What is Anaphylactic Shock?
Anaphylactic Shock is a fatal condition, which can occur as a result of anaphylaxis, which is a serious and potentially life-threatening allergic response to an allergen. In Anaphylaxis, patient experiences swelling, low blood pressure, hives and dilated blood vessels. If the anaphylaxis or the allergic reaction is severe, then the patient can go into shock which is known as Anaphylactic Shock, which should be treated immediately, otherwise it can be fatal.
Patient experiences anaphylactic reaction and shock when the immune system develops immunoglobulin E or IgE, which is a specific type of antibody which fights allergens. This causes an exaggerated or inappropriate reaction to a substance that is usually harmless, such as food. Patient’s body may not have a reaction upon initial exposure; however, antibodies get produced with later exposures. When the patient’s body gets exposed to the substance afterwards, there is attachment of the allergen to the antibodies, which causes huge amounts of production of histamine, which is a substance which causes the symptoms of Anaphylaxis including Anaphylactic shock.
Symptoms of Anaphylaxis & Anaphylactic Shock
Patient initially experiences severe itching of the face or eyes , which in a matter of few minutes, escalates into more serious symptoms such as difficulty in swallowing and breathing, pain in the abdomen, cramps, diarrhea, vomiting, hives, angioedema, which produces swelling under the skin instead of on the skin’s surface and ultimately anaphylactic shock.
If the patient experiences the above symptoms of anaphylaxis, then immediate medical attention should be sought. Anaphylaxis can rapidly worsen and produce more severe symptoms, such as increased heart rate, a drop in blood pressure, sudden weakness, anaphylactic shock where the patient loses consciousness and can even die.
Common Triggers of Anaphylaxis
- The most common cause of anaphylaxis is usually a food item. Some of the common food triggers of anaphylaxis and anaphylactic shock include dairy products, shellfish (lobster, shrimp), nuts, sesame seeds and egg whites. Bee or wasp stings also commonly cause anaphylaxis.
- If the patient exercises after consuming allergy-provoking food, then it can also cause anaphylaxis and anaphylactic shock.
- Inhaled allergens including pollens can also cause anaphylaxis.
- Some medications can also cause anaphylaxis.
- Anaphylactoid reaction is a condition which is similar to anaphylaxis and is an equally serious condition. However, the difference is that Anaphylactoid reaction does not involve immunoglobulin E antibodies. Some of the common triggers for Anaphylactoid reaction include dyes which contain iodine which can be seen on x-rays, opioids, nonsteroidal anti-inflammatory drugs such as aspirin, blood transfusions and exercise.
Diagnosis of Anaphylaxis & Anaphylactic Shock
Symptoms experienced by the patient help in arriving at the diagnosis of anaphylaxis and Anaphylactic Shock. Patients who have a previous history of allergic reactions are at an increased risk for developing anaphylaxis and anaphylactic shock. The following steps are undertaken to confirm the diagnosis of anaphylaxis and Anaphylactic Shock:
- Medical history and physical examination of the patient is conducted where the patient’s signs and symptoms are examined in detail. Patient is asked detailed questions regarding how the anaphylactic reaction and shock came about.
- Blood tests are done to look for the presence of specific antibodies.
- Skin prick tests are done to rule out or confirm suspected triggers of Anaphylactic Shock.
- Other tests are done for excluding medical conditions, which produce similar symptoms to anaphylaxis, such as if the patient has lost consciousness, then it could also be a sign of epilepsy instead of Anaphylactic Shock.
Preparing for Anaphylaxis
Patient should always be prepared if he/she is allergic to any food substance or bee stings, which cause anaphylaxis, as this reaction can worsen and lead to anaphylactic shock. Always carry an epinephrine injection kit prescribed by the doctor. Prevention of allergic triggers is main thing to do to prevent allergic reactions. Patients should try to educate themselves on recognizing and avoiding potential triggers. It is also very important that the patient’s health care provider should be informed regarding any drug allergies before starting any type of treatment for anything. Patient should also wear a medical alert pendant/bracelet or carry a card which identifies the type of allergy. All these measures will help in saving the patient’s life.
