Anaphylactic shock in children

Anaphylactic shock (or more precisely, collapse) is an acute, generalized allergic reaction with decompensated hemodynamic impairment mediated by type I allergic reactions (IgE reagins or IgG). This is the most severe form of allergic reaction and is classified as an emergency medical condition. The first mention of anaphylactic shock dates back to 2641 BC: according to surviving documents, the Egyptian pharaoh Menzes died from a wasp or hornet sting.

Clinically, anaphylactic shock is no different from an anaphylactoid reaction - pseudoallergic anaphylaxis, which is not pathogenetically associated with antigen-antibody interaction, although it is caused by external factors.

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Causes of anaphylactic shock

Anaphylactic shock develops acutely after the patient's contact with an intolerable allergen and is a life-threatening condition that is accompanied by hemodynamic disturbances, leading to circulatory failure and hypoxia in all vital organs. A feature of anaphylactic shock is the possible development of skin manifestations in the form of urticaria, erythema, edema, bronchospasm before or simultaneously with the appearance of hemodynamic disturbances. Mortality in this condition is 10-20%.

What causes anaphylactic shock in children?

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Symptoms of anaphylactic shock

The severity of anaphylactic shock depends on the speed of development of vascular collapse and impairment of brain function.

Anaphylactic shock is characterized by stages. In the first stage, general excitement or, conversely, lethargy, fear of death, throbbing headache, noise or ringing in the ears, squeezing pain behind the breastbone are noted; skin itching, urticarial rash, Quincke's edema, hyperemia of the sclera, lacrimation, nasal congestion, rhinorrhea, itching and sore throat, spasmodic dry cough occur. Blood pressure at this stage is within normal limits; central venous pressure is at the lower limit of normal.

The second stage is characterized by a decrease in blood pressure to 60% of the age norm, harsh breathing, dry scattered wheezing; a weak pulse, heart rate up to 150% of the age norm, and the development of low cardiac output syndrome. Confusion, compensatory dyspnea, and the formation of shock lung. Prognostically poor harbingers are the appearance of acrocyanosis against the background of general pallor, hypotension, and oliguria.

The third stage is characterized by an extremely severe condition, consciousness is absent, there is a sharp pallor of the skin, cold sweat, oliguria, frequent, shallow breathing, increased tissue bleeding. Diastolic blood pressure is not determined, the pulse is thready, tachycardia. Sludge syndrome and DIC syndrome occur.

Symptoms of anaphylactic shock in children

Diagnosis of anaphylactic shock

The diagnosis of anaphylactic shock is clinical and anamnestic. Differential diagnosis is carried out with other types of shock: traumatic, posthemorrhagic, cardiogenic, septic; vasovagal collapse; generalized cold urticaria; aspiration of a foreign body, etc. Bradycardia, nausea and the absence of respiratory and skin manifestations of allergy, stable blood pressure are typical for vasovagal collapse (fainting). Symptoms are relieved after the patient is placed in a horizontal position with raised lower limbs.

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Emergency care for anaphylactic shock

It is necessary to lay the patient horizontally with slightly raised legs, warm him up, perform an energetic massage of the abdomen and extremities, clear the mouth and respiratory tract of mucus and vomit, turn the child's head to the side to prevent aspiration. Above the injection site or bite (sting), it is necessary, if possible, to apply a tourniquet, loosened for 1-2 minutes. Monitor blood pressure constantly, without removing the cuff.

A 0.1% solution of adrenaline is administered intramuscularly or intravenously at a rate of 0.01 ml/kg (no more than 0.3 ml) and prednisolone 10 mg/kg. Chloropyramine (suprastin) 2% solution or diphenhydramine (diphenhydramine) 1% solution is prescribed - 0.05 ml/kg intravenously, intramuscularly. If the effectiveness is low, repeated intravenous administration of the drugs is necessary after 10-15 minutes. If bronchospasm persists, inhalations of salbutamol 1.25-2.5 mg (1/2-1 nebula) or 2.4% solution of aminophylline (euphyllin) 4-5 mg/kg are administered intravenously by drip. If arterial hypotension persists, 0.9% sodium chloride solution (10-30 ml/kg h) intravenously with phenylephrine (mesaton) (1-40 mcg/kg h min) or dopamine (6-10 mcg/kg h min) is indicated. Oxygen therapy is performed: 40-60% oxygen through a nasal catheter. If breathing is inadequate. Blood pressure is below 70 mm Hg, and laryngeal edema develops, mechanical ventilation is required. With a low response to epinephrine, glucagon is used at 1-2 mg intravenously by jet stream, then drip at a rate of 5-15 mcg/min until the effect is achieved. Glucocorticosteroids are re-administered in case of refractory bronchospasm and to prevent recurrence of symptoms after 6-8 hours (biphasic reactions). If there is a good response to therapy, antihistamines are prescribed orally every 6 hours for two days, prednisolone 1-2 mg/kg every 4-6 hours, or equivalent doses of other glucocorticosteroids.

How is anaphylactic shock treated in children?

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