Treatment Of Anaphylactic Shock Research Articles

Anaphylactic Shock Caused by Eating Buckwheat.

Background: Urticaria is a common disease with a marked influence on quality of life. The key cell involved is the mast cell, which can be activated by a vast variety of stimuli, and the major mediator is histamine. Allergic urticaria is a disorder with a large variety of causes: food, drugs, insect venom, skin contact with allergens, and physical exercise. Buckwheat consumption has increased in European countries and the USA because it is gluten-free. It can trigger anaphylactic shock if ingested, inhaled, or handled with the hands. Five common buckwheat allergens named Fag e1 to 5 (Fag e1, 2, and 3 are considered the major allergens) and two tartary buckwheat allergens named Fag t1 and Fag t2 have been described. Method: We present the case of a patient who experienced two anaphylactic shocks and in whom the etiological factor was buckwheat. The patient presented to the Allergology department for the evaluation of two episodes of severe allergic reactions that required emergency therapy, episodes that involved the loss of consciousness and were of major severity. At each anaphylactic shock, an ambulance was requested, and emergency therapy was administered, leading to the patient's recovery within a few hours. Diagnosis: Since each episode occurred a few minutes after eating, the diagnosis was established based on a detailed anamnesis and prick skin tests, followed by specific IgE dosages. Other foods consumed by the patient, assessed by prick skin testing and specific IgE dosages of suspected foods, were excluded as the etiological cause. Increased levels of buckwheat-specific immunoglobulin E were highlighted, thus identifying the etiological agent. The treatment of anaphylactic shock was performed urgently by the ambulance crew with adrenaline, infusion solutions, cortisone preparations, and antihistamines. Result: Following the treatment that was initiated, there was a partial remission of the lesions after a few hours. Conclusions: Buckwheat allergy is rare, but it produces symptoms that affect the skin, gastrointestinal tract, and respiratory tract, as well as anaphylaxis. In a professional environment, it can trigger allergic rhinitis, asthma, and hives. Although buckwheat allergens have been described, their clinical relevance has only been studied in a small number cases. In current practice, the only commercially available allergen is Beech e2 per the ImmunoCAP ISAC microarray. Diagnosis can be difficult in clinical practice. This reported case suggests the need for a thorough anamnesis, since buckwheat is consumed as a hidden allergen, and in Europe, it is not necessary to label foods containing this allergen.

Histamine induced high mobility group box-1 release from vascular endothelial cells through H1 receptor.

BackgroundSystemic allergic reaction is characterized by vasodilation and vascular leakage, which causes a rapid, precipitous and sustained decrease in arterial blood pressure with a concomitant decrease of cardiac output. Histamine is a major mediator released by mast cells in allergic inflammation and response. It causes a cascade of inflammation and strongly increases vascular permeability within minutes through its four G-protein-coupled receptors (GPCRs) on endothelial cells. High mobility group box-1 (HMGB1), a nonhistone chromatin-binding nuclear protein, can be actively secreted into the extracellular space by endothelial cells. HMGB1 has been reported to exert pro-inflammatory effects on endothelial cells and to increase vascular endothelial permeability. However, the relationship between histamine and HMGB1-mediated signaling in vascular endothelial cells and the role of HMGB1 in anaphylactic-induced hypotension have never been studied.Methods and resultsEA.hy 926 cells were treated with different concentrations of histamine for the indicated periods. The results showed that histamine induced HMGB1 translocation and release from the endothelial cells in a concentration- and time-dependent manner. These effects of histamine were concentration-dependently inhibited by d-chlorpheniramine, a specific H1 receptor antagonist, but not by H2 or H3/4 receptor antagonists. Moreover, an H1-specific agonist, 2-pyridylethylamine, mimicked the effects of histamine, whereas an H2-receptor agonist, 4-methylhistamine, did not. Adrenaline and noradrenaline, which are commonly used in the clinical treatment of anaphylactic shock, also inhibited the histamine-induced HMGB1 translocation in endothelial cells. We therefore established a rat model of allergic shock by i.v. injection of compound 48/80, a potent histamine-releasing agent. The plasma HMGB1 levels in compound 48/80-injected rats were higher than those in controls. Moreover, the treatment with anti-HMGB1 antibody successfully facilitated the recovery from compound 48/80-induced hypotension.ConclusionHistamine induces HMGB1 release from vascular endothelial cells solely through H1 receptor stimulation. Anti-HMGB1 therapy may provide a novel treatment for life-threatening systemic anaphylaxis.

