Anaphylaxis is a sudden pathological, that is, pathological, immediate reaction of the immune system to certain antigens that are not normally dangerous to the human body.
What is anaphylaxis?
Upon contact with the allergen, the antibodies react and histamine is released, which causes inflammatory reactions in the body. Anaphylaxis is an allergic reaction of the so-called type I (immediate type). An allergy is a hypersensitivity to normally completely harmless environmental substances (allergens). The allergy is acquired through initial contact with the antigens, small molecules found on the surface of the allergen. Bacteria also carry antigens on their surface. In simple terms, these antigens cause a defensive reaction of the immune system. In the case of bacteria, this is a completely physiological, i.e. healthy, reaction. In the case of an allergy, however, the immune system overreacts and forms antibodies against the antigens of the allergenic substance, which are actually harmless.
Causes
During the first contact with the allergen, nothing happens yet except this antibody formation. If contact with the allergen then occurs again, an allergic reaction is triggered. It is not possible to predict when hypersensitivity will manifest itself. It often occurs years after the first contact with the allergen. In principle, almost all environmental substances can become allergens. Particularly widespread allergens are pollen, house dust, nuts and penicillin. A specific cause for allergies has not yet been identified. However, both genetic and environmental factors seem to play a role. In allergic reactions of the immediate type, the organism reacts on first contact with the allergen with a very strong formation of antibodies, which attach themselves to the surface of the so-called mast cells. In case of a new contact, there is a reaction of these antibodies with the allergen. Within a very short time, the mast cells on which the antibodies are located release their constituents, including primarily histamine. Histamine is a tissue hormone that causes inflammatory reactions in the body.
Symptoms, complaints and signs
Although the symptoms of anaphylaxis are very unpleasant and significantly limit the quality of life of the affected person, they do not have a direct negative effect on the health of the affected person and are thus usually harmless. Patients primarily suffer from severe itching and reddening of the skin. Scratching usually only intensifies the itching. Vomiting, diarrhea or severe nausea may also occur. Sufferers also exhibit hives and in some cases may also suffer from asthma. In severe cases, the breathing difficulties can lead to a loss of consciousness, during which the affected person can injure himself. Also a permanent tiredness and fatigue due to the breathing problems. There is also swelling in various parts of the body, possibly limiting movement. In most cases, the person affected can no longer perform his or her usual activities due to the anaphylaxis and is thus significantly restricted in his or her everyday life. Anxiety or dizziness may also occur as a result of anaphylaxis. The symptoms are usually accompanied by severe headaches, and the affected person’s blood pressure also drops sharply.
Diagnosis and course
An anaphylactic reaction can be divided into five stages. The severity of this reaction depends on the allergen effect on the organism. External contacts, e.g. via the skin, usually lead to more localized reactions. If the allergen is absorbed via the bloodstream, the body reacts in a generalized manner. In general, anaphylaxis can be divided into five stages. Each stage requires a specific action. Since anaphylaxis can be life-threatening, rapid action is essential. In stage 0, local reactions occur at the site of allergic contact within seconds of allergen contact. Swelling, redness and itching may occur. At this stage, treatment is usually not yet necessary. However, renewed contact with the allergen should be avoided at all costs. In the first stage, these local reactions spread.This means that, for example, the redness or the rash no longer occur only at the site of allergy contact, but additionally preferentially on the face, hands and upper body. In addition, other general symptoms appear, such as anxiety, dizziness, headache. If the throat swells, the affected person also complains of shortness of breath. At this stage, the emergency physician must be called as soon as possible. The affected person should be calmed down and pulse and breathing checked. In stage II, the organs also react to the allergen contact. Asthmatic complaints, abdominal or lower abdominal cramps, a pulse increase and a drop in blood pressure occur. If the emergency physician has not yet been called, it is now time to act with the utmost urgency. The legs of the affected person should be elevated. Stage III corresponds to anaphylactic shock. The pulse accelerates to more than 100 beats per minute and the blood pressure drops. The affected person loses consciousness. Unconscious victims should be placed in the recovery position. If possible, the legs should be slightly elevated during this process. Anaphylaxis (stage IV) ends with circulatory and respiratory arrest. If resuscitation is not performed or remains unsuccessful, the affected person dies.
Complications
Anaphylaxis occurs as part of an allergic reaction and has several complications. Allergy in general severely limits quality of life because the triggering substance must be avoided to prevent a reaction. In the most harmless case, contact with the allergen can cause severe reddening of the skin and itching, and it is not uncommon for wheals to occur as well. Swelling of the respiratory tract is also common and leads to massive respiratory problems in the affected person, so that he or she must take an anti-allergic medication as soon as possible. In addition to the shortness of breath, swallowing difficulties also occur. In the context of Quincke’s edema, there is a stronger swelling of the respiratory tract, and deeper layers of the skin also swell, so that this is more difficult to treat. In the course of the allergy, so-called cross-allergies can also occur. The allergen has a molecular structure that can be similar to other substances. This means that other substances can also trigger anaphylaxis. Anaphylaxis can also end in anaphylactic shock, because the blood vessels are opened wide and thus important organs such as especially the kidneys and lungs are no longer supplied with blood properly. This can end in kidney or lung failure. A heart attack is also a possible complication of anaphylactic shock. In one percent of cases, anaphylaxis is fatal.
