Anafilaksiye Yaklaşım

Abstract

Anafilaksi hızlı başlangıçlı, yaşamı tehdit edici, sistemik bir aşırı duyarlılık reaksiyonudur. Tanısı öykü ve klinik bulgular ile konulan bu klinik durum hızla tanınmalı ve erken müdahale edilmelidir. Prevelansın tahmini %0,3 olduğu ancak anafilaksiye bağlı ölüm oranının %0,001’in altında olduğu gösterilmiştir. Tüm yaş gruplarında anafi- laksinin en sık nedenleri besin, ilaç ve böcek sokmasıdır. Semptom ve bulgular çoğunlukla alerjenle karşılaşma son- rası ilk 2 saat içinde ortaya çıkmaktadır. Deri bulguları vakaların %80-90’ında görülmektedir. Solunum sistemine ait semptomlar çocuklarda daha sık görülmekteyken; kar- diyovasküler semptomlar erişkinlerde daha sık ortaya çık- maktadır. Anafilaksi tedavisinde ilk seçenek ilaç olan adrenalin; ölüm ve hastaneye yatışı önleyen tek ilaçtır

Keywords

• Anafilaksi,adrenalin,acil

Approach to Anaphylaxis

Abstract

Anaphylaxis is a sudden onset, life-threatening, systemic hypersensitivity reaction. This clinical condition, diagno- sed with history and clinical findings, should be recognized quickly and intervened early. It has been shown that its prevalence is estimated to be 0.3% but anaphylaxis-related mortalityl ess than 0.001 percent. The most common causes of anaphylaxis in all age groups are food, medicine and insect bites. Symptoms and signs usually appear within the first 2 hours after exposure to allergens. Skin findings are seen in 80-90% of the cases. While symptoms of respiratory system are seen more frequently in children, cardiovascular symptoms are more common in adults. Adrenalin is the first line treatment of anaphylaxis, and it is the only medication that prevents death and hospitalization

Keywords

• Anaphylaxis,adrenalin,emergency

References

1. Simons FER, Ardusso LRF, Bilo mB, El- Gamal Ym, Ledford DK, Ring J, et al. World Allergy Organization gui- delines for the assessment and management of anaphylaxis. J Allergy Clin Immunol 2011;127:587-93. https://doi.org/10.1016/j.jaci.2011.01.038
2. Joint Task Force on Practice Parameters; American Academy of Allergy, Asthma and Immunology; American College of Allergy, Asthma and Immunology; Joint Council of Allergy, Asthma and Immunology. The diagnosis and management of anaphylaxis: an updated practice parameter. J Allergy Clin Immunol 2005;115(3 Suppl 2):S483-523. https://doi.org/10.1016/j.jaci.2005.01.010
3. Lieberman p, Camargo CA Jr, Bohlke K, Jick h, miller RL, Sheikh A, et al. Epidemiology of anaphylaxis: findings of the American College of Allergy, Asthma and Immunology Epidemiology of Anaphylaxis Working Group. Ann Allergy Asthma Immunol 2006;97:596-602. https://doi.org/10.1016/S1081-1206(10)61086-1
4. panesar SS, Javad S, De Silva D, Nwaru BI, hickstein L, muraro A, et al. The epi- demiology of anaphylaxis in Europe: a systematic review. Allergy 2013;68:1353-61. https://doi.org/10.1111/all.12272
5. muraro A, Roberts G, Worm m, Bilò mB, Brockow K, Fernández Rivas m, et al. EAACI Food Allergy and Anaphylaxis Guidelines Group. Anaphylaxis: guidelines from the European Academy of Allergy and Clinical Immunology. Allergy 2014;69(8):1026-45. https://doi.org/10.1111/all.12437
6. Orhan F, Canitez Y, Bakirtas A, Yilmaz O, Boz AB, Can D, et al. Anaphylaxis in Turkish children: a multi-centre, retros- pective, case study. Clin Exp Allergy 2011;41(12):1767-76. https://doi.org/10.1111/j.1365-2222.2011.03859.x
7. Umasunthar T, Leonardi-Bee J, Turner pJ, hodes m, Gore C, Warner JO, et al. Incidence of food anaphylaxis in people with food allergy: a systematic review and meta- analysis. Clin Exp Allergy 2015;45:1621-36. https://doi.org/10.1111/cea.12477
8. Simons et al. World Allergy Organization Journal 2015;8:32. https://doi.org/10.1186/s40413-015-0080-1