Anaesthetic Management of Anaphylactic Shock Caused by ruptured Hydatid Cyst of the Liver: A Case Report

Hepatic hydatid disease is very common in developing nations. Although anaphylactic shock is a rare complication during anaesthesia, it can present with severe cardiovascular shock and hypersensitive reactions during surgical removal of hydatid cyst, requiring prompt emergency management. We report a case of 43 year old female posted for elective removal of hydatid cyst in the right lobe of liver under general anaesthesia. An anaesthesist should be aware of the “tell-tale” signs of anaphylaxis and be prepared for early and prompt treatment of anaphylactic shock. Anaphylactic prophylaxis and close monitoring for early diagnosis and prompt treatment of anaphylaxis are essential to avert any complications associated with anaphylactic shock.

Acute Myocardial Infarction and Allergy, Causal or Casual Relationship?

A 53-year-old man with a known allergy to metamizole presented for acute gonalgia, receiving metamizole by mistake. He suffers a severe allergy reaction accompanied by chest pain and signs of acute lower myocardial infarction, which subsides with treatment of anaphylactic shock and fibrinolysis, without observing intracoronary thrombus or signs of complication of atherosclerotic plaque. LEARNING OBJECTIVE An exceptional clinical case is presented illustrating an acute myocardial infarction related to a severe allergic reaction. In addition, a review of the optimal management of this entity is carried out. We intend to make this entity known, which should be suspected in the appropriate clinical setting

Effect of Landiolol Hydrochloride on Hemodynamics in a Histamine-Induced Shock Model.

Background and ObjectiveAnaphylactic shock is a serious adverse drug reaction that can occur in response to contrast media used during coronary computed tomography angiography. The imaging quality of coronary computed tomography angiography is improved by β-blockers, which decrease heart rate. In this study, we sought to analyze anaphylactic shock treatment in patients receiving short-acting β1-blockers.MethodsWe examined the influence of epinephrine and glucagon on hemodynamics during β-blocker treatment, using a dog histamine shock model; the β1-blocker landiolol hydrochloride was used. The effects of these drugs were assessed by recording changes relative to established baselines. ResultsHistamine and landiolol decreased mean blood pressure. Histamine exerted no apparent effect on heart rate, whereas landiolol decreased heart rate. Further, landiolol reduced histamine-mediated increases in the force of cardiac contraction. Increasing the doses of epinephrine and glucagon ameliorated anaphylactic shock-induced deterioration in hemodynamic parameters in subjects receiving landiolol.ConclusionsIn patients receiving landiolol for coronary computed tomography angiography, deterioration in hemodynamic parameters due to anaphylactic shock can be mitigated by increasing the doses of epinephrine and glucagon. Clinicians should thus prepare appropriate amounts of epinephrine and glucagon prior to coronary computed tomography angiography.

Diagnostic and treatment algorithm for anaphylactic shock of the Self-regulatory organization of the “National board of phlebologists” Association

Many phlebologists today work in ambulatory settings, using both local anesthetics and sclerosants. Cases of anaphylactic shock are rare, but its consequences can be catastrophic. At the request of the self-regulatory organization of the “National College of Phlebologists” Association with the support of “Servier” company, the legal partner of the LLC “Faculty of Medical Law” board, together with leading anesthesiologists-resuscitators, has developed an easy-to-understand and easy-to-deliver information Algorithm for the diagnosis and treatment of anaphylactic shock. This algorithm will not only reduce the risks of adverse effects of anaphylaxis for the patient, but will also protect the physician in case of litigation, as it is prepared with references to current sources of evidence-based medical practice and regulations.

