected individually or perform in various combinations, is no less dangerous.
Symptoms of anaphylactoid reaction
Symptoms of an allergic reaction in a patient in a waking state are:
- general weakness of the body;
- violation of heart rhythms( tachycardia, arrhythmia);
- lowering of blood pressure;
- difficulty breathing, attacks of suffocation, broncho- and laryngospasm, edema of the lungs and larynx;
- burning of the skin, itchy rashes, hives, hyperemia of the veins, edema of Quincke;
- intestinal cramps, nausea, diarrhea, vomiting;
- lack of pulse;
- cardiovascular collapse;
- slowing and stopping the work of the heart.
Probable complications after anaphylactoid reaction
The greatest threat in itself is a shock associated with bronchospasm. After a certain period of time( from 30 seconds to half an hour, sometimes 2-3 hours) the antigen that enters the body contributes to the development of pathological allergic processes in the body. In many respects, the course of the reaction depends on the form of penetration of the stimulus( orally or parenterally). Rapid development often causes death, causing sudden acute respiratory failure, a critical drop in perfusion pressure, resulting in severe circulatory failure, cerebral edema or hemorrhage, impaired stem function, arterial thrombosis.
On the second day after the shock, the threat to life and recovery is the progression of concomitant diseases caused by an allergic reaction. Even after a couple of weeks the risk of complications remains large. Often, after anaphylactic shock, doctors diagnose such dysfunctions and diseases:
- renal and hepatic insufficiency, hepatitis, glomerulonephritis;
- epidermal necrolysis;
Similar consequences may be threatened by both anaphylactic and anaphylactoid reactions. The difference from anaphylactic shock of these pathologies lies in the fact that the latter requires preliminary sensitization and is not able to develop at the first meeting with the allergenic substance.
Treatment of anaphylaxis
It is right to draw up an emergency treatment plan according to the diagnosis, only an anamnesis will help, so it is extremely important to assemble it. Symptomatic allergies, i.e., a clinical picture, also play a significant role in making an early decision. However, the most reliable and complete answer to the question about the diagnosis can be obtained only after allergists and immunologists have conducted a laboratory study. In this case, based on the critical condition of the patient, first of all he must be provided with emergency medical care, and in case of cardiac arrest or respiration - reanimating actions.
At the stage of recognizing the root causes of an allergic response of the body, the task of physicians is to carry out detailed differential diagnosis. This type of examination is designed to exclude the possible factors of influence, not associated with the release of histamine.
Similar reaction of the body to other non-allergic causes
The most common anaphylactic and anaphylactoid reaction( what is it and what are dangerous pathologies, it is important to know people who are prone to even the most harmless, at first glance, allergic manifestations in the form of rhinitis), have similarity with other factors,potentially capable of causing bronchospasm, hypotension:
- overdose with anesthetics;
- thromboembolism as a result of ingress of air or development of atherosclerosis;
- severe aspiration of gastric contents;
- myocardial infarction, pericardial tamponade;
- septic shock;
- edema of the lungs and other signs not associated with allergy.
Emergency care with rapidly developing both anaphylactic and anaphylactoid reactions does not differ from the set of actions aimed at the elimination and treatment of anaphylactic shock.
The procedure for urgent actions
With the progression of allergy, the qualification of medical professionals and the provision of assistance in the near future is the key to successful treatment. The main measures for the immediate relief of anaphylaxis are the mandatory passage of several steps:
- The introduction of an unconfirmed but potentially dangerous antigen must be discontinued.
- Anaphylactic or anaphylactoid reaction( photos in the article clearly demonstrate the most common manifestations and signs of pathology) developing during anesthesia or during surgery, requires immediate suspension. A qualitative test should be carried out on the fact of the introduction of allergens. At a sharp jump in blood pressure down, it is necessary to interrupt the supply of anesthetic. In the case of bronchospasm, inhalation anesthetics are mandatory.
- Ventilation and airway patency should be provided even at a stage when the patient's condition has not significantly deteriorated. In intubation, the lungs need constantly, until it becomes finally clear that the airway is provided by the body on its own.
- Anaphylactoid reaction, the treatment of which requires the intravenous injection of epinephrine, is dangerous for the patient even after several hours after the removal of bronchospasm. Dosage of epinephrine with repeated administration can be increased, since this substance positively affects the stabilization of mast cells, a decrease in the permeability of the endothelium of blood vessels, which is extremely important in the therapy of anaphylaxis.
- With the urgent need for resuscitation, it is also important to increase the volume of circulating fluid in the body. To this end, doctors put a catheter of considerable diameter intravenously( the vein used can not always be central - time to search for it can play against the patient's condition) and pour in a few liters of crystalloids.
- If it is not possible to detect allergens that caused an anaphylactoid reaction, pay attention to the use of latex items during contact with the patient. Surgical gloves, drugs collected through latex cap vials, urinary catheters - all this could provoke anaphylaxis.
After an emergency treatment, anaphylactoid reaction( as well as anaphylactic reaction) requires a prolonged therapeutic course in order to prevent recurrences of pathology. Neglect of doctors' instructions increases the risk of expanding the range of potential allergens.
Follow-up treatment of
Among the medication program for the therapy of bronchospasm, an important role belongs to the drug "Salbutomol", it can be replaced by "Aminophylline".If possible, then additionally resort to inhalation with isoproterenol or orciprenaline. Because the anaphylactoid reaction is a clinical systemic manifestation in which the symptoms can be complex, it is necessary to use glucocorticoids( for example, "Dexamethasone", "Hydrocortisone") that inhibit the process of cardiovascular collapse.
Usually arresting anaphylactic shock is followed by a continued long-term alertness of doctors. The fact is that the development of late dysfunctions can always take place, therefore, for any degree of severity of the patient's condition, hospitalization is an unequivocal decision. Obligatory doctors also consider the forthcoming examination of the skin for the detection of specific antibodies.
Prevention of anaphylactic and anaphylactoid reactions
A thorough history review is the best measure to prevent and prevent re-anaphylaxis. Having collected all the necessary information about the course of the disease, it is possible to isolate the patient from the risk group and determine what will be the threat of a second anaphylactoid reaction. What does it mean?
Because each subsequent attack can be much more difficult, patients need a thorough selection of drugs in both anesthesia and intensive care. Before the blood transfusion, people prone to anaphylaxis are tested for compatibility with certain blood products.
The presence of an allergy to latex products predetermines in the future the conduct of various manipulations without the use of such means.