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Dx Anaphylaxis Treatment: Read More...


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SUMMARY:
The consensus to the treatment of Anaphylaxis prevention is strict dietary monitoring. A Cochrane Database suggested since the risk of recurrence of allergic reaction is high (30-42.8% and 71% of the reactions were to food), that an Epipen®-like (adrenaline/dilute epinephrine injector) be available. They were unable to find well designed studies of the use of SubCutaneous ImmunoTherapy(SCIT) by a sub-specialist to compare although the costs [of SCIT] would be much higher.


Anaphylaxis

The Merck Manual Home Edition
states:
"Anaphylactic reactions (anaphylaxis) are sudden, widespread, potentially severe and life-threatening allergic reactions.

*These reactions often begin with a feeling of uneasiness, followed by tingling sensations and dizziness.
*People then rapidly develop severe symptoms, including generalized itching and hives, swelling, wheezing and difficulty breathing, fainting, and/or other allergy symptoms.
*These reactions can quickly become life threatening.
*Avoiding the trigger is the best approach.
*Affected people should always carry antihistamines and a self-injecting syringe of epinephrine.
*Anaphylactic reactions require emergency treatment.

Anaphylactic reactions are most commonly caused by the following:
*Drugs (such as penicillin) *Insect stings *Certain foods (particularly eggs, seafood, and nuts) *Allergy injections (allergen immunotherapy) *Latex

But they can be caused by any allergen. Like other allergic reactions, an anaphylactic reaction does not usually occur after the first exposure to an allergen but may occur after a subsequent exposure. However, many people do not recall a first exposure. Any allergen that causes an anaphylactic reaction in a person is likely to cause that reaction with subsequent exposures, unless measures are taken to prevent it.

Symptoms:
Anaphylactic reactions typically begin within 15 minutes of exposure to the allergen. Rarely, reactions begin after 1 hour. Symptoms vary, but people usually have the same symptoms each time.

The heart beats quickly. People may feel uneasy and become agitated. Blood pressure may fall, causing fainting. Other symptoms include tingling (pins-and-needles) sensations, dizziness, itchy and flushed skin, coughing, a runny nose, sneezing, hives, and swelling of tissue under the skin (angioedema). Breathing may become difficult and wheezing may occur because the throat and/or airways constrict or become swollen. People may have nausea, vomiting, abdominal cramps, and diarrhea.

An anaphylactic reaction may progress so rapidly that people collapse, stop breathing, have seizures, and lose consciousness within 1 to 2 minutes. The reaction may be fatal unless emergency treatment is given immediately.

Symptoms may recur 4 to 8 hours after the initial exposure or later.

Anaphylactoid Versus Anaphylactic:
Anaphylactoid reactions resemble anaphylactic reactions. However, anaphylactoid reactions, unlike anaphylactic reactions, may occur after the first exposure to a substance.

Also, anaphylactoid reactions are not allergic reactions because immunoglobulin E (IgE), the class of antibodies involved in allergic reactions, does not cause them. Rather, the reaction is caused directly by the substance.

The most common triggers of anaphylactoid reactions include iodine-containing dyes that can be seen on x-rays (radiopaque dyes), aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, blood transfusions, and exercise.

If possible, doctors avoid using radiopaque dyes in people who have anaphylactoid reactions to such dyes. However, some disorders cannot be diagnosed without dyes. In such cases, doctors use dyes that are less likely to cause reactions. In addition, drugs that block anaphylactoid reactions, such as prednisone and diphenhydramine, are usually given before the dye is injected.

Diagnosis:
The diagnosis is usually obvious based on symptoms. Because symptoms can quickly become life threatening, treatment is begun immediately. If symptoms are mild, the diagnosis can be confirmed by blood or urine tests, which measure levels of substances produced during allergic reactions. However, these tests are usually unnecessary.

Prevention:
Avoiding the allergen is the best prevention. People who are allergic to certain unavoidable allergens (such as insect stings) may benefit from long-term allergen immunotherapy.

People who have these reactions should always carry a self-injecting syringe of epinephrine and antihistamine pills for prompt treatment. If they encounter a trigger (for example, if they are stung by an insect) or if they start to develop symptoms, they should immediately inject themselves and take the antihistamines. Usually, this treatment stops the reaction, at least temporarily. Nonetheless, after a severe allergic reaction and immediately after injecting themselves, such people should go to the hospital emergency department, where they can be closely monitored and treatment can be adjusted as needed. People should also wear a Medic Alert bracelet with their allergies listed.

Treatment:
In emergencies, doctors give epinephrine by injection under the skin, into a muscle, or into a vein. If breathing is severely impaired, a breathing tube may be inserted into the windpipe (trachea) through the person's mouth or nose (intubation) or through a small incision in the skin over the trachea, and oxygen is given through the breathing tube. Low blood pressure often returns to normal after epinephrine is given. If it does not, fluids are given intravenously to increase the volume of blood. Sometimes people are also given drugs that cause blood vessels to narrow (vasoconstrictors) and thus help increase blood pressure. Antihistamines (such as diphenhydramine) and histamine-2 (H2) blockers (such as cimetidine) are given intravenously until symptoms disappear. If needed, beta-agonists that are inhaled (such as albuterol) are given to widen the airways and help with breathing.
*An [oral] corticosteroid [such as Medrol®]is sometimes given [or started] to help prevent symptoms from recurring several hours later".

Medications Used in Treatment:
1. Corticosteroids: prednisone, Medrol®, dexamethasone, etc.
2. Antihistamines: Promethegan®, Phenadoz®, cyproheptadine
3. Catecholamines: Epipen®, Epipen®, Adrenoclick®

* [Editor]: The cost of 5 ampules of 1 ml Epinephrine (1:1000) is just $ 21.98. But this is not recommended because in the event of the emergency, treatment demands immediate intervention.

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