[Anaphylactic shock].

Deutsche medizinische Wochenschrift (1946) Pub Date : 2025-03-01 Epub Date: 2025-03-14 DOI:10.1055/a-2288-2323
Sascha David, Alix Buhlmann
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Abstract

Anaphylactic shock is a severe, potentially life-threatening systemic allergic reaction. It can involve multiple organ systems and is triggered by medication, food, or insect stings. Epidemiological data vary due to differing definitions, but studies estimate that 0,26% of hospital admissions are due to anaphylaxis, with 1-3 deaths per million annually. The incidence of allergic reactions has increased, though anaphylaxis-related mortality remains stable. Triggers vary by age, with food allergies being common in children, and insect stings and medication predominant in adults.An initial allergen exposure sensitizes the immune system, resulting in IgE production and binding to mast cells and basophils. Upon re-exposure, allergen-IgE binding triggers the release of mediators like histamine, prostaglandins, and cytokines, causing vasodilation, bronchospasm, and capillary leakage. Risk factors include asthma, cardiac or thyroid conditions, and elevated IgE levels. Symptoms usually affect 4 organ systems: skin, gastrointestinal tract, respiratory tract, and cardiovascular system. Grading is based on the severeness of symptoms, ranging from mild skin reactions (grade 1) to respiratory or circulatory arrest (grade 4). A reliable diagnostic marker is elevated serum tryptase.The cornerstone of treatment is adrenaline, administered intramuscularly for rapid action. Fluid resuscitation with balanced electrolyte solutions and high-flow oxygen are also fundamental. Antihistamines and corticosteroids are used a bit later to prevent recurrence but have delayed onset. Adrenaline can also be nebulized or given intravenously in severe cases.Post-crisis management includes patient education, allergy identification, and an emergency kit with an adrenaline auto-injector.

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[过敏性休克]
过敏性休克是一种严重的、可能危及生命的全身性过敏反应。它可涉及多个器官系统,由药物、食物或昆虫叮咬引发。由于定义不同,流行病学数据也不尽相同,但据研究估计,过敏性休克占入院人数的 0.26%,每年每百万人中有 1-3 人死亡。虽然过敏性休克相关死亡率保持稳定,但过敏反应的发生率却在上升。诱发因素因年龄而异,食物过敏常见于儿童,而昆虫叮咬和药物过敏则主要发生在成年人身上。初次接触过敏原会使免疫系统过敏,导致 IgE 生成并与肥大细胞和嗜碱性粒细胞结合。再次接触过敏原时,过敏原与 IgE 的结合会引发组胺、前列腺素和细胞因子等介质的释放,导致血管扩张、支气管痉挛和毛细血管渗漏。危险因素包括哮喘、心脏病或甲状腺疾病以及 IgE 水平升高。症状通常影响 4 个器官系统:皮肤、胃肠道、呼吸道和心血管系统。根据症状的严重程度进行分级,从轻微的皮肤反应(1 级)到呼吸或循环停止(4 级)不等。可靠的诊断指标是血清胰蛋白酶升高。治疗的基石是肾上腺素,通过肌肉注射快速发挥作用。使用平衡电解质溶液和高流量氧气进行液体复苏也很重要。抗组胺药和皮质类固醇稍后使用,以防止复发,但起效延迟。危机后的管理包括患者教育、过敏识别和配备肾上腺素自动注射器的应急包。
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