What Is Anaphylaxis-
Anaphylaxis is a form of severe allergy that can manifest itself in a very normal manner but as it escalates, it can be severe and fatal as well if uncontrolled.
It is not that every case poses a danger but to classify it as a normal allergy and accordingly treating the same is unwarranted. In other words, any laxity is shown towards it instant treatment can have very harmful consequences.
The main cause is an allergy to a particular body exposure like certain types of food consumption, insect bite, external exposure, body touch with a particular type of clothing material, latex, usage of a particular type of drug, etc.
These are the most common causes. It can differ from person to person.
Defining the Anaphylaxis through biological answers -
As and when the allergy hits the body, a loose category of proteins is released simultaneously. These proteins are typically used in cell signaling and they are biologically known by the term Cytokines.
These are released from the mast cell of connectivity tissues and the white blood cells known as Basophils. More often than not, an immune reaction is the cause for the Anaphylaxis to manifest itself.
The protein in the cells of the immunity system also known as antibodies then presses itself on the antigen. The antigen is a foreign substance that causes to induce the immune reaction in the body.
Anaphylaxis can also be caused due to non – immunological reasons known as degranulation of the mast cells. As the name itself specifies, the granules of the mast cells get released thereby reducing the content.
In the aftermath of Anaphylaxis, the immunity system of the body lets loose a stream of chemicals that lead to the impairment of several body functions.
It causes the blood pressure to dip substantially. There is no age or gender classification for the Anaphylaxis. The precedence so far has not pointed to any particular age group orientation so far.
This is more to do with the body's immunity system of the person and their reaction to the attack.
However certain specific studies have found that adults are more prone to Anaphylaxis than children. However, so far, this has not been classified or generalized to date.
Going by the cases of occurrence many children have also been affected by the same.
The global prevalence -
It is difficult to point out the specific geographical or global locational presence of the Anaphylaxis since there is a limitation of data on the subject from the different countries of the world.
A panel of world experts conducted a recent study covering the countries of Australia, China, France, Hungary, Japan, South Africa, South Korea, and the USA.
In none of the countries, it was found to be more than 2% of the total population as being affected by this allergy disease. China had the maximum number of cases but that was relative to its large population.
In terms of death-related cases, the USA and China were found to be more as compared to the other countries. As of 2018, it was found that incidents of Anaphylaxis were increasing in many parts of the world including South America and Asia.
The time frame of the symptoms coming out can vary from minutes to hours. The great matter of comfort is that Anaphylaxis can be eliminated completely to a good extent. The only pre-condition is timely treatment.
At this stage, it is not causing an alarm to the same extent that certain other types of fatalities like a sudden heart attack or early stage,non-detectable diseases such as malignancy and cancer. It also has proper treatment management and elimination.
But still, care and precaution need to be taken.
A lot of effort into the research and findings of the Anaphylaxis is supported by the World Allergy Organization (WAO).
The other global research studies and supporting organizations include the International Collaboration in Asthma, Allergy, and Immunology (iCAALL), the American College of Allergy,
Asthma and Immunology [ACAAI], European Academy of Allergy and Clinical Immunology [EAACI]). All of them are focussed on providing an evidence-based understanding of Anaphylaxis and all other related allergy diseases as well.
But sometimes it may so happen that symptoms may not come out openly very fast even if an allergic reaction has been caused in the body.
There may be a time gap in such a period and there are chances of the disease coming out with more force as and when the symptoms are clearly discernible.
However, in most of the cases, going by precedence, it is evident that symptoms are not hidden for a long period and start showing themselves in a short time frame.
When the symptoms and the consequent reactions are very much evident, it is known as Uni-phasic. In this scenario, the situation can worsen within a short span and immediate treatment is required.
In another type of reaction, it may start in a mild manner and then a certain lull in the symptoms may appear. After this very brief hiatus, the symptoms may come back in a more severe manner.
This is known as Biphasic. The common symptoms in this phase are breathing issues and blood pressure problems.
When the Anaphylaxis is affected due to any intravenous reasons like particular drug consumption, then symptom manifestation normally happens within a time frame of not more than 30 minutes.
