Anaphylactic shock in children

Anaphylactic shock - (more precisely, collapse) - acute, generalized allergic reaction with decompensated hemodynamic disorder, mediated by type I allergic reactions (IgE-reactants or IgG). This is the most severe form of allergic reaction and refers to urgent medical conditions. The first mention of anaphylactic shock refers to 2641 BC. E.: according to the surviving documents, the Egyptian Pharaoh Menzes died from a bite of a wasp or hornet.

Clinically, anaphylactoid reaction is not different from anaphylactic shock - pseudoallergic anaphylaxis, which is pathogenetically unrelated to antigen-antibody interaction, although it is caused by external causes.

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Causes of anaphylactic shock

Anaphylactic shock develops sharply after the patient's contact with an intolerable allergen and is a life-threatening condition that is accompanied by a violation of hemodynamics, leading to circulatory insufficiency and hypoxia in all vital organs. The peculiarity 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 disorders. Mortality in this condition is 10-20%.

What causes anaphylactic shock in children?

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Symptoms of anaphylactic shock

The degree of severity of anaphylactic shock depends on the rapidity of the development of vascular collapse and impaired brain function.

Anaphylactic shock is characterized by a staged flow. In the first stage, general excitement or, conversely, lethargy, fear of death, throbbing headache, noise or ringing in the ears, compressing the pain behind the sternum; there is skin itch, urticaria rash, Quincke's edema, flushing of sclera, lacrimation, nasal congestion, rhinorrhea, itching and choking in the throat, spasmodic dry cough. The arterial pressure is normal within this stage; CVP - at the level of the lower limit of the norm.

The second stage is characterized by a decrease in blood pressure to 60% of the norm, stiff breathing, dry, scattered rales; pulse of weak filling, heart rate up to 150% of age norm, small heart emission syndrome develops. Confusion, compensatory shortness of breath, the formation of a shock lung. Prognostically bad precursors are the appearance of acrocyanosis against the background of general pallor, hypotonia and oligoanuria.

The third stage is characterized by an extremely difficult condition, there is no consciousness, note the sharp pallor of the skin, cold sweat, oligoanuria, rapid respiration, superficial, increased bleeding of tissues. Diastolic blood pressure does not determine, the pulse is threadlike, tachycardia. There is a sluggish syndrome, DVS-syndrome.

Symptoms of anaphylactic shock in children

Diagnosis of anaphylactic shock

The diagnosis of anaphylactic shock is clinico-anamnestic. Differential diagnosis is performed with other types of shock: traumatic, posthemorrhagic, cardiogenic, septic; vasovagal collapse; generalized cold urticaria; aspiration of a foreign body, etc. For vasovagal collapse (fainting) bradycardia, nausea and absence of respiratory and cutaneous manifestations of allergy, stable blood pressure are typical. Symptoms stop after giving the patient a horizontal position with raised lower limbs.

[11], [12], [13], [14], [15]

Emergency care for anaphylactic shock

It is necessary to lay the patient horizontally with a few raised legs, warm it, hold a vigorous massage of the abdomen and extremities, the oral cavity and the respiratory tract clear of mucus and vomit, and turn the child's head sideways to prevent aspiration. Above the place of administration of the drug or bite (sting), it is necessary to apply a tourniquet, attenuated for 1-2 minutes if possible. Control of blood pressure constantly, without removing the cuffs.

Intramuscular or intravenous injection of 0.1% solution of epinephrine from the calculation of 0.01 ml / kg (not more than 0.3 ml) and prednisolone 10 mg / kg. Chloropyramine (suprastin) is prescribed 2% solution or diphenhydramine (diphenhydramine) 1% solution - 0.05 ml / kg intravenously, intramuscularly. With low effectiveness, repeated intravenous administration of the drugs is necessary after 10-15 minutes. With the preservation of the phenomena of bronchospasm, inhalations of salbutamol 1.25-2.5 mg (1 / 2-1 nebulas) or 2.4% solution of aminophylline (euphyllin) 4-5 mg / kg are intravenously dripped. With the preservation of arterial hypotension, the introduction of 0.9% sodium chloride solution 10-30 ml / kghch) intravenously with the introduction of phenylephrine (mezatonum) 1-40 μg / kg hmin) or dopamine 6-10 μg / kg hmin) is shown. Oxygen therapy is carried out: 40-60% oxygen through the nasal catheter. Inadequate breathing. Arterial pressure below 70 mm Hg, the development of edema of the larynx is necessary for ventilation. With a low response to epinephrine, glucagon 1-2 mg is used intravenously. Then drip at a rate of 5-15 μg / min until the effect is obtained. Re-administered glucocorticosteroids with refractory bronchospasm and to prevent the return of symptoms after 6-8 h (biphasic reactions). With a good response to therapy, antihistamines are prescribed 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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