Reaksi Anafilaktik

Dr. Irma Chandra Pratiwi, Sp.PD

Endah Wahyuningrum

Pontianak, 3 Januari 2020

 Anaphylactic reactions
• Anaphylactic reactions merupakan reaksi
hypersensitivity cepat akibat interaksi antara
antigen dan antibodi spesifik yang berada
pada mast cells dan basophils.

• Terjadi pelepasan zat vasoactive

bronchoconstrictive seperti:Histamine,
Leukotrienes, Chemotactic factors.
 Kelainan imunologi
1.Respon kurang: immune deficiency
(hiv)
2.Respon berlebihan: allergy
3.Respon tidak wajar: autoimmunity
Figure 16.1
Perbandingan keempat tipe hipersensitifitas

Karakteristik tipe-I tipe-II tipe-III tipe-IV

antibodi IgE IgG, IgM IgG, IgM None

antigen Eksogen Permukaan sel larut Jaringan &

organ
Waktu respon 15-30 menit Menit-jam 3-8 jam 48-72 jam

Bilur & lisis and eritema dan eritema and

Tanda edema,
terang nekrosis nekrosis indurasi

basophils antibody and complement and monocytes and

Histologi and lymphocyte
eosinophil complement neutrophils s
Ditransfer dengan antibody antibody antibody T-cells

Erythroblastosis SLE, farmer's

allergic fetalis, lung disease, tuberculin test,
Contoh asthma, Goodpasture jantung poison ivy,
rematik, artritis
hay fever 's nephritis Rematik granuloma,
Reaksi tranfusi  
 Classification
Coombs and Gell classification
1-Type I - immediate ( atopic, or anaphylactic)
2-Type II - antibody-dependent
3-Type III - immune complex
4-Type IV - cell-mediated or delayed
 Type I Allergic Reactions: Atopy and
Anaphylaxis

– Atopy: chronic local allergy: hay fever (alergi

serbuk bunga), asthma

– Anaphylaxis: systemic, seringkali fatal (syok

anafilaksi)
 Anaphylaxis definitions
• Any acute onset illness with typical skin
features (urticarial rash or erythema/flushing,
and/or angioedema), plus involvement of
respiratory and/or cardiovascular and/or
persistent severe gastrointestinal symptoms; or
• Any acute onset of hypotension or
bronchospasm or upper airway obstruction
where anaphylaxis is considered possible, even
if typical skin features are not present.
 Reaksi cepat

• Terjadi dalam hitungan detik,menghilang

dalam 2 jam.
• Antigen yg diikat IgE pd permukaan sel mast
menginduksi pelepasan mediator vasoaktif.
• Manifestasi : anafilaksis (sistemik), atopik
(lokal)  pilek,bersin, asma, urtikaria &
eksim
 Reaksi Tipe I
1. Fase sensitisasi: wkt yg dibutuhkan u/ pembtkan
IgE smp diikat oleh reseptor spesifik (Fce-R) pd
permukaan sel mast & basofil
2. Fase aktivasi: waktu yg diperlukan antara pajanan
ulang dg antigen spesifik & sel mast melepas isinya
yg berisi granul yg menimbulkan reaksi
3. Fase efektor: waktu terjadi respons kompleks
(anafilaksis) sbg efek mediator yg dilepas sel mast
dg aktivitas farmakologik
Figure 16.3
Figure 16.4
 Important Clinical Aspects of Immediate
Hypersensitivity
Main organ Disease Main symptoms Typical allergens Route of entery

Lung Asthma Wheezing, Pollens, house Inhalation

dyspnea, dust, animal
tachypnea danders

Nose and Eyes Rhinitis, conjunctivitis Runny nose, Pollens Contact with
Hay fever redness and mucous membrane
itching of eyes

Skin Eczema (atopic Pruritic, Uncertain Uncertain

dermatitis) vesicular lesions Various foods Ingestion
Urticaria Pruritic, bullous Drugs Various
lesions

Intestinal tract Allergic Vomiting Various food Ingestion

gastroenteropathy diarrhea
Systemic Anaphylaxis Shock, Insect venom;bee Sting
hypotension, Drugs; penicillin Various
wheezing Foods; Peanuts Ingestion
 Signs and symptoms of allergic
reactions
Mild or moderate reactions (may not always occur before anaphylaxis):
• Swelling of lips, face, eyes
• Hives or welts
• Tingling mouth
• Abdominal pain, vomiting (these are signs of anaphylaxis for insect sting or
injected drug (medication) allergy)
Anaphylaxis – Indicated by any one of the following signs:
• Difficult/noisy breathing
• Swelling of tongue
• Swelling/tightness in throat
• Difficulty talking and/or hoarse voice
• Wheeze or persistent cough (unlike the cough in asthma, the onset of coughing
during anaphylaxis is usually sudden)
• Persistent dizziness or collapse
• Abdominal pain, vomiting (for insect stings or injected drug (medication) allergy).
Normal larynx Laryngeal oedema
Atopic Dermatitis

Alyson W. Smith, MD
Director of Pediatric Allergy
St. Barnabas Hospital
 Diagnosis of Allergy
• In vitro methods
– Differential blood cell count
– Leukocyte histamine-release test
– Serological tests that use radioimmune
assays
• Skin testing
– skin injected
– scratched, pricked test memakai pure
allergen extract 20 minutes
Patch testing
Figure 16.6
 Tata laksana Allergy
– Hindari alergen
– Obat penghambat lymphocytes,
– Obat penghambat mast cell
– Obat penghambat mediator kimia
– desensitization therapy
 Tata Laksana Anafilaksis

ASCIA Guidelines: Acute Management of Anaphylaxis

 Tata Laksana Anafilaksis

ASCIA Guidelines: Acute Management of Anaphylaxis

 Tata Laksana Anafilaksis

During severe anaphylaxis with hypotension, marked fluid extravasation

into the tissues can occur: DO NOT FORGET FLUID RESUSCITATION.

ASCIA Guidelines: Acute Management of Anaphylaxis

Treatment
 Therapy to Counteract Allergies

Figure 16.7
Figure 16.8
Administering EpiPen or EpiPen Junior
Terima Kasih