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3-9. Anaphylaxis

Anaphylaxis (anaphylactic shock) is an immediate, severe hypersensitivity. This allergic reaction may occur to a person who comes in contact with something to which he is extremely allergic. This type of shock is a true emergency, requiring medications to combat the allergic reaction.

a. Causes of Anaphylaxis. Causes of anaphylactic reaction include:

(1) Insect stings--bees, yellow jackets, wasps, hornets, fire ants.

(2) Ingested substances--spices, berries, fish and shellfish, certain drugs.

(3) Inhaled substances--dust, pollens, chemical powders.

(4) Injected substances--antitoxins and drugs like penicillin.

(5) Absorbed substances--certain chemicals when they come in contact with the skin.

b. Signs/Symptoms of Anaphylaxis. An anaphylactic reaction affects many of the systems of the body, including the following: integumentary system (skin), respiratory system, gastrointestinal system, cardiovascular system, urinary system, and the nervous system. Look at the way each of these systems is affected.

(1) Integumental system (the skin). Signs and symptoms include:

(a) Redness (redness of the skin).

(b) Urticaria (hives).

(c) Angioedema (skin and subcutaneous tissues swell).

(d) Pruritus (itching and burning skin, especially around the face and chest).

(2) Respiratory system. The child develops bronchospasms with wheezing (the bronchial tubes get smaller, spasmodically causing wheezing). The tissues of the larynx swell, causing the child to make a harsh, respiratory sound when he breathes. He also becomes hoarse.

(3) Gastrointestinal system. The child experiences vomiting, abdominal cramps, and diarrhea.

(4) Cardiovascular system. Cardiac blood vessels collapse. Tachycardia (abnormally fast heart beat) occurs, and the heart beat itself is irregular.

(5) Urinary system. The child is incontinent (cannot control the passage of urine or feces).

(6) Nervous system. The child has seizures and is acutely anxious.

NOTE: In emergency pediatrics, anaphylaxis is, fortunately, very rare. When it occurs, the cause is usually an insect sting.

c. Treatment for Anaphylaxis. Follow these procedures:

(1) Administer aqueous epinephrine in the dosage 1:1000, 0.1 to 0.3 ml subcutaneously. The dosage may be repeated in 15 minutes.

(2) Apply a tourniquet above the injection site of antigen or the inoculation site if the injury is a bit or a sting. An assistant should inject 0.2 ml of aqueous epinephrine in the dosage 1:1000 around the antigen injection site or sting.

(3) Quickly begin administering normal saline intravenously to support blood pressure and treat hypovolemia.

(4) Arrange for the monitoring of blood pressure and an electrocardiogram for cardiovascular complications.

(5) Maintain a patent airway. View the uvula and pharynx frequently, checking for evidence of swelling.

David L. Heiserman, Editor

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Revised: June 06, 2015