When should you go to the doctor?
In the event of anaphylaxis, an emergency physician must be called immediately. First aid should be administered at the first sign of an allergic shock reaction. Depending on the particular symptoms, it may be necessary, for example, to perform cardiac massage (in case of cardiac arrest) or mouth-to-mouth resuscitation (in case of respiratory distress). In the event of vomiting, the body must be placed in the recovery position. If circulatory collapse or a heart attack occurs in connection with an insect bite or the consumption of certain foods, anaphylaxis is probably present. Prior to this, cramps, palpitations or intense pain indicate an allergic reaction that must be treated immediately. This should be accompanied by a check to see whether the person affected has an anaphylaxis passport with him or her. If this is not the case, the document should be requested at the next doctor’s visit. Medical treatment is required in any case of anaphylaxis. After recovery, the affected person should take advantage of further counseling appointments and learn about avoidance strategies and remedies. Good preparation can significantly reduce the risks associated with anaphylactic shock.
Treatment and therapy
A therapy of the allergy, and thus a safe prevention of an anaphylactic reaction is not possible. Protection is provided solely by careful avoidance of the anaphylaxis trigger. In case of a known strong allergy to food or insect venoms, the physician can prescribe an emergency kit. This contains medications that can provide rapid relief until the emergency physician arrives. Those affected by a severe allergy should always carry an anaphylaxis passport. This can save lives in an emergency.
Outlook and prognosis
The extent and treatment of the anaphylactic reaction are critical to the prognosis.The faster action is taken in the event of a stronger reaction, the sooner the reaction can be expected to subside and thus the condition of the person affected to improve. This applies up to the point where the anaphylactic reaction has such a strong impact on the organism that it is permanently damaged by an anaphylactic shock. Mild reactions caused by the initial phase of an anaphylactic reaction are considered harmless insofar as they pass on their own within a few hours. Consequential damage is not to be expected. If, on the other hand, the patient’s condition worsens, it is often no longer possible for the reaction to subside without the administration of medication. An anaphylactic reaction that is treated quickly usually has no sequelae. If left untreated, an anaphylactic reaction that progresses beyond the stage of transient minimal symptoms often leads to life-threatening shock that, without appropriate measures, will result in the death of the affected individual. The allergic reaction will recur for many sufferers whenever they are exposed to the appropriate allergen. A swiftly treated anaphylactic shock is followed by monitoring in the hospital to determine any damage to the organism. The lethality rate in the case of severe shock is approximately one percent. It is significantly lower in the case of mild anaphylactic reactions.
Prevention
An important measure for allergy prevention is a low-allergen environment in childhood, which includes avoiding care products with many additives. An important goal should also be to build an intact immune system. The rule here is: too much cleanliness does more harm than good. The way for an allergy can also be paved in the womb. Studies show that children whose mothers smoked during pregnancy are more frequently exposed to allergies. If an allergy develops despite all prevention, anaphylaxis can be prevented almost exclusively by avoiding the allergen.
Follow-up
After a diagnosis of anaphylaxis, patients have a responsibility to avoid an allergic reaction. The attending physician will provide information about dangerous substances and agents after an initial illness. Only in rare cases a new diagnosis becomes necessary. Physicians determine an illness by blood and skin tests. Anaphylaxis persists for a lifetime. Affected persons do not acquire immunity to certain substances after a reaction. Thus, unlike other diseases, follow-up care cannot aim to ensure early detection. To avoid life-threatening complications, affected individuals must avoid allergens in everyday life. These occur in different areas of life. Food can cause a reaction, as can clothing. Some patients also fall ill from insect bites. Especially when traveling, it is advisable to carry necessary medication with you. This allows life-saving immediate measures to be taken. An allergy passport and special neck and wrist bands inform first responders about the underlying disease. They should always be carried in the event of severe forms of anaphylaxis. Allergy sufferers should always inform those closest to them about the condition and have emergency instructions ready. If breathing is affected, the emergency physician must be informed immediately. The actual aftercare thus falls to the patient.
Here’s what you can do yourself
The best variant to prevent anaphylactic shock or anaphylaxis is to avoid the allergen in question as a matter of principle. Thus, on the part of the affected person, the ingredients should always be checked when buying food, especially processed food. In the case of strong reactions to specific insects, certain areas in which they occur in large numbers should be avoided if possible. An important course of action to prevent allergies is to provide a low-allergen environment in childhood. The use of care products with many additives should also be avoided. The development of an intact immune system can also help to prevent the occurrence of anaphylaxis. Too much cleanliness may even prove harmful in this regard. Expectant mothers should refrain from smoking. Various studies have shown that the way for a later allergy can already be paved in the womb. If an allergy develops first, the only effective prevention is consistent avoidance of the specific allergen.However, severe allergy sufferers can wear special wristbands or neckbands in order to provide other people with the right information in an extreme emergency and thus receive help more quickly. In addition, it is advisable for those affected to carry an emergency kit with them at all times, with the appropriate medication, in order to be prepared in an emergency.
