Anaphylactic shock or allergic shock is a condition that is life-threatening and and absolutely requires rapid recognition and treatment.
What is anaphylactic shock?
First aid and measures for anaphylactic shock. Click image to enlarge. In the context of various allergic reactions that can occur due to a variety of causes, anaphylactic shock is one of the most severe adverse health effects. Since anaphylactic shock has the symptoms of a severe allergy, the terms allergic shock or allergy shock are also appropriate. In anaphylactic shock, the typical signs of a classic state of shock are evident, usually occurring acutely and very quickly after exposure to the triggers. If not recognized and if left untreated, anaphylactic shock can lead to a loss of function of the entire cardiovascular system. This condition is considered life-threatening in anaphylactic shock. The diagnosis of anaphylactic shock can be made relatively quickly with a fairly high degree of certainty. This is possible because quite characteristic health impairments occur.
Causes
The causes leading to the development of anaphylactic shock are usually external triggers that are also characteristic of normal allergies. In addition to wasp or bee stings (insect venom allergy), anaphylactic shock also occurs when there is an intolerance to substances in medications. This is often observed with penicillin. In addition, administration of various contrast media for X-ray diagnostic procedures via the injection route also leads to anaphylactic shock. Allergy sufferers are usually extremely hypersensitive to various components in food. These may come from fruits or nuts. (see food allergy (food allergy)).
In addition, allergens from animals such as animal hair or the feces of mites (see house dust allergy) are considered among the causative triggers of anaphylactic shock. In most cases, anaphylactic shock builds up in patients who have already been diagnosed with type 1 allergy.
Symptoms, complaints, and signs
Depending on the severity, anaphylactic shock is manifested by a number of symptoms. Severity one allergic shock is accompanied by mild general reactions such as dizziness, headache, and nausea. Skin reactions such as itching, hives and redness may also occur. Severity Two causes similar symptoms, but is joined by other signs such as an accelerated heartbeat, drop in blood pressure and mild shortness of breath. The nausea develops into serious gastrointestinal symptoms – vomiting, diarrhea and other sequelae occur. Third-degree anaphylactic shock is characterized by cramping of the airway muscles and a shock reaction. In individual cases, swelling of the larynx with shortness of breath occurs. Severity IV leads to respiratory and cardiovascular arrest. The affected person usually becomes unconscious or suffers severe convulsions, which clearly indicate a severe course. Depending on the type and severity of the allergy, other symptoms and complaints may occur. For example, a pollen allergy is usually also associated with respiratory problems and rhinitis, while a food allergy can manifest itself with serious gastrointestinal complaints and fever. Anaphylactic shock can be recognized by the fact that it occurs shortly after contact with an allergen and causes multiple symptoms within a few minutes.
Course
The course of anaphylactic shock is characterized into an acute form, which is evident in that symptoms occur in two stages. In anaphylactic shock, these are referred to as the initial phase and the systemic reaction. In the initial phase, those affected initially suffer from malaise, nausea and mild diarrhea, as well as pain in the intestinal area. Localized changes in the skin occur in anaphylactic shock and breathing difficulties set in. These resemble a mild asthma attack in anaphylactic shock. In the further course of anaphylactic shock, increasing itching, severe reddening of the skin on the face, inflammatory processes on the skin with intense redness and hives can be observed.Due to the narrowing of the airways caused by their swelling, anaphylactic shock also leads to increased shortness of breath. Those affected usually vomit and show a marked reduction in blood pressure. If left untreated, the pulse rate (low pulse) drops rapidly, patients lose consciousness, and cardiovascular activity stops. The latter symptoms are characteristic of a typical state of shock and, in anaphylactic shock, are due to the fact that the blood vessels dilate enormously.
Complications
In anaphylactic shock (allergic shock), there is initially a sharp drop in blood pressure and an increase in heart rate. Due to the drop in blood pressure, important organs are no longer supplied with sufficient blood, which can fail as a result, including especially the kidneys and lungs. In harmless cases of anaphylaxis, there is only a reddening of the skin and mild itching. However, these symptoms quickly disappear when the corresponding allergen is avoided and heal without complications. In addition, nausea, vomiting and diarrhea may also occur. If an allergy remedy is used, these harmless symptoms quickly subside without consequences. In addition, in the more severe cases, there is severe swelling of the muscles in the throat and bronchial tubes, which leads to difficulty in swallowing, as well as difficult breathing, which can lead to respiratory distress and even suffocation. In the context of Quincke’s edema, in which the deeper layers of the skin also swell, the symptoms are even worse. In addition to the neck and face, the hands, feet, and genitals are usually painfully swollen in Quincke’s edema. During anaphylactic shock, the affected person may become unconscious and also stop breathing. Therefore, an emergency physician should be called immediately, as this can lead to circulatory arrest and death of the patient if left untreated.
When should you go to the doctor?
