Anaphylactic shock: mechanisms and treatment

Abstract

This paper reviews the mechanisms of anaphylactic shock in terms of the immunoglobulin and non‐immunoglobulin triggering events; and the cellular events based on the rise in intracellular cyclic AMP and calcium that release preformed granule associated mediators and the rapidly formed, newly synthesised mediators predominantly based on arachidonic acid metabolism. These primary mediators recruit other cells with the release of secondary mediators that either potentiate or ultimately curtail the anaphylactic reaction. The roles of these mediators in the various causes of cardiovascular collapse are examined. The treatment of anaphylactic shock involves oxygen, adrenaline and fluids. The importance and safety of intravenous adrenaline are discussed. Combined H1 and H2 blocking antihistamines and steroids have a limited role. Glucagon and other adrenergic drugs are occasionally used, and there are several new experimental drugs.

Pattern of use of epinephrine as anti-anaphylactic at a university hospital, Saudi Arabia

“…Intramuscular injection of epinephrine is the most preferred route because it allows the highest plasma level very rapidly compared with other routes [15,16]. If the patient needed repeated doses of epinephrine or went to anaphylactic shock, the intravenous route can be used [17]. Outside hospital, epinephrine auto-injectors (EpiPen) are the mainstay of therapy for anaphylaxis [18].…”

Anaphylactic Reaction Induced by Diclofenac: A Case Report

“…Unfortunately, the correct dosage and route for administration of adrenaline have been a source of confusion and conflict in medical literature 7 . Many authors conclude that the use of intravenous adrenaline is too dangerous and rarely, if ever, justified, as it causes severe complications such as cardiac arrhythmias, myocardial ischemia, and severe hypertension 7,8 . Therefore, we performed subcutaneous injection to prevent such complications.…”

“…Therefore, we performed subcutaneous injection to prevent such complications. Corticosteroids and antihistamines could be used in conjunction with adrenaline to help reduce the overall duration of the reaction and may prevent a relapse 7,9 . However, these drugs should never be used to the exclusion of adrenaline in the management of anaphylactic reactions 9 .…”

Cholinergic modulation of anaphylactic shock: plasma proteins influence

“…It is known that the immunological stage of anaphylactic shock is connected with the production of IgE or IgG1 by B cells and sensitization of mast cells and basophiles (Brown, 1995).…”