2. is a severe, life-threatening, systemic
hypersensitivity reaction resulting from the
sudden release of mast cell and basophil-derived
mediators
3. The earliest recorded case of anaphylaxis in
2641 B.C.E. the Egyptian King Menes died from
the bite of a wasp
4. The incidence of anaphylaxis during peri-operative
period is about 1:13,000
5. Can be catagorized into :
IgE-mediated reactions (calassical)
non-IgE mediated (anaphylactoid)
6. is a type I immunologic reaction
happens when a sensitized person is re-exposed
to an allergen
7. Type I: Immediate (IgE-dependent)
Type II: Cytotoxic (IgG, IgM-dependent)
Type III: Immune complexes (IgG, IgM-
dependent
complex)
Type IV: Delayed (T lymphocyte-dependent)
8. 1. Initial exposure to allergen
2. IgE antibody produced in reponse to allergen
3. Re-exposure of patient to same allergen
4. Preformed IgE cross links on mast cell
surface
5. Mediators (esp. histamine) released by mast
cell
9. Non-IgE-DependentAnaphylaxis
the release of the mediators can be initiated by
different factors that directly interfere with the
mast cells and basophils
For this type of a reaction, no sensitization is
needed, and therefore this type of anaphylactic
reaction may occur with the first contact to the
allergen.
10. Mast cells
Final common pathway of all allergic reactions
Present in most tissues
When activated, release :
Histamine
Bradykinins
Prostaglandins
Leukotrienes
Clinical effects are due to these above mediators
11. 3 types with the following effects when
stimulated :
H1 : brochoconstriction, increases vascular
permeability, smooth muscle contraction
H2 : increases gastric acid secretion, cardiac
chronotropy & inotropy
H3 : inhibition of histamine formation & release
14. Penicillin is most common cause
Incidence of hypersensitivity about 4 %
Anaphylaxis in 1 per 10,000 administrations
100 to 500 deaths per year in U.S.
Co-reactivity with cephalosporins < 5%
Can undergo desensitization process but risky
and many alternative antibiotics now available
15. An increasingly recognized problem
Can result in fatal anaphylaxis
More common in patients with Spina bifida &
congenital syndromes
Physician should select non-latex gloves &
catheters for patients with this allergy
16. Occur in 1 % of cases if given I.V
10 % of these are severe
About 500 ( ? ) fatal reactions in U.S. annually
17. Anaphylactoid like reactions have been reported to
occure during the non-vascular administration of
iodinated contrast media.
Underreported ;nonvascular iodinated contrast media
absorption is slower than vascular absorption.
Therefore, mild reactions such as rashes are delayed
and attributed to something else
19. Other diagnoses that might mimic anaphylaxis
shouldbe considered, since there are several
conditions that can also cause abrupt and dramatic
patient collapse.
Acute reactions should be excluded if possible; these
include
vasovagal reactions
myocardial dysfunction
pulmonary embolism
Aspiration
Hypoglycemia.
20. (slight to moderate general reaction)
1 Stop the cause, stop the antigen
2 Give oxygen by mask(6–10l/min)
3 Place an i.v. line and apply volume (saline or Ringers solution
20 cc / kg)
4 at the same time measure vital signs
6 Inject an H1-antagonist i.v./i.m (e.g., diphenhydramine 50
mg, or dimetindene maleat 8 mg)
Optionally add an H2-antagonist (e.g., cimetidine 400 mg or
ranitidine 100 mg)
If more severe reaction
7 Call resuscitation team (help)
8 Give corticosteroids i.v. (e.g.,hydrocortisone 100-200 mg)
9 Give adrenaline 1:1000 i.m. (0.2–0.5 mg)
21. Patients with an anaphylactic reaction need
continuous surveillance for 24 h in hospital.
Thisis also necessary in patients with a good
reaction to appropriatetherapy because of the
possibility of recurrenceand the delayed
reaction (up to 12 h after the initial reaction)
with arrhythmia, myocardial ischaemia or
respiratory insufficiency .
