ANAPHYLAXIS

Ig-E mediated
anaphylaxis
Release of mediators from mast
cells and basophils
Histamine
PGD2
LTC4
Tryptase
leads to the clinical presentation of
anaphylaxis

Stimulation of H1 and H2
receptors

Profound vasodilation
Decrease in systemic vascular
resistance with hypotension
Tachycardia
Flushing
Increase in bronchial and GI
smooth muscle contraction and
glandular secretion

Tryptase

Inactivates fibrinogen to inhibit

coagulation : key feature of
anaphylaxis
decreases the activity
Neuropeptide
VIP :bronchoconstriction

Phathogenic mechanism
and aetiology of
anaphylaxis
I . IgE mediated anaphylaxis ( 60 %)

Drugs: penicillin cephaosporins,

sulphonamides, tetracyclines, quinolones
Foreigns protein s : horse serum, egg albumin,
insect venom, enzym like papain,
chemopapain, latex
Food ( 30 %) : eggs, milk, wheat, soy, peanut,
tree nut, shellfish, apple, peach
Therapeutic and diagnostic agent : anaesthetic
agents, muscle relaxants, hormones
Allergen immunotherapy
Exercise induced anaphylaxis

II. Imune complex- mediated

anaphylaxis

Blood and blood products

Dialysis membranes

III direct mast cell degranulation

Opiates, quinolones, vancomycin,
muscle relaxants
Radio contrast media

IV. Modulators of arachidonic acid

metabolism
Aspirin, indomethacin

V. idiopathic anaphylaxis
Exercise
Catamenial anaphylaxis
Idiopathic anaphylaxis

Diagnosis of
anaphylaxis

Symptom presentation

Rapid in onset (usually within

minutes of exposure to the
precipitant) and progress rapidly,
10 20 minutes
The speed of onset and clinical
features vary with allergen
concentration and patients
sensitivity

Differential diagnosis
All causes of respiratory obstruction and
vascular collapse including :
Pulmonary embolism
Cardiac arrythmias
Cardiac tamponade
Myocardial infarction
Sepsis
Seizure disorders
Insulin reaction

Additional tests

Tryptase
Specific IgE antibodies are
raised : SPT, RAST
Provocation tests ---- RAST (-)

Management of
anaphylaxis

Management of the acute episode

Subsequent evaluation
Prophylaxis

Management of
anaphylaxis