Anaphylactic Shock: Causes

Pathogenesis (development of disease)

The allergic reaction to a food allergen, insect venom, or drug is usually an immediate-type reaction (type I allergy; synonyms: type I allergy, type I immune reaction, immediate allergic reaction). The initial contact, which is usually asymptomatic, is called sensitization. T and B lymphocytes recognize the antigen independently of each other. The second reaction is IgE-mediated. Here, the allergen binds to the IgE present on the mast cells and various mediators (histamine, leukotrienes, prostaglandins, tryptase, chemokines, platelet-activating factor, cytokines) are released. The following symptoms may occur: Urticaria (hives) (anaphylactic reaction: 15-20 min; IgE-mediated: 6-8 h), rhinitis (inflammation of the nasal mucosa), angioedema (sudden swelling of the skin or mucous membranes), bronchospasm (cramping of the muscles surrounding the airways), and even anaphlactic shock (the most severe allergic reaction, which can be fatal). Note: In anaphylactic shock, immunological sensitization need not be detectable. Such reactions are called “pseudoallergic reaction” (see below pseudoallergy) or also “non-allergic anaphylaxis“. Most common triggers of anaphylaxis in children and adults.

Contact with the allergen most commonly occurs through oral or parenteral(via infusion/transfusion)/hematogenic (“by the bloodstream”) delivery. In rare cases, it is also aerogenic (“by the airway”) or via application to the skin surface.

Etiology (causes)

Factors that may exacerbate anaphylaxis or, when several of these factors coincide, may precipitate anaphylaxis (= augmentation factors)

• Hormonal factors (e.g., menstruation).
• Physical stress
• Certain foods and food additives
• Psychogenic factors (e.g., stress)
• Alcohol
• Infectious diseases
• Mastocytosis – two main forms: cutaneous mastocytosis (skin mastocytosis) and systemic mastocytosis (mastocytosis of the whole body); clinical picture
  • Cutaneous mastocytosis: yellowish-brown spots of varying size (urticaria pigmentosa);
  • Systemic mastocytosis: in this case, episodic gastrointestinal (stomach and intestinal) complaints (nausea (nausea), burning abdominal pain/abdominal pain and diarrhea/diarrhea), ulcer disease, as well as gastrointestinal bleeding and malabsorption (insufficient breakdown of food components) also occur.In systemic mastocytosis, there is an accumulation of mast cells (cell type that, among other things. In systemic mastocytosis, there is an accumulation of mast cells (cell type involved in allergic reactions, among other things) in the bone marrow, where they are formed, and in the skin, bones, liver, spleen, and gastrointestinal tract (GIT); mastocytosis is not curable; course usually benign and life expectancy normal; Extremely rarely mast cells degenerate (= mast cell leukemia)The prevalence (disease frequency) of insect venom allergy/venom allergy in patients with systemic mastocytosis is 20-30%; population average (0.3-8.9%).
• Medications (see below drug exanthema/causes).

Medication

• Oral immunotherapy (OIT) in children for peanut allergyNote: OIT with peanut increased the risk and frequency of anaphylaxis by about threefold compared with not using this therapy (22, 2 vs. 7.1 percent); OIT children were about twice as likely to require epinephrine as emergency medication compared with children in the control group without the oral immunotherapy.
• see below drug exanthema / pathogenesis – etiology.