Sometimes it can happen instantly also. If the cause is consumption of a particular type of food, the onset of the symptoms should be within a time frame of 2 hours and beyond also.
Some of the main symptoms -
The areas where these rashes develop become reddish. The portion having this rash starts feeling itchy in most of the cases.
Another major symptom is the flushing of the skin. It is somewhat similar to nettle rash but the difference is that small hives do not appear.
The skin flushing leads to reddening of the skin in the neck, face and upper chest areas. The affected skin areas have a feeling of warmth to even hot or irritating feeling at certain times.
It happens when the blood vessels below the skin expand with blood infusion. This turns the skin into red or pinkish.
Mouth and throat swelling is another pointing symptom of Anaphylaxis. This happens through sores, boils, and blisters. Sometimes a single boil that is much larger in size can also impede the usage of the mouth in its daily functions.
Once mouth swelling happens, it may lead to difficulties in swallowing and chewing. The same is the case with throat swelling. There will be difficulties in the intake of any form of solid and liquid food.
Another side effect of mouth and throat swelling is an overall constraint in speaking small sentences or speaking at a stretch.
Those affected by Anaphylaxis are very much susceptible to Asthma. The latter is a chronic case of breathing issues. Due to inflammation in the lungs, the airways get narrowed down.
This blocks the free flow of air to the lungs. It is common to see people suffering from Asthma get affected by any form of allergy caused on account of Anaphylaxis.
This may be food-related or drug-related as well. The combined effect can be very much harmful. In many cases, those who get Anaphylaxis for the first time have a tendency to become Asthmatic, if the Anaphylaxis is not treated on time.
The symptoms are wheezing, breathing difficulty and long coughing bouts.
Another common symptom is abdominal pain and other forms of nausea and vomiting sensation. The time span over which this starts showing differs according to each person.
The abdominal pain can take various forms like cramps, severe stomach pulls and pain on the sides of the abdomen and in and around the waist. Nausea will be giddiness or dizzy feeling which might stay for a long time. Sometimes this turns into vomiting.
The Stridor is another symptom that comes forth during Anaphylaxis. This is a breadth sound that becomes very much obvious to someone nearby.
It takes the tone of a deep and high pitched sound. The reason is obstructed airflow in the bronchial tree.
The drop in blood pressure also is linked to this form of allergy disease. It causes sudden weakness and tiredness in the entire body. In extreme cases, this can lead to a collapse.
Another symptom caused by low blood pressure is the fast heartbeat of the person. This is especially possible in people having some form of cardiac-related issues.
The other cardiovascular symptom is the occurrence of Angina or Chest pain. This is caused due to the release of Histamine cells in the heart.
It needs to be mentioned that many of the symptoms of Anaphylaxis are non –specific by nature. These can be caused by various other reasons as well.
The symptoms of abdominal pain, nausea and vomiting are common for a lot of body-related issues including indigestion and food poisoning.
Again, heart-related issues may be due to other body defects like obesity and lack of exercise. Similarly, an allergic reaction is only one cause of low blood pressure.
There may be a plethora of reasons like dehydration, lack of proper nutrients in the diet, infection, etc. But it is always better to place caution at the highest level and consult a GP so that the root issue is understood.
It is caused by the release of inflammatory mediators like histamine from the white blood cells in the body. Histamines are chemicals created by the immune systems of the body.
When an allergy hits the body, there is a chemical reaction that occurs from the immune systems. This reaction is relayed to the mast cells in the various body parts like lungs, mouth, skin, nose, etc.
The signal is a request for the release of the Histamine is ensconced within the mast cells. When these Histamines are then released from the mast cells, it hits the part of the body affected by the allergy. This causes an increase in the blood flow to that part and thereby causing inflammation.
Subsequently, Histamine sets up itself in special places in the body known as receptors. This leads to a build-up of mucus on the affected areas. The result is external body reactions like coughing and itching.
SinceAnaphylaxis is caused due to allergy of the body due to the release and accumulation of mediators, this may take the form of an immunologic or non-immunologic process as explained earlier.
