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Anaphylactic Shock: A Whole-Body Reaction

By: Katelyn Cherry October 25, 2012

Audience and Purpose

The main premise of this document is to inform the public about lifethreatening allergic reactions, the process behind them and the immediate treatment required. This information could prove to be particularly beneficial for parents, teachers and medical professionals who deal with children or teenagers on a regular basis. This is article is especially important because some young individuals are not allergic to a particular allergen the first time they are exposed to it. It is possible that the reader will recognize the symptoms of a severe allergic reaction and take appropriate measures to help save the individuals life. The ideal audience for this description would be those who already have a background in physiology and biology because the terminology is quite extensive. The audience will most likely be familiar with allergic reactions and treatment options, however they probably will not know the mechanism behind the symptoms.

Introduction to Anaphylactic Shock

Anaphylactic shock is a severe, whole-body allergic response in which a substance causes a chemical reaction that can rapidly develop into a life threatening medical condition. There are many symptoms associated with anaphylaxis, including: - hives - nausea/vomiting - throat swelling/wheezing - angioedema (face and eye swelling) - low blood pressure
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There are a variety of substances that are likely to cause anaphylaxis. The most common include:

- latex

- peanuts - bee/wasp stings - medications (penicillin) - dust - shellfish An anaphylactic reaction is only possible if an individual has been exposed and sensitized to a particular substance. Sensitization refers to each subsequent time a person is exposed to the substance, a more severe allergic reaction will develop. The more severe the reaction, the more body systems will be affected.

During an anaphylactic attack, many organ systems in the body are affected

including the respiratory system, the cardiovascular system, the integumentary system (skin), the gastrointestinal tract and the central nervous system. The figure below demonstrates the effects of anaphylactic reactions on the given organ systems. Severe allergic reactions may advance quickly and have the potential to completely block the airway. Because of this rapid development a special type of medication, called Epinephrine, must be immediately administered. Treatment will be discussed at the end of this document.

Hista-what?
This section of the document primarily focuses on the medical terminology that will be introduced during the disease process. The table below defines the various terms that will be used in the next segment.

Terminology
Antigen

IgE antibody Bronchoconstrictio n Vasodilation Histamine Leukotrienes Mast Cells Basophils Chemical Mediator Receptor

A foreign substance that produces an immunological response Released in response to a foreign substance Causes inflammation resulting in symptoms (ex. throat swelling) Constriction of airways in the lungs Widening of blood vessels Chemical produced causing itching, nasal swelling and sneezing Substance produced causing bronchoconstriction A cell found in the connective tissue that releases histamine A white blood cell that also contains histamine Chemicals released from mast cells and basophils Examples: histamine and leukotrienes A molecule that responds to a certain chemical This response leads to a reaction or symptoms

Definition

Pathophysiology: The Disease Process

The pathophysiology, or disease process, of

anaphylactic shock is quite extensive, however it can be broken down into three main topics.

Sensitization
As explained in the introduction section, sensitization is an immunological response that occurs when an individual comes into contact with an antigen. Sensitization occurs in a few simple steps as outlined below: - After contact with the foreign substance, IgE antibodies are secreted (1) - The antibodies attach to mast cells and basophils on cell membrane (2) Once the mast cells and basophils attach to receptors on the membrane, the person is sensitized to that particular antigen. As long as the IgE antibodies are attached to the mast cell or basophils, the individual is likely to have an anaphylactic response when reintroduced to the antigen.

The Shock In Anaphylactic Shock

Once an antigen is reintroduced

to a sensitized individual, anaphylactic symptoms will quickly develop. The figure to the left depicts this process. - The antigen is binds to the IgE antibodies (1) - The attachment causes the membrane to degrade and subsequently release chemical mediators (2) Mediators cause the symptoms associated with an anaphylactic attack. They are the substances that cause the blood vessels to widen resulting in low blood pressure and the bronchi to constrict resulting in difficulty breathing.

Chemical Mediators: The Real Problem

Histamine and leukotrienes are the two main chemical mediators involved in anaphylactic reactions. If these specific substances were not released, a severe allergic reaction would not be possible. Consequently, it is these chemicals that are responsible for any possibly fatal symptoms. Histamine, the chief mediator, is released from mast cells and basophils once the cell membrane disintegrates. It contains three receptors (H1, H2, H3) that produce different symptoms. -H1: Responsible for bronchoconstriction (causes chest tightness), vasodilation (causes low blood pressure) and mucous production (causes difficulty breathing) - H2: Responsible for gastric acid secretion (causes nausea and vomiting) and an increase in heart contractions (causes tachycardia and dizziness) - H3: Found in the central nervous system and is responsible for the production and release of histamine Leukotrienes are the dominant chemical mediators because they have a slower onset, thus they last much longer. Leukotrienes are primarily involved in bronchoconstriction.

Treatment
The best pre-hospital treatment for

anaphylaxis is with an injectable medication called the Epinephrine Pen (Epi Pen). Epinephrine controls the bodys fight-or-flight response system and is the medication administered to an individual in anaphylactic distress. Epinephrine increases heart rate, blood pressure and dilates the bronchioles counteracting the reaction symptoms.

While an Epi Pen may stop a life-threatening reaction, proper training is required for its use. Talk to your healthcare professional for more information on the Epi Pen.

Conclusion
The process of anaphylaxis can be quite complicated, but understanding it can help an individual to recognize the signs and symptoms of a reaction and possibly save a life. The three predominant topics to remember are sensitization, the shock, and chemical mediators. These are responsible for life-threatening reactions, including angioedema, throat swelling, difficulty breathing and low blood pressure. Anaphylactic shock is a life-threatening response that can rapidly develop if medical attention is not received right away. It is important for parents, teachers and medical professionals to be prepared for these types of instances.

References
http://www.emsworld.com/article/10324669/anaphylactic-and-anaphylactoidreactions?page=2 http://www.google.com/images http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001847/