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There are a variety of substances that are likely to cause anaphylaxis. The most common include: - latex - peanuts - bee/wasp stings - medications (penicillin) - dust Image Source: Google Images - shellfish An anaphylactic reaction is only possible if an individual has been exposed and sensitized to a particular substance. Sensitization refers to each subsequent time a person is exposed to the substance, a more severe
allergic reaction will develop. The more severe the reaction, the more body systems will be affected. During an anaphylactic attack, many organ systems in the body are affected including the respiratory system, the cardiovascular system, the integumentary system (skin), the gastrointestinal tract and the central nervous system. The figure below demonstrates the effects of anaphylactic reactions on the given organ systems.
Severe allergic reactions may advance quickly and have the potential to completely block the airway. Because of this rapid development a special type of medication, called Epinephrine, must be immediately administered. Treatment will be discussed at the end of this document.
Hista-what?
This section of the document primarily focuses on the medical terminology that will be introduced during the disease process. The table below defines the various terms that will be used in the next segment.
Terminology
Antigen IgE antibody Bronchoconstrictio n Vasodilation Histamine Leukotrienes Mast Cells Basophils Chemical Mediator Receptor
Definition
A foreign substance that produces an immunological response Released in response to a foreign substance Causes inflammation resulting in symptoms (ex. throat swelling) Constriction of airways in the lungs Widening of blood vessels Chemical produced causing itching, nasal swelling and sneezing Substance produced causing bronchoconstriction A cell found in the connective tissue that releases histamine A white blood cell that also contains histamine Chemicals released from mast cells and basophils Examples: histamine and leukotrienes A molecule that responds to a certain chemical This response leads to a reaction or symptoms
Sensitization
As explained in the introduction section, sensitization is an immunological response that occurs when an individual comes into contact with an antigen. Sensitization occurs in a few simple steps as outlined below: - After contact with the foreign
1 2
substance, IgE antibodies are secreted (1) - The antibodies attach to mast cells and basophils on cell membrane (2)
Image Source: Google Images Once the mast cells and basophils attach to receptors on the membrane, the person is sensitized to that particular antigen. As long as the IgE antibodies are attached to the mast cell or basophils, the individual is likely to have an anaphylactic response when reintroduced to the antigen.
Once an antigen is reintroduced to a sensitized individual, anaphylactic symptoms will quickly develop. The figure to the left depicts this process. - The antigen is binds to the IgE antibodies (1) - The attachment causes the membrane to degrade and subsequently release chemical mediators (2)
Mediators cause the symptoms associated with an anaphylactic Image Source: Google Images attack. They are the substances that cause the blood vessels to widen resulting in low blood pressure and the bronchi to constrict resulting in difficulty breathing.
Inflamed Bronchi
Normal Bronchi
released from mast cells and basophils once the cell membrane disintegrates. It contains three receptors (H1, H2, H3) that produce different symptoms. -H1: Responsible for bronchoconstriction (causes chest tightness), vasodilation (causes low blood pressure) and mucous production (causes difficulty breathing) - H2: Responsible for gastric acid secretion (causes nausea and vomiting) and an increase in heart contractions (causes tachycardia and dizziness) - H3: Found in the central nervous system and is responsible for the production and release of histamine Leukotrienes are the dominant chemical mediators because they have a slower onset, thus they last much longer. Leukotrienes are primarily involved in bronchoconstriction.
Treatment
The best pre-hospital treatment for anaphylaxis is with an injectable medication called the Epinephrine Pen (Epi Pen). Epinephrine controls the bodys fight-or-flight response system and is the medication administered to an individual in anaphylactic distress. Epinephrine increases heart rate, blood pressure and dilates the bronchioles counteracting the reaction symptoms.
While an Epi Pen may stop a life-threatening reaction, proper training is required for its use. Talk to your healthcare professional for more information on the Epi Pen.
Conclusion
The process of anaphylaxis can be quite complicated, but understanding it can help an individual to recognize the signs and symptoms of a reaction and possibly save a life. The three predominant topics to remember are sensitization, the shock, and chemical mediators. These are responsible for life-threatening reactions, including angioedema, throat
swelling, difficulty breathing and low blood pressure. Anaphylactic shock is a life-threatening response that can rapidly develop if medical attention is not received right away. It is important for parents, teachers and medical professionals to be prepared for these types of instances.
References
http://www.emsworld.com/article/10324669/anaphylactic-and-anaphylactoidreactions?page=2 http://www.google.com/images http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001847/