The American Academy of Pediatrics, has developed a Guide for pediatricians and other healthcare professionals to use the new allergy and anaphylaxis emergency plan; In this way, a more up-to-date and appropriate treatment of this allergic manifestation is offered, of which we had already spoken. As you know, anaphylaxis affects several organs at the same time and its symptomatic manifestation is very complex, in addition to acute (in a few minutes a serious picture can appear in the affected person).
The most serious cases can be fatal; so from the beginning of a reaction it is a medical emergency situation. It is important to know a little more about anaphylaxis and its approach, because although the most basic indication is to call the emergency number quickly, any teacher or person in charge of children should not only have complete information about allergies, but also about how to solve problems that could seriously compromise the health of the little ones.
Anaphylaxis is the most serious allergic manifestation of all, and in anaphylactic shock (which you have surely heard of) it causes a drop in blood pressure and cardiovascular involvement. What happens to trigger an anaphylactic relationship? Usually the allergic reaction itself after the exposure of allergy sufferers to IgE antibodies, causes the cells to cause symptoms by releasing substances; one of them is histamine, capable of originating from urticaria to constriction of the bronchi, going through redness, among other manifestations. As well, When two types of cells called mast cells and basophils release different substances in an “explosive” way, we can speak of anaphylaxis.
Knowing Anaphylaxis.
In the first place, I would like to emphasize that the symptomatic picture that we will see below is not always anaphylaxis, because it does not always respond to an allergic reaction, in this case it is called non-allergic anaphylaxis, and the same symptoms are present, but not related to the reaction of the antibodies. With various symptoms, anaphylaxis affects, as we have said, at least 2 systems of the body. It can present as severe, but also moderately and mildly, in this case the skin, the upper respiratory tract, and mild wheezing in the bronchi would be compromised. When we speak of a servera manifestation, cyanosis, difficulties of the heart to maintain rhythm, severe respiratory symptoms or loss of consciousness (and sometimes respiratory arrest) appear.
The Spanish Association of Pediatrics states that the prevalence "is underestimated", since mild or moderate symptoms are not always considered anaphylaxis. In the general population, the figures speak of 0,05 to 2 percent (increasing), and in children the prevalence is unknown. It has been proven in recent years that there are more hospital admissions in children of 3/4 years, adolescents and young adults. It is significant that in the United States, one case of food allergy anaphylaxis occurs every six minutes. Mortality is low, although no less worrying for that.
It is therefore a disease of remarkable frequency, although only a small percentage of cases have fatal consequences. It is clear that the cause is always an allergen, and in this order: medicines, food and stings (bees / wasps). In children the triggers are usually milk protein, nuts, fish or shellfish and eggs.
It goes without saying (and this has been commented on more than one occasion, that people with food allergies, and their families (in the case of underage patients), must spend a lot of time selecting packaged foods, since sometimes deciphering labels becomes an adventure); Y of course prioritize basic and easily identifiable foods; always excluding those that contain allergens.
How do I recognize an episode of anaphylaxis?
The symptoms will be taken into account as a whole, since they are multi-organ; and on the other hand they can be variable in different people. The reaction starts in a matter of minutes and can last for hours; but after disappearing, they can appear again (biphasic anaphylaxis). It is estimated that 80 percent of anaphylaxis is affected by the skin (warmth, redness, itching, swelling of the genitals / lips / eyelids, hives with hives). Other symptoms are:
- Complications in the respiratory tract: congestion, sneezing, coughing, choking, glottis edema, ...
- Localized pain in the abdomen, vomiting or diarrhea (or both), cramps, pain.
- Lowering of the TA until reaching shock; and as a consequence dizziness, loss of consciousness or blurred vision.
- Cardiac involvement.
Approach and prevention of anaphylaxis.
La IM epinephrine is the treatment of first choice and there are no contraindications, given the urgency of this situation. According to AEPaP, should be instituted on suspicion of meeting diagnostic criteria or in children with a previous history of anaphylaxis (even without diagnostic criteria). As recounted in the following video, the injector is administered in the vastus external part of the thigh (outer part). The administration should be done in the first moments, taking into account that allergy sufferers usually carry auto-injectors in backpacks or bags, and that they also have them in schools.
Attention! Nobody who has suffered anaphylaxis and has breathing difficulties or vomiting should remain lying down, but be slightly upright.
But at the same time that the affected person is lying down (with the legs raised), it is recommended (and must be fulfilled) to call the 112 emergency number, or 061 for health emergencies, as well as follow exactly the steps indicated, facilitating the health professional other side of the line, all the information you request. Once treated in the place where the episode occurred, and transferred to a hospital, she will remain under observation
The allergist suspects anaphylaxis before symptoms of an allergic reaction involving 2 or more organs; Y takes a complete medical history to find the cause and facilitate prevention.
Images - Georges hodan, jlcampbell104,