Treating Anaphylaxix
In the emergency setting, anaphylaxis is a dangerous, life threatening condition
that must be treated in an aggressive and timely fashion. Anaphylaxis is a
condition related to acute allergic reactions. Following the body's exposure to
the offending allergen, there are common systemic reactions. The most serious
reactions involve the respiratory and cardiovascular systems, but the
gastrointestinal, dermatologic, and genitourinary systems are often involved
causing varied symptoms such as urticaria, flushing, angioedema, bronchospasm,
hypotension, cardiac arrythmias, nausea, intestinal cramps, pruritus, and
finally uterine cramps. (Physician Assistant, 8/94) The above list is by no
means exhaustive, specific symptoms vary from person to person. The same person
suffering from several anaphylactic reactions can also present with differing
symptoms.
Physiologically speaking, the two main effects of the body's released mediators
(IgE) during an anaphylactic reaction are smooth muscle contraction and
vasodilatation, which cause most of the body's adverse symptoms. (JAMA,
11/26/82) Since the most life threatening reactions usually involve the
respiratory and cardiovascular systems, that is where emergency treatment is
focused. In the cardiovascular system, a combination of vasodilatation,
increased vascular permeability, tachcycardia, and arrhythmias can lead to
severe hypotension. In the respiratory system, the swelling of tissues along
with bronchospasm and increased mucus production are the main cause of death.
So, if untreated, anaphylaxis can be fatal as a result of the body's going into
what is essentially shock, while simultaneously (and more importantly) being
deprived of the oxygen needed to sustain life.
As of today there is one universally accepted treatment for acute anaphylaxis.
Epinephrine. Epinephrine is both an alpha and a beta agonist. This makes it
the drug optimally suited to treat anaphylaxis. "Epinephrine will increase
vascular resistance, reduce vascular permeability, produce bronchodilation and
increase cardiac output." (Emergency, 10/93)
Epinephrine will directly counteract the potentially life threatening aspects of
anaphylaxis. Epinephrine can , and is, used in the both the pre-hospital
environment as well as in definitive care institutions. Epinephrine is widely
administered ...
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... well as traumatic shock.
"Naloxone improves cardiovascular function in a variety of animal models of
shock caused by…and anaphylaxis. Administration of TRH …also has pressor
effects in these shock models." (Annals of Emergency Medicine, 8/85)
"TRH has been shown to increase mean arterial pressure during anaphylactic
shock." (Annals of Emergency Medicine, 5/89) In animal studies of anaphylaxis
the use of TRH, epinephrine, and normal saline were compared. TRH treated
rabbits responded slightly better than those treated with epinephrine (the study
focused on cardiovascular and respiratory parameters.) (Annals of Emergency
Medicine, 5/89)
I started this project with the aim of identifying alternative treatments for
anaphylaxis. I had mistakenly assumed that there are a host of viable and
effective treatment regiments for anaphylactic shock. What I discovered was
that as of today, the only universally accepted therapy for acute anaphylaxis is…
epinephrine. Due to it's alpha and beta adrinergic effects epinephrine is
miraculously suited for anaphylaxis. It almost seems to be a natural antidote,
a wonder drug with singular abilities in the treatment of anaphylaxis.
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