Prevention of Anaphylaxis & Anaphylactic Shock
It is important to strictly avoid any type of contact with the allergen, which is triggering anaphylaxis.
- Patient should read food labels carefully if the causative trigger is a food substance. Always ask about the ingredients when eating in friend’s homes or ordering foods at restaurants. In case if you are not able to assess the ingredients of the food, then avoid eating unknown food.
- If the trigger of anaphylaxis is a medicine, then always inform your doctor about your allergic reaction. Explain clearly about your symptoms when you had the anaphylaxis. It is advisable to wear a tag, such as a bracelet or necklace to help identify the allergy quickly.
- Avoiding insect stings, such as a bee or wasp stings, is more difficult. Patient should wear long pants and long-sleeved shirts when outdoors. Patient should also avoid perfumes and bright colors as these things tend to attract insects. Never drink uncovered sweetened beverages which are present outdoors.
- Be knowledgeable about your allergies. Discuss with your doctor regarding things which will give you an allergic reaction and ultimately anaphylactic shock and how to recognize symptoms of anaphylactic shock and anaphylactic reaction.
- Allergy shots (desensitization therapy) should be taken if the patient has insect venom allergy.
- Make sure that the attending doctors are aware of allergies and make sure that all the information regarding the allergies in recorded in the file.
- Patient should follow the treatment of asthma regularly to cut down on the risk of anaphylactic reaction and anaphylactic shock.
- Patient should always carry an epinephrine kit containing 2 doses wherever he/she goes. Make sure that the patient and the attendants know how to use the injections and that the injections are not expired.
- Identification tags such as MedicAlert bracelet should be worn by the patient so that the allergies of the patient are easily identifiable.
- Patient should take all the steps needed for avoiding the things which he/she has allergy to.
- Patients who are at a risk for re-exposure to the allergen which has caused anaphylaxis and anaphylactic shock in the past should consult an allergist for desensitization. Testing of the skin also helps in identifying the allergen.
Treatment for Anaphylactic Shock
Anaphylaxis has no cure. Treatment for Anaphylactic Shock and Anaphylaxis includes:
- If the patient is suspected to have Anaphylaxis or Anaphylactic Shock then an ambulance needs to be called as this is a medical emergency.
- Epinephrine is the only treatment, which is effective in rapidly treating anaphylaxis. Epinephrine is usually given via an automatic injection. It has adrenaline which reverses the symptoms of anaphylactic reaction rapidly. The most effective and the most common site of injection is the thigh. If you are in doubt if the patient’s symptoms are allergy related, then also you should not hesitate to administer the injection. Adrenaline auto-injector (AAI), which is injectable adrenaline, should always be carried by the patient who has been diagnosed with anaphylaxis.
- If you are near someone who has gone into anaphylactic shock, then seek immediate medical help. Lifesaving measures including CPR should be done.
- Other than epinephrine, treatment for anaphylactic shock also includes medicines and intravenous fluids, which support the action of the heart and the circulatory system.
- Antihistamines and steroids are given to the patient after he/she has stabilized from the anaphylactic shock to further reduce the symptoms.
- Patient is referred to an allergy specialist, who will chalk up a management plan for anaphylaxis and anaphylactic shock which is according to the needs and circumstances of the patient. Patient should also regularly follow-up with allergist visits with an allergy specialist for the rest of his/her life.
Prognosis of Anaphylactic Shock
Coming to the prognosis of Anaphylactic shock, if the appropriate treatment is done on time, then the patient suffering from anaphylaxis can make a complete recovery. Death may occur due to low blood pressure or cardiac and respiratory cardiac arrest in severe anaphylaxis, where the patient has gone into Anaphylactic Shock.
- Mayo Clinic. “Anaphylaxis.” Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/anaphylaxis/symptoms-causes/syc-20351468
- American Academy of Allergy, Asthma & Immunology. “Anaphylaxis.” AAAAI. https://www.aaaai.org/conditions-and-treatments/allergies/anaphylaxis
- Healthline. “Anaphylactic Shock: Symptoms, Causes, and Treatment.” Healthline. https://www.healthline.com/health/anaphylactic-shock
- MedlinePlus. “Anaphylaxis.” MedlinePlus. https://medlineplus.gov/anaphylaxis.html