Anaphylaxis shock

1. Written by student dentist Tal Kaplan

2.  Notion Anaphylaxis shock
 Classification's
 Types of hypersensitivity reaction's
 Etiology
 Pathophysiology
 Singe’s & Symptom’s
 Diagnosis
 First aid
 Treatment
 Prevention

3. The term derived from greek language ana – (without) ,
phylaxis – (protection). A sudden, severe allergic reaction
characterized by a sharp drop in blood pressure, urticaria
(skin rash), and breathing difficulties that is caused by
exposure to a foreign substance, such as a drug or bee
venom, after a preliminary or sensitizing exposure. The
reaction may be fatal if emergency treatment is not achieved
immediately, treatment including epinephrine injections.
Also called anaphylactic shock.

4. By the Type of shock:
• Typical
• Cardiac
• Asthmatic
• Cerebral
• Abdominal
By type of development:
• Momentry
• Easy
• Medium
• Grave

5. Mast cell
release
histamine
and other
mediators
Immediate
hypersensitivity
Antibodies
directed
against cell
or tissue
antigens
Antibody-
mediated
Antibody-
antigen
complex
deposit in
blood vessels
immune complex
diseases
Reactions
of T
lymphocytes
T cell-mediated
diseases

6. Idiopathic 37%
Food 34%
Drugs 20%
Exercise 7%
Latex, hormons,
insect bites 2%

7. Pharmlogic
agents
•Antibiotics
(penicillin)
•Nonsteroidal anti-
inflammatory drugs
(Asprin)
•intravenous (IV)
contrast agents
Stinging
insects
•Ants, bees,
hornets, wasps,
and yellow
jackets.
Food
• Peanuts,
seafood, and
wheat
Latex
•Rare
•No latex-
associated
deaths

8.  First exposure
 Activation of TH2 cell → Stimulate IgE switiching
Allergen
TH2 Cell
B Cell

9.  First exposure
 IgE production
IgE secreting B cell IgE

10.  First exposure
 IgE bind to mast cell

11.  Second exposure
 Recognition
Allergen

12.  Second exposure
 Activation of mast cell to release histamine and
other mediators
Mediators
Allergen

13. • Typical type:
Dizziness weakness fainting
rapid, slow,
or irregular
heart rate
low blood
pressure
Nausea vomitingcramps
Itcing swlling around
the eyesItching flushinghives swelling

14. • Respiratory type:
Difficulty breathing coughing chest tightness
wheezing or other
sounds
increased mucus
production
throat swelling or
itching
change in voice
or a sensation of
choking

15. • Cardiac type:
Dizziness weakness fainting
rapid, slow, or irregular
heart rate
low blood pressure

16. • Abdominal type:
Nausea vomiting
cramps diarrhea

17. The diagnosis of anaphylaxis is based upon symptoms that occur
suddenly after being exposed to a potential trigger.
Usually in dental clinic it will be more hard to get conclusive diagnosis.
Differential diagnosis:
• severe asthma attack
• heart attack
• panic attack
• food poisoning
- Those differential diagnosis are very similar to anaphylaxis shock and
a doctor could get a wrong diagnosis due to lack of tools in reach to
doctor hand.
- An increased amount of tryptase protein can be measured in a blood
sample collected during the first three hours after anaphylaxis
symptoms have begun.
- Tryptase levels are seldom elevated in food-induced anaphylaxis

18. Place patient in horizontal with legs up position.
Establish and maintain airway.
Give oxygen via nasal airway as needed.
Place a tourniquet above the reaction site.
Epinephrine at the site of antigen injection.
Start IV to rise BP.

19. • Adrenalina sol. – 0.1% 0.5 ml, if patient state doesn't improve in 10-15 min, we
Introduce 1.0 ml more of sol.
• Suprastine sol. – 2% 1ml.
• Prednisolone sol. 30-60 mg (unique dose) or hydrocortisone 75-125 mg.
• Caffeine sol. Or cordiamine, or corazoli – 20% 1-2 ml.
• In case of bronchospasm: eupheline sol. – 2.4% 5-10 ml or galidore sol. – 2ml (i/m).
• To maintain cardiac activity are given cardiac glycosides & diuretics: lazex sol. – 2-4 ml (i/v),
Corglicon sol. – 0.06% 0.5-1 ml (i/v).
• In case of cardiovascular insufficiency: strophantini sol. 0.05% 0.5-1 ml, mazatoni sol. 0.1% 1m
• Ionic sol. of NaCl 0.9% 400 ml or glucose sol. 5-10% 400 ml, in perfusion introduced dopamin
sol. 200 gr or noradrenaline 0.1% 1ml.
• Injection place should be infiltrated with adrenalin sol.
• Artificial respiration with extern massage of the heart.

20. Avoid the responsible allergen (e.g. food,
drug, latex, etc.).
Keep an adrenaline kit (e.g. Epipen) and
Benadryl on hand at all times.
Wear medic Alert bracelets .
Venom immunotherapy is highly effective
in protecting insect-allergic individuals.