Therapy | Anaphylactic shock


If there are signs of anaphylactic shock, an emergency doctor should be called immediately, as this is a life-threatening condition that requires immediate therapy. The most important measure in an anaphylactic reaction is to remove the allergen (as far as possible). As a first aid measure, it should first be checked whether the person is still breathing and whether the circulation is still functioning.

If this is not the case, resuscitation should be started immediately. To stabilize the circulation the so-called shock position is useful. For this purpose, the person is laid flat on the floor and the legs are raised to facilitate the return flow of blood from the legs into the body.

The therapy by the emergency doctor depends on the severity of the allergic reaction. For mild reactions, the administration of an antihistamine and cortisone (glucocorticoid) is often sufficient. Circulatory instability can be counteracted by the administration of fluid as an infusion.

In the event of a shock, adrenaline can cause a narrowing of the vessels, which causes blood pressure to rise. In case of additional asthmatic complaints, an asthma spray (emergency spray/short-acting beta mimetic) should be used. If breathing problems occur due to swelling of the airways in the throat, ventilation by the emergency doctor may also be necessary.

Emergency kit

People who are known to have an allergy with strong reactions such as anaphylactic shock are often given a so-called “emergency kit” for self-therapy. This is an antihistamine and a cortisone preparation. These can then be taken in an emergency situation.

In addition, such a set contains an adrenaline auto-injector, but this can only be used after prior training. This is a ready-to-use syringe that injects adrenaline into the thigh muscle by pressing firmly on the thigh. It is important not to touch the top of the auto-injector to prevent accidental injection into the finger!

In acute anaphylactic shock, the diagnosis is usually based on the typical symptoms often together with a typical trigger such as a bee sting or an antibiotic that has just been taken. In order to prove an allergy after an allergic reaction, further diagnosis by a dermatologist can be useful. For this purpose, possible triggers and typical symptoms are first asked about in a detailed conversation and brought into a context.

In addition, a reaction to typical allergens can be provoked. These tests all carry the risk of a severe anaphylactic reaction and should therefore only be carried out by an experienced doctor on emergency call. The most commonly used test is the “prick test“: For this purpose, standardized allergens are dripped onto the forearm and then the skin is pricked with a small lancet.

After approx. 20 minutes, the allergens to which the reaction was caused can be read (a wheal with reddening is considered a reaction). However, this test can only detect a sensitization to the substance.

Which symptoms this substance causes is not shown. In a “scratch test” the skin is scratched for about 1 cm and the suspected allergen is then dripped or rubbed on. If these tests do not indicate sensitization and there is still a strong suspicion of an allergy, the allergen can also be injected into the skin of the back with a syringe.

However, this test is associated with a higher risk of an anaphylactic reaction. Furthermore, blood tests with determination of antibodies against possible allergens are possible (total IgE and specific IgE). In some cases a direct provocation with the triggering substance can be considered. After an anaphylactic shock, however, this should only be done very cautiously.