ANAPHYLAXIS SHOCK

Primary symptoms of
anaphylaxis
• Skin: • Respiratory:
flushing, itching, dysphonia, cough,
urticaria, stridor, wheezing,
angioedema dyspnea, chest
tightness,
• Gastrointestinal: asphyxiation, death
nausea, vomiting,
bloating, cramping, • Cardiovascular:
diarrhea tachycardia, hypotension,
dizziness, collapse, death
• Other:
feeling of
impending doom,
metallic taste
Causes of Anaphylaxis

www.emnet-usa.org
 Agents that cause anaphylaxis:
IgE-dependent triggers
• foods (eg peanut, tree nuts, • hormones
seafood)
• animal or human proteins
• medications (eg, β-lactam
antibiotics) • colorants (insect-derived,
• venoms eg. carmine)
• latex • enzymes
• allergen immunotherapy
• polysaccharides
• diagnostic allergens
• aspirin and NSAIDs
• exercise (with food or
(possibly through IgE)
medication co-trigger)

Kemp SF and Lockey RF, J Allergy Clin Immunol

2002;110:341-8
 Anaphylaxis: non-immunologic causes
MULTIMEDIATOR COMPLEMENT ACTIVATION/ACTIVATION
OF CONTACT SYSTEM

• radiocontrast media
• ethylene oxide gas on dialysis tubing (possibly
through IgE)
• protamine (possibly)
• ACE-inhibitor administered during renal dialysis
with sulfonated polyacrylonitrile, cuprophane, or
polymethylmethacrylate dialysis membranes

Kemp SF and Lockey RF, J Allergy Clin Immunol

2002;110:341-8
 Anaphylaxis: non-immunologic
causes
NONSPECIFIC DEGRANULATION OF MAST
CELLS
AND BASOPHILS

• opiates
• physical factors:
- exercise (no food or medication co-
trigger)
- temperature (cold, heat)

Kemp SF and Lockey RF, J Allergy Clin Immunol 2002;110:341-8

Mechanisms of allergic anaphylaxis

…a severe, acute,
systemic allergic reaction
caused by the rapid, IgE-
mediated release of
potent mediators such as
histamine from tissue
mast cells and peripheral
blood basophils
 Acutely released mediators of
anaphylaxis
• degranulation of mast cells and basophils causes
the release of:
- preformed granule-associated substances,
eg histamine, tryptase, chymase,
carboxypeptidase, and cytokines
- newly-generated lipid-derived mediators,
eg prostaglandin D2, leukotriene (LT) B4,
LTC4, LTD4, LTE4, and platelet activating factor.

Kemp SF and Lockey RF. J Allergy Clin Immunol 2002; 110:341-8

 Anaphylactic Reaction
Allergen

Mast cell granules IgE antibody

Mast Cell

Immediate
reaction
Wheeze
Urticaria
Hypotension
Abdominal cramping

Late-phase reaction
Phil Lieberman: Anaphylaxis,a clinicians manual
 Biphasic/late-phase reaction
Cellular infiltrates: 3 to 6 hours (LPR)
Eosinophil
CysLTs, GM-CSF,
TNF-, IL-1, IL-3, PAF,
Histamine IL-4, IL-6
ECP, MBP

Allergen
3 to 6 hours Basophil
Histamine,
(CysLTs, PAF, CysLTs, Return
IL-5) TNF-, IL-4, IL-5, IL-6
of
Monocyte Symptoms
PGs CysLTs CysLTs, TNF-,
PAF, IL-1
Proteases

Mast cell Lymphocyte

IL-4, IL-13, IL-5,
IL-3, GM-CSF
EPR 15 min
(Early-Phase Reaction)
 Uniphasic Anaphylaxis
Treatmen
t

Initial
Symptom
s

0 Time

Antigen Exposure
 Biphasic Anaphylaxis
Treatmen Treatmen
t t

Initial 1-8 hours

Second-
Symptom Phase
s Symptom
s

0 Classic Model Time

1-72 hours
Antigen
Exposure New Evidence
Laboratory tests in the diagnosis
of anaphylaxis
Plasma histamine
Serum tryptase
24-hr Urinary histamine
metabolite

0 30 60 90 120 150 180 210 240 270 300 330

TERIMA KASIH