The biggest and most common factor is exposure to an external substance. This mainly includes food, drug or medication intakes, insect bites, and latex contact.
Sometimes it may happen due to body exercises of different types that do not accept it and releases a particular reaction to it. It may also occur due to hormonal changes or climatic exposure.
In very rare cases, it may also happen that Anaphylaxis may affect the body without any particular reason or exposure of any sort. Such cases typically fall in the category of what is known as “idiopathic diseases”.
Listing of some of the causes –
The consumption of many different types of food can result in Anaphylaxis. Sometimes this can happen in the very first case of consumption or in certain cases it can be after multiple ingestion or consumption.
The food items that have been identified are peanuts, eggs, and fish and in some cases milk also. This is mainly in western countries. In Asian countries, Sesame seeds and chickpeas have been identified as the main cause.
In many cases, especially in children, the allergy effects of foods like milk and fish are gotten over after a certain age completion. Normally it is around 16 to 20 years.
Medication and drugs:
It may be difficult to restrict the allergic effects to certain types of medicines only. To a good extent, it depends on the body mechanism of the patient.
While a person may get rashes by the intake of a certain medicine, the other person may have giddiness and nausea. In some cases, the reaction may be immediate while in certain other instances it will take hours to manifest.
The antibiotics like B-Lactum are said to be the most common medicines that can trigger Anaphylaxis allergic reaction. It has also been observed that people having high Blood Pressure resort to Angiotensin-Converting enzyme (ACE) inhibitors.
This leads to swelling of the tongue and the face. It also causes persistent coughing. Among the anti-inflammatory drugs known as NSAIDs, Aspirin is said to have caused the maximum known cases of Anaphylaxis.
The other medicine is Ibuprofen. Within the B-Lactum Antibiotics, the Penicillin can be named as a common drug. The other type of medication includes vaccines, chemotherapy treatment.
Insect bite and stings:
Stinging and biting insects like bees, or event ants or bugs can cause Anaphylaxis to those people who are prone to such bites. This may again be person-specific. The outcome of the reaction will vary according to the body chemistry of those affected.
Exposure to substances:
Exposure to latex can cause different varieties of allergies related to Anaphylaxis. In some cases, people having exposure to substances used in enhancing the visibility of internal structures in X-Ray, fluoroscopy, and Radiography, also develop symptoms of Anaphylaxis.
These substances are known as Radiocontasrt agents. This risk is higher in the case of those people having defective mast cells.
This is the least known cause of Anaphylaxis prevalence in the body. It is purely dependant on the body anatomy and chemistry. Sometimes ingestion of a particular food before the exercise can also lead to allergy.
In general, it can be said that people having a background of diseases like Asthma, skin inflation and other allergies are more susceptible to Anaphylaxis through their exposure to the above-mentioned food, drugs, and substances.
The various studies have pointed out that children having a pre-condition of Asthma had a higher rate of fatalities through Anaphylaxis. If there is minimal contact, then all the fewer chances of any allergy.
This is conducted on the basis of the symptoms exhibited by the affected persons. As soon as the symptoms are evident, it is better to consult a General Physician at the bare minimum.
Much more preferable would be the Allergist Immunologist. They are specialized in diagnosing the problem and suggesting the best-suited treatment to prevent any future re-occurrence.
Like all other diseases, the entire case history and any pre-existing condition or occurrence of related symptoms, even though it may belong back, has to be specified to the practitioner.
The most common diagnosis is conducted through the recognition of the most potent symptoms. These can start within minutes or maximum in a couple of hours subsequent to exposure to the substance.
It starts with the skin or mucosal membrane being affected. The mucosal tissue or membrane covers that part of the body passage which covers the respiratory tracts.
These have cells that secrete mucus. So when this tissue is affected, there is always a breathing difficulty. It also causes low blood pressure.
The low blood pressure diagnosis is very much important as this is non-specific and there can be varied reasons for it. As soon as the linkage to the skin or mucosal tissue is established, along with the background of exposure to any allergen - Anaphylaxis is confirmed as the main cause.
The main skin-related factors that are prevalent include hives, rashness and itching feeling in the affected areas. The skin tissue is affected in all these symptoms.