Anaphylactic shock often affects allergy sufferers. It is potentially fatal and is therefore an extreme emergency situation. An emergency physician or ambulance must be alerted immediately. However, allergic shock can vary in severity – but it is never to be trifled with. It may be known that the person is an allergy sufferer. Often, allergy sufferers inform those around them that they are allergic to certain things. In this case, there is often a four-piece emergency kit in the house. If the person is still responsive, those present can ask them where to keep it. Otherwise, calling an emergency physician is the first course of action. There may be a paramedic or emergency physician on site at public events. Alerting them would also be an appropriate action. It is important to act quickly. Suspicion of anaphylactic shock must be voiced. First aid measures in case of anaphylactic shock are to be taken depending on the condition of the affected person. In case of respiratory distress, breathing should be facilitated. In case of unconsciousness, the stable lateral position is necessary. Circulatory problems require elevation of the legs. If necessary, resuscitation measures such as cardiac massage and ventilation should be initiated. The doctor called in will decide on further measures after his arrival. With timely administration of antihistamine, cortisone and/or histamine, the allergy sufferer usually gets back on his feet.
Treatment and therapy
Therapy for anaphylactic shock depends on the severity of the individual symptoms and the patient’s condition. In addition to rapid emergency medical acute treatment, further treatment is also required for anaphylactic shock. In addition to the practiced first aid measures that are applied in the event of shock, medical professionals also use special medications in the event of anaphylactic shock. These are intended to stop the allergic reaction and stabilize the cardiovascular system again. In addition to adrenaline and glucocorticoids, the drugs used include so-called antihistamines and beta-2 sympathomimetic drugs. The latter group of drugs affects the conduction of the heart and, like all other substances, is introduced into the organism by infusion in anaphylactic shock. The other drugs prevent the narrowing of the airways and clear the bronchi.
Outlook and prognosis
As a rule, the further course in this complaint depends greatly on the cause of the shock, so that a general prediction is not possible in most cases. However, this is a life-threatening condition that must be treated by a physician in any case. Those affected usually suffer from circulatory problems and also from circulatory shock. Furthermore, there is vomiting and nausea. Patients also show shortness of breath and also suffer from palpitations, so that loss of consciousness can occur. Not infrequently, this shock also leads to anxiety and a panic attack. Likewise, redness and itching occur on the skin or directly at the injection site and can further reduce the quality of life. In the worst case, the affected person suffers a complete cardiac arrest and dies. As a rule, anaphylactic shock can be treated relatively well with the help of medication and first aid measures. There are no particular complaints or complications. With successful and rapid treatment, the patient’s life expectancy is also not affected.
Prevention
To counteract anaphylactic shock prophylactically, it makes sense to pay attention to the known triggering causes and to avoid them. However, if these still enter the organism, then an emergency kit or a special emergency preparation can be helpful in preventing the development of anaphylactic shock. This can be represented by either a glucocorticoid-containing drug or an antihistamine in anaphylactic shock.
Follow-up
Aftercare for anaphylactic shock consists of continuing to monitor the individual and taking preventive measures. If someone with anaphylactic shock is brought to a hospital, initial care is given first. The patient is then monitored by a doctor for a certain period of time – for example, to rule out organ damage or to check the circulatory functions. If necessary, further medical measures are then taken. These range from administering medication to replacing organ functions with machines, depending on the severity of the anaphylactic shock. Monitoring time in the ICU is usually at least 24 hours. If this is the first allergic shock with no known allergen, attempts are usually made to locate the allergen. An anaphylaxis passport can then be issued. In addition, affected persons are advised to urgently contact a physician, who will provide further preventive measures regarding the possible allergy. There is no medical aftercare in the narrower sense in the case of allergic shock. Rather, prophylactic measures (such as avoiding the allergen) must be taken. In addition, the affected person should carry an emergency kit at the latest after the first anaphylactic shock in order to be able to take (have taken) measures quickly in the event of a further shock.
What you can do yourself
Because vital organs are affected in anaphylactic shock, a doctor should be consulted immediately. When allergic shock occurs as a severe form of allergic reactions, it is important to remain calm and perform first aid measures. Since anaphylactic shock is accompanied by circulatory problems, these should be minimized by elevating the legs. This can promote blood flow to the brain. Adopting the stable lateral position is also recommended, as this keeps the airways open. In addition to keeping calm and avoiding panic actions, it is important to recognize the triggering allergen. If the allergen is known, further ingestion should be prevented immediately. If the allergic reaction occurred from an insect sting, the stinger of the insect can be removed by careful scratching to prevent further toxins from entering the person’s circulation. Those who have anti-allergic medications in their immediate vicinity should take them immediately. If sufferers know about the triggering allergen in advance and suspect an allergic shock reaction, they should carry the anti-allergic medication with them at all times if possible. In this way, those affected are well prepared for an emergency, can gain a little security and minimize their fears of a dangerous shock reaction.
