Anaphylaxis: etiology and guidelines for management

Recognizing Hospital Adverse Drug Reactions

Adverse drug reactions (ADRs) are a frequently overlooked complication of drug therapy. The categories of drugs most commonly implicated include anticoagulants, antimicrobials, cardiac agents, CNS agents, diagnostic agents, nonsteroidal antiinflammatory agents, and hormones. In addition to knowing what drug classes most commonly produce ADRs, the clinician should also recognize what drugs are most frequently associated with specific ADRs. Anaphylaxis is one of the most serious, and potentially life-threatening, ADRs. Treatment of an anaphylactic reaction involves correcting the physiologic effects of released chemical mediators and also inhibiting the release of additional mediators. The mainstay of therapy is aqueous epinephrine. Severe reactions may require administration of aminophylline, inotropic agents, antihistamines, corticosteroids, and intravenous fluids. The best treatment for any ADR is prevention. Pharmacists can actively participate in the monitoring of risk factors, especially the number of drugs in a regimen, potential drug interactions, and drug allergies, which may predispose patients to ADR development. Pharmacists can also assist in the detection of ADRs by monitoring alerting orders. Other potential activities for pharmacists include providing timely and accurate information about ADRs ; educating patients, physicians, and other health care professionals; and influencing prescribing patterns to minimize the trend towards polypharmacy.

Anaphylaxis secondary to chymopapain

Anaphylaxis occurs in approximately 1% of the patients treated with chymopapain. The incidence of anaphylaxis is ten times higher in women than in men. The severity of the reaction may be attenuated by pretreatment with H1- and H2-histamine receptor antagonist. Once anaphylaxis occurs, prompt and correct treatment must be instituted.

Anaphylaxis: pathophysiology, clinical presentations and treatment

Anaphylaxis and anaphylactoid reactions are abrupt, often life-threatening episodes, secondary to the liberation of certain chemical mediators, and their effects on target organs. The number of agents known to trigger such reactions is expanding, with the most common fatal reactions secondary to penicillins, iodinated contrast material (ICM), and hymenoptera stings. Limited studies point to upper airway obstruction and circulatory collapse as the causes of death in man. It is felt that the frequency of cardiovascular involvement is not widely appreciated, and that hypotensive patients can be markedly hypovolemic. The primary goals of treatment should be aimed at preventing or reversing complications, and include immediate attention to the airway, cardiac monitoring, and establishment of intravenous access. The cornerstone of pharmacologic therapy is epinephrine. A comprehensive review of the pathophysiology, symptomatology, and treatment is presented.

Endotracheal epinephrine in a canine anaphylactic shock model

This study was undertaken to determine if epinephrine administered endotracheally is as effective in treating anaphylactic shock as is intravenously administered epinephrine. An animal model of anaphylactic shock was produced in anesthetized dogs by the intravenous administration of histamine phosphate. Both the endotracheal and intravenous routes of epinephrine administration resulted in efficient and effective reversal of histamine-induced hypotension. At the doses employed, the intravenous administration of epinephrine resulted in the production of significantly (p less than 0.05) greater numbers of ventricular cardiac arrhythmias than did the endotracheal route of administration.

Anaphylaxis in the monkey: pulmonary oedema after pre-treatment of beta-receptor stimulants

Aggregate anaphylaxis was induced in seven ovalbumin-sensitized monkeys, with high tires of ovalbumin specific haemagglutinating antibodies. After pretreatment with an intravenous (i.v.) injection of 0.25 mg/kg terbutaline (n = 6) or an infusion of isoprenaline (n = 1), anaphylactic shock was induced by i.v. challenge with specific antigen. Haemodynamics, regional blood flows, respiratory mechanics, blood gases and haematological changes were studied during the following 30 min. Severe shock developed following ovalbumin challenge and the cardiac output was reduced by a mean of 74%. Pulmonary vascular resistance increased 11-fold. Pulmonary dynamic compliance decreased, but there was only a minor increase in pulmonary resistance. Hypoxaemia and severe metabolic acidosis developed. Circulating platelets and leucocytes decreased markedly. Three animals died with fulminant pulmonary oedema. In conclusion, the reaction pattern was similar to that found in studies of monkeys that received no prior treatment. However, the occurrence of pulmonary oedema suggests that the effects of large doses of terbutaline on the heart, combined with the high pulmonary vascular resistance, resulted in more severe pulmonary changes than took place in untreated animals.