Acute myocardial infarction and allergy, causal or casual relationship?

A 53-year-old man with a known allergy to metamizole presented for acute gonalgia, receiving metamizole by mistake. He suffers a severe allergy reaction accompanied by chest pain and signs of acute lower myocardial infarction, which subsides with treatment of anaphylactic shock and fibrinolysis, without observing intracoronary thrombus or signs of complication of atherosclerotic plaque. Keywords: Kounis syndrome; Allergic myocardial infarction; Myocardial infarction with normal coronary arteries.

The main complications of infusion therapy and methods to overcome them

Background. Infusion therapy (IT) is an integral part of the modern treatment process and the most common method of inpatient treatment. Indications for the IT use include dehydration, changes in blood properties, intoxication, the impossibility or inexpediency of the drug administration in other ways, the impossibility of oral nutrition, and impaired immunity.
 Objective. To describe the main complications of IT and their treatment.
 Materials and methods. Analysis of literature data on this issue.
 Results and discussion. Before conducting IT, you should take into account all the indications and contraindications and carefully read the instructions for use of drugs. It is advisable to use several drugs to reduce the number and severity of side effects. The rate of administration is important: in most cases, the safe rate is 20-30 drops per minute. Accidental needle injuries (ANI) and blood contact are potential IT risks for healthcare professionals. The National Union of Nurses of Private Practice has launched a survey of health workers to reduce the prevalence of these injuries. There are three components to injection safety: safe solution preparation, safe injection, and safe disposal. IT via the needle has a number of disadvantages: complications due to frequent punctures, limited ability to conduct long-term IT, increased risk of ANI. The installation of a permanent venous catheter reduces the likelihood of these defects. After catheter placement, before and after infusion, it should be flushed with 0.9 % NaCl, heparin or Soda-Bufer solution (“Yuria-Pharm”). However, as the number of catheterizations increases, the number of catheter-associated infections increases too, ranking third among nosocomial infections and first among the causes of bacteremia. In general, the frequency of complications of venous catheterization is 15 %. Mechanical complications occur in 5-19 % of patients, infectious – in 5-26 %, thrombotic – in 2-26 %. Complications of IT are classified into the complications due to violation of the rules of administration (hematoma, tissue damage, thrombophlebitis (septic, mechanical and chemical), embolism) or blood composition disorders (acidosis, blood thinning), as well as overdose, and specific complications (anaphylactic shock, pulmonary edema, hyperthermia). Anaphylaxis most often accompanies the introduction of nonsteroidal anti-inflammatory drugs, antibiotics, muscle relaxants, radiocontrast, hypnotics, etc. The first line of treatment of anaphylactic shock involves drug discontinuation, intravenous adrenaline, 100 % oxygen, rapid intravenous infusion of crystalloids, in case of bronchospasm – 2-3 inhalations of salbutamol. Additionally, antihistamines and glucocorticoids may be prescribed.
 Conclusions. 1. IT is an integral part of the modern treatment process and the most common method of treatment in the hospital. 2. In IT, it is advisable to use several drugs, which reduces the number and severity of side effects. 3. Potential IT risks for healthcare professionals include ANI and blood contact. 4. Injection safety requires three components: safe solution preparation, safe injection, and safe disposal. 5. Complications of IT are divided into complications due to violations of the rules of installation or violation of blood composition, as well as overdose, and specific complications. 6. Anaphylaxis often accompanies the introduction of nonsteroidal anti-inflammatory drugs, antibiotics, muscle relaxants, radiocontrast, hypnotics, etc.