In certain cases, doctors also go-ahead for a blood test on Histamine as its release from the white cells is considered as an important cause of Anaphylaxis.
But it needs to be noted that such a test is a preferred method when the cause is due to any form of insect bite and drug intake. If it the reason is low blood pressure or food intake, then the Histamine test will not prove as an effective diagnosis.
The after-effects of Anaphylaxis is classified into three types –the first is leads to low blood pressure and this is termed as shock reaction, the second is the emergence of symptoms in the body and skin within a time span of anywhere between one to seventy-two hours and the third does not exhibit any reaction.
It is an internal process of mast cell degranulation that releases molecules from the secretory vesicles of the body cells.
Normally in every diagnosis of Anaphylaxis, there has to be an allergy testing. This helps to determine the cause. There are specific skin tests for determining the causes related to food intake and the type of food that has caused the same.
In many cases, the health care providers and specialist doctors go for blood testing of the Immunoglobin to determine the food item that has caused the allergy.
Skin allergy testing is used as a form of diagnosis to find out the triggering causes. This is possible in some kind of food and insect bites but not in all.
In cases where the affected person exhibits symptoms like nausea and vomiting, the allergy specialist can go for a digestive tract examination. But this will not touch on cases of diarrhea, constipation or blood urine passing as it is not related to Anaphylaxis.
Any diagnosis of non-immunological reasons is based on understanding the complete patient history and does not rely on blood or skin test.
As mentioned earlier, many symptoms are sometimes common to other diseases and ailments as well. This is especially so in the case of Asthma and other forms of loss of consciousness.
But there are differential diagnosis symptoms as well. For example in the case of Asthma, the similarity is restricted to breathing issues.
There is no itching or body rashness or digestive tract symptoms. Similarly, loss of consciousness again will not have any skin related allergies.
Treatment Management –
As the very first step, the persons having gone into Anaphylaxis shock need to be treated on an emergency basis without any loss of time. In the shock state, the affected person has low blood pressure.
This leads to breathing problems due to the narrowing of the airways. Such cases immediately call for Controlled Pressure Respiration methods. It is better to have the person hospitalized if they are on the weaker side.
The specialist should be called to administer proper airway management. Depending upon body anatomy, intravenous fluid may have to be injected into the affected person.
It is always advised for a period of one or 2 days of close monitoring. It is recommended to give corticosteroid medications like Dexamethasone.
Another drug that can be administered is Antihistamines and this is effective for treating all types of allergic reactions on the body. These are generic, Over the Counter drugs that can be used for short term treatment for problems like coughing and wheezing.
It is not recommended for any chronic allergies. For those with breathing issues, a Beta Agonist Inhaler can be used. This inhaler opens the muscles around the airways and relaxes them. This allows easy breathing.
There is another treatment method known as desensitization. This is a dose of allergen and it helps in easing the reaction of any allergy. This is useful in the case of Penicillin.
The main treatment for Anaphylaxis is Epinephrine also known as Adrenalin. It is a medicine that has no form of restriction to its usage on those affected. It other words, it has no contraindication.
It is used for different types of conditions including cardiac arrest, Asthma, Bronchitis. This can be administered through intravenous or subcutaneous injection or through normal inhaling.
It increases the response rate of the body cells and improves the blood flow to the muscles.
It is recommended to give the medicine intramuscularly upon the first detection.
The second dose can be administered within ten to fifteen minutes depending upon the effectiveness of the first dosage. In only rare cases beyond two injections will be required. The Epinephrine comes in different doses for adults and children.
There are no adverse side effects of this medicine expect for mild headaches and muscle contractions or tremors.
Prevention of Anaphylaxis –
For those who are prone to medication allergies, it always better to ask the doctor or the dentist before taking any medicine or injection and to give them a detailed history without hiding any facts.
After taking any medication or injection even if there is slight uneasiness, there is nothing wrong with rushing back to the doctor.
If there are multiple allergies, then wearing a medical bracelet can prove to be useful.
Wear protective clothing to gaud against insect sting.
Precaution in food intake is a must.
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