Anaphylactic shock - Anaphylaxis experts and information

What is anaphylactic shock?

Anaphylactic shock is a severe reaction triggered by an allergy. The immune system reacts very strongly to the allergen within a short period of time.

The body releases large amounts of histamine in a short time, which causes the blood vessels to dilate. Blood pressure drops and the heartbeat increases to compensate for the drop in blood pressure.

A life-threatening circulatory collapse can occur within a very short time, leading to multiple organ failure if no treatment is given. In other cases, the anaphylactic reaction leads to swelling of the larynx, which closes the airways.

Causes of anaphylactic shock

A severe allergic reaction can be caused by various allergens, such as

• Food (such as nuts, eggs, milk, seafood, fish)
• Insect venoms (e.g. wasps, bees, hornets, bumblebees)
• Medication (including antibiotics, painkillers, iodine-containing contrast agents)
• Inhalation allergens (e.g. pollen, house dust, animal hair, molds)
• cosmetics
• Natural latex

In adults, insect venoms are responsible for more than 50% of anaphylactic shocks. In children, food in particular triggers severe allergic reactions. In most cases, those affected are unaware of the allergy. This is particularly true of allergens that people rarely come into contact with, such as medicines or insect venom.

Food allergies such as an allergy to nuts can be life-threatening @ Goffkein /AdobeStock

The four degrees of severity of anaphylactic shock

Doctors speak of four degrees of severity for anaphylaxis, ranging from individual local symptoms to severe shock. The signs do not necessarily occur in the order described; in some cases, only individual symptoms manifest themselves.

Important to know: The faster an allergic reaction occurs, the faster you need to act and contact a doctor!

• Grade 1: Reactions such as a rash, itching, swelling or hives occur on various areas of the skin. The patient may also complain of dizziness or headaches.
• Grade 2: In addition to the symptoms of grade 1, there are the following: drop in blood pressure, accelerated heartbeat, nausea, vomiting or diarrhea, slight shortness of breath, hoarseness or swelling of the body.
• Grade 3: From grade 3 there is a real danger to life. In addition to the previous symptoms, cramps occur in the respiratory tract: Swelling of the larynx, shortness of breath, difficulty swallowing and speaking, weakness, drowsiness and bluish discoloration of the skin, mucous membranes, lips and fingernails
• Grade 4: The symptoms of grade 1 to 3 lead to unconsciousness and eventually to respiratory and cardiovascular arrest.

Treatment of anaphylactic shock

There is usually a few minutes between allergen exposure and anaphylactic shock. Around ten to 15 minutes elapse in the case of insect bites, around 30 minutes or longer in the case of ingestion of incompatible foods.

If severe allergic reactions occur, you must act immediately. From severity level 2, you should inform the emergency doctor. First aid must be administered until the emergency services arrive:

1. You should stop the allergen intake (bee sting, food or medication infusion) as quickly as possible.
2. You must then give the patient first aid. If there are only symptoms of shock but no breathing problems, place the patient in the shock position: keep the upper body low and the legs high. The aim is to ensure that the blood does not flow into the legs but is available to the vital organs.
3. In the event of breathing problems, you must place the victim's upper body in an almost upright position and in the stable lateral position if they are unconscious.
4. You should then monitor the patient's breathing, pulse and blood pressure and provide reassuring support.
5. If symptoms of grade 4 occur before the emergency doctor arrives, rescue breathing or resuscitation is necessary.

Emergency kit for allergy sufferers

Patients who are aware of their allergy can protect themselves with an emergency kit. The kit usually contains an adrenaline auto-injector, an antihistamine and a cortisone preparation. The adrenaline from the pre-filled syringe raises the blood pressure within a few minutes and causes the heart function to normalize. The bronchial tubes relax. This stabilizes the circulation and makes breathing easier.

The antihistamine stops the allergic reaction and the cortisone prevents further reactions. The medication can be available in liquid form or as tablets. Liquid preparations are preferable as they are easier to take if there is swelling around the mouth and throat. Asthmatics should also carry an emergency spray to dilate the bronchial tubes. Ask your doctor to prescribe an emergency kit. It is available from the pharmacy.

The treatment of anaphylactic shock

If this has not already happened, the emergency doctor will stop the supply of allergens and place the patient in the correct position. The doctor then usually administers the same medication that can be found in the emergency kit. With the help of a venous access, the adrenaline enters the bloodstream more quickly. The function of the cardiovascular system improves and the mucous membranes swell.

In addition, the doctor supplies the patient with oxygen and administers a volume replacement solution to increase blood pressure again. Infusions can also ensure an adequate supply of fluids. An antihistamine and cortisone are also used.

If it is a case of fourth-degree anaphylactic shock, the doctor will begin resuscitation immediately. The length of hospitalization varies depending on the severity. Monitoring for at least 24 hours is necessary even if the symptoms improve quickly.

Once the patient is well again, an allergy test should be carried out immediately so that doctors can determine the exact cause and prevent further anaphylactic shock.

The skin test is the most common test procedure to detect allergies @ Pixel-Shot /AdobeStock