Effects of high-fidelity simulation in practical teaching of nursing pharmacology

Objective To explore the application and the effects of high- fidelity simulation teaching in nursing pharmacology course. Methods 34 students were divided into two groups. The high- fidelity simulation teaching of the treatment of anaphylactic shock of Penicillin was implemented to the experimental group (16 students). The results of survey instruments and the written examinations were compared. Results The difference in the evaluation to the simulation teaching between two groups was statistically significant(P< 0.05). The students knowledge between two groups also showed statistical significance(t=- 9.35, P= 0.000). Conclusions It is practicable to implement high- fidelity simulation teaching in nursing pharmacology course. The students'problem- solving and comprehensive abilities could be enhanced through the implement of3P high- fidelity simulation teaching model. Key words: Nursing pharmacology; High-fidelity simulation teaching; Practical teaching

Update on anaphylactic shock treatment recommendations: what's new in the use of epinephrine?

In 1998, the Sociedad Argentina de Pediatría issued the recommendation of the treatment of anaphylactic shock. While this recommendation suggested the use of subcutaneous epinephrine, currently the intramuscular via is considered the most appropriate one. Pharmacological aspects determine this preference. For outpatient treatment, the correct use of autoinjectors can control anaphylaxis quickly and effectively. The use of other medications in the proposed 1998 recommendation remains unchanged.

Brain injury due to anaphylactic shock: broadening manifestations of Kounis syndrome

Anaphylactic shock is a real and life threatening medical emergency which is encountered in every field of medicine. The coronary arteries seem to be the primary target of anaphylaxis resulting in the development of Kounis syndrome. Kounis syndrome is a pan-arterial anaphylaxis -associated syndrome affecting patients of any age, involving numerous and continuously increasing causes, with broadening clinical manifestations and covering a wide spectrum of mast cell activation disorders. Recently, Kounis-like syndrome affecting the cerebral arteries was found to be associated with mast cell activation disorders. In anaphylactic shock, the decrease of cerebral blood flow is more than what would be expected from severe arterial hypotension. This is attributed to the early and direct action of anaphylactic mediators on cerebral vessels. While adrenaline is a life saving agent in the treatment of anaphylactic shock, it contains sodium betabisulfite as preservative and should be avoided in sulfite allergic patients. Potential allergens encountered in endodotic practice include formocresol, zinc compounds thiurams, sodium dimethyldithiocarbamade, and mercaptobenzothiazole that might have synergistic action. All these agents together with analgesics, antibiotics, antiseptics, formaldehyde, latex, local anaesthetics and metals used in dental practice, in general, can induce anaphylactic shock. Practitioners should be aware of these consequences. A careful history of previous atopy and reactions is of paramount importance for safe and effective management.

Methylene Blue and Epinephrine: A Synergetic Association for Anaphylactic Shock Treatment: Zheng F, Barthel G, Collange O, et al. Crit Care Med 2013;41:195–204.

Methylene Blue and Epinephrine: A Synergetic Association for Anaphylactic Shock Treatment: Zheng F, Barthel G, Collange O, et al. Crit Care Med 2013;41:195–204.

Anaphylactic shock: Kounis hypersensitivity-associated syndrome seems to be the primary cause

Experiments have shown that anaphylaxis decreases cardiac output; increases left ventricular end diastolic pressure; induces severe early acute increase in respiratory resistance with pulmonary interstitial edema; and decreases splanchnic, cerebral, and myocardial blood flow more than what would be expected from severe arterial dilation and hypotension. This is attributed to the constrictive action of inflammatory mediators released during anaphylactic shock. Inflammatory mediators such as histamine, neutral proteases, arachidonic acid products, platelet-activating factor (PAF), and a variety of cytokines and chemokines constitute the pathophysiologic basis of Kounis hypersensitivity-associated acute coronary syndrome. Although the mechanisms of anaphylactic shock still remain to be elucidated, myocardial involvement due to vasospasm-induced coronary blood flow reduction manifesting as Kounis syndrome should be always considered. Searching current experimental and clinical literature on anaphylactic shock pathophysiology, causality, clinical appearance, and treatment via PubMed showed that differentiating global hypoperfusion from primary tissue suppression due to mast cell mediator constrictive action on systemic arterial vasculature is a challenging procedure. Combined tissue suppression from arterial involvement and peripheral vasodilatation, perhaps, occur simultaneously. In cases of anaphylactic shock treatment targeting the primary cause of anaphylaxis together with protection of coronary vasculature and subsequently the cardiac tissue seems to be of paramount importance.

人工血管を介した経皮的心肺補助装置からの送血により救命したアナフィラキシーショックによる心停止例

人工血管を介した経皮的心肺補助装置からの送血により救命したアナフィラキシーショックによる心停止例

Successful Treatment of Anaphylactic Shock after Protamine Administration-Report of a Case

Protamine sulfate is administered intravenously to reverse heparin induced anticoagulation during open heart surgery. Allergic reactions to protamine occur sporadically, but arguably with increased incidence in diabetic patients, especially those who receive protamine zinc insulin preparations, patients with true fish allergy or a history of previous protamine exposure, and those who have undergone vasectomy. Adverse effects of protamine administration vary from urticaria and rash to systemic hypotension, bronchospasm, pulmonary hypertension, cardiovascular collapse, and death. The most common reaction in adults is a transient decrease in systemic arterial blood pressure, which is usually associated with the rate of administration. Despite adverse effects, it remains widely used for this purpose. Life-threatening reactions to protamine, although extremely rare, entail substantial risk. We are herein report a case of coronary artery disease received the coronary artery bypass grafting and then life-threatening reactions to cardiovascular collapse after protamine administration without risk factor.

Acute coronary thrombosis after anaphylactic shock treatment

Acute coronary thrombosis after anaphylactic shock treatment

Methylene blue and epinephrine, a synergistic association for anaphylactic shock treatment in anesthetized brown Norway rats

Methylene blue and epinephrine, a synergistic association for anaphylactic shock treatment in anesthetized brown Norway rats

Collecting Live Ant Specimens (Colony Sampling)

Because of the great diversity of ants, it is difficult to give a single protocol for the collection of live specimens. Ant body size can be very small or extremely large; the ants can be hard or soft, sting or spray toxic chemicals, live in the open or in hard-to-reach places; and colony size can range from tens of individuals to millions. Thus, collection techniques must be tailored to each particular species. In particular, caution must always be taken when dealing with stinging species, and symptoms and basic first-aid measures, especially for the treatment of anaphylactic shock, should be reviewed before beginning fieldwork. Nonetheless, many species are collectable as whole colonies. This protocol reviews some basic techniques for collecting ground-nesting species and describes how to collect whole live colonies (with queens), which are necessary for long-term laboratory studies and addressing questions of social organization and ecology.

The Pivotal Role of Vasopressin in Refractory Anaphylactic Shock

Severe anaphylaxis can be associated with cardiovascular collapse that is difficult to manage and does not respond to treatment with epinephrine. Because anaphylaxis is uncommon, unpredictable and may be fatal, a prospective, randomized, controlled trial in humans on the best management is difficult and guidelines are based on theory and anecdotes only. We report six cases in which the use of vasopressin was successful in the treatment of anaphylactic shock. Standard treatment of anaphylactic shock, including discontinuation of the causative agent, administration of epinephrine, and infusion of IV fluids, did not stabilize cardiocirculatory function, and adding arginine vasopressors resulted in prompt hemodynamic stabilization.

Treatment of Anaphylactic Shock: Where Is the Evidence?

The casepresentations are convincing and leave little doubt that the patientssuffered from anaphylactic shock, and that they would have improved asrapidly with a therapy other than AVP.As suggested by the authors, it is unlikely that evidence-basedmedicine-derived criteria are useful tools to determine an effective therapyfor anaphylaxis and anaphylactic shock. Because allergic symptoms canvary in their quality and extent and virtually all cases of anaphylacticshock occur unpredictably, it will be difficult to conduct prospective,randomized, controlled trials for this condition.To summarize the clinical evidence for therapeutic interventions recom-mended by the European Resuscitation Council for the treatment ofanaphylaxis and anaphylactic shock,