9. de Silva IL, mehr SS, Tey D, Tang mLK. Paediatric anaph- ylaxis: a 5 year retrospective review. Allergy 2008;63:1071-6. https://doi.org/10.1111/j.1398-9995.2008.01719.x
10. pumphrey RSh. Lessons for management of anaphylaxis from a study of fatal reactions. Clin Exp Allergy 2000;30:1144- 50. https://doi.org/10.1046/j.1365-2222.2000.00864.x
11. Worm m, Edenharter G, Rueff F, Scherer K, pfohler C, mahler V, et al. Symptom profile and risk factors of anaph- ylaxis in Central Europe. Allergy 2012;67:691-8. https://doi.org/10.1111/j.1398-9995.2012.02795.x
12. Lee Jm, Greenes DS. Biphasic anaphylactic reactions in pediatrics. Pediatrics 2000;106:762-6. https://doi.org/10.1542/peds.106.4.762
13. mehr S, Liew WK, Tey D, Tang mLK. Clinical predictors for biphasic reactions in children presenting with anaphylaxis. Clin Exp Allergy 2009;39:1390-6. https://doi.org/10.1111/j.1365-2222.2009.03276.x
14. Gonzalez-perez A, Aponte Z, Vidaurre CF, Rodriguez LAG. Anaphylaxis epidemiology in patients with and patients without asthma: a United Kingdom database review. J Allergy Clin Immunol 2010;125:1098-104. https://doi.org/10.1016/j.jaci.2010.02.009
15. Brown SGA. Clinical features and severity grading of anaph- ylaxis. J Allergy Clin Immunol 2004;114:371-6. https://doi.org/10.1016/j.jaci.2004.04.029
16. hompes S, Kohli A, Nemat K, Scherer K, Lange L, Rueff F, et al. Provoking allergens and treatment of anaphylaxis in children and adolescents – data from the anaphylaxis registry of German-speaking countries. Pediatr Allergy Immunol 2011;22:568-74. https://doi.org/10.1111/j.1399-3038.2011.01154.x
17. Simons FE, Sampson hA. Anaphylaxis: Unique aspects of clinical diagnosis and management in infants (birth to age 2 years). J Allergy Clin Immunol 2015;135(5):1125-31. https://doi.org/10.1016/j.jaci.2014.09.014
18. Rudders SA, Banerji A, Clark S, Camargo CA Jr. Age- related differences in the clinical presentation of food-induced anaphylaxis. J Pediatr 2011;158:326-8. https://doi.org/10.1016/j.jpeds.2010.10.017
19. De Schryver S, halbrich m, Clarke A, La Vieille S, Eisman h, Alizadehfar R, et al. Tryptase levels in children presenting with anaphylaxis: Temporal trends and associated factors. J Allergy Clin Immunol 2016; 137(4):1138-42. https://doi.org/10.1016/j.jaci.2015.09.001
20. Wongkaewpothong p, pacharn p, Sripramong C, Boonchoo S, piboonpocanun S, Visitsunthorn N, et al. The utility of serum tryptase in the diagnosis of food-induced anaphylaxis. Allergy Asthma Immunol Res 2014;6:304-9. https://doi.org/10.4168/aair.2014.6.4.304
21. muraro A, Roberts G, Clark A, Eigenmann pA, halken S, Lack G, et al. The management of anaphylaxis in childhood: position paper of the European academy of allergology and clinical immunology. Allergy 2007;62:857-71. https://doi.org/10.1111/j.1398-9995.2007.01421.x
22. Simons FER. Anaphylaxis in infants: can recognition and management be improved? J Allergy Clin Immunol 2007;120: 537-40. https://doi.org/10.1016/j.jaci.2007.06.025
23. Sampson hA, munoz-Furlong A, Campbell RL, Adkinson NF Jr, Bock SA, Branum A, et al. Second symposium on the definition and management of anaphylaxis: summary report: Second National Institute of Allergy and Infectious Disease/ Food Allergy and Anaphylaxis Network Symposium. J Allergy Clin Immunol 2006;117:391-7. https://doi.org/10.1016/j.jaci.2005.12.1303
24. Westfall TC. Adrenergic agonists and antagonists. In: Chabner BA, Brunton LL, Knollmann BC, editors. Goodman and Gilman’s the Pharmacological Basis of Therapeutics. New York: Mc Graw-Hill, 2006: 215-68.
25. Simons FER, Gu X, Silver NA, Simons KJ. EpiPen Jr versus EpiPen in young children weighing 15 to 30 kg at risk for anaphylaxis. J Allergy Clin Immunol 2002;109:171-5. https://doi.org/10.1067/mai.2002.120758
26. Soreide EB. Severe anaphylactic reactions outside hospital: etiology, symptoms and treatment. Acta Anaesthesiol Scand 1988;32:339-42. https://doi.org/10.1111/j.1399-6576.1988.tb02740.x
27. pumphrey RS, Gowland mh. Further fatal allergic reactions to food in the United Kingdom, 1999-2006. J Allergy Clin Immunol 2007;119:1018-9. https://doi.org/10.1016/j.jaci.2007.01.021
28. Lin RY, Curry A, pesola GR, Knight RJ, Lee hS, Bakalchuk L, et al. Improved out comes in patients with acute allergic syndromes who are treated with combined H1 and H2 antagonists. Ann Emerg Med 2000;36:462-8. https://doi.org/10.1016/S0196-0644(00)43749-2
29. Thomas m. Best evidence topic report. Glucagon infusion in refractory anaphylactic shock in patients on beta-blockers. Emerg Med J 2005;22:272-3. https://doi.org/10.1136/emj.2005.023507
30. Cheng A. Emergency treatment of anaphylaxis in infants and children. Paediatr Child Health 2011;16(1):35-40.