Anaphylactic shock: mechanisms and treatment.

Abstract

SUMMARYThis paper reviews the mechanisms of anaphylactic shock in terms of the immunoglobulin and non-immunoglobulin triggering events, and the cellular events based on the rise in intracellular cyclic AMP and calcium that release preformed granule-associated mediators and the rapidly formed, newly synthesized mediators predominantly based on arachidonic acid metabolism. These primary mediators recruit other cells with the release of secondary mediators that either potentiate or ultimately curtail the anaphylactic reaction. The roles of these mediators in the various causes of cardiovascular collapse are examined. The treatment of anaphylactic shock involves oxygen, adrenaline and fluids. The importance and safety of intravenous adrenaline are discussed.Combined Hi and H blocking antihistamines and steroids have a limited role. Glucagon and other adrenergic drugs are occasionally used, and several new experimental drugs are being developed.

Role of Corticosteroids in Oral Lesions

“…The term anaphylaxis literally meaning "against protection" was introduced by Richet and Portier in 1902 (Brown 1995).…”

Anaphylaxis treatment: current barriers to adrenaline auto-injector use

“…And corticosteroid treatment is considered to have only a limited role in the treatment of anaphylaxis (45), mainly because of its delayed effects. Corticosteroids may be beneficial in the treatment of the more protracted anaphylactic reactions, particularly for bronchospasm (10,46,47), but require up to 4-6 h to reach maximum effect even after intravenous injection (43,44).…”

Anaphylactic Reaction: An Overview

“…Hypotension should be treated with intravenous fluids to expand the intravascular volume. Colloids, when available, may have an advantage over crystalloid solutions because colloids remain in the intravascular space and potentially attract extravasated fluid into the vascular space [6].…”

“…Commonly available ampoule of adrenaline when diluted in a 10 ml syringe will have a concentration equivalent to 1:10000 solution. It should be given over at least a ]0 minute period, but the dose is usually limited to 3 mL for an average sized (70 kg) adult [6]. Continuous infusion may subsequently be needed to sustain the blood pressure [7].…”