A as in Anaphylaxis

Yes, my dear, this needle goes into the thigh, now!

Epinephrine, or adrenaline, is a vital hormone produced in the adrenal glands located on top of both kidneys. In the human body, it serves to prepare for an acute stress response (also known as the fight or flight reaction), e.g. in a life threatening event like a bear attack or, as it is more likely nowadays, an encounter with a fox… .To enable an individual to react to a threatening situation appropriately, epinephrine rapidly

1. relaxes muscle to open airways

2. tightens blood vessels

3. releases energy (glucose, sugar)

by linking to compatible receptors, like a key (epinephrine) solely fitting into its proper lock (epinephrine receptor).

In anaphylaxis

1. Smooth muscle tightens (leads to tightening of airways)

2. Blood vessels relax (leads to heart rate and blood pressure decrease and skin swelling)

3. High quantities of allergic chemicals occur (leads to further and even more severe allergic reaction)

So we learned that epinephrine tackles severe allergic reactions on different levels (muscle, blood vessels, chemicals) and in different organ systems (airways, cardiovascular, skin, bowels) and is capable of interrupting the vicious circle which makes it a unique substance in anaphylaxis.

Epipen

One of the Epinephrine Auto Injectors is the Epipen and Epipen jr.

Since it does not treat the actual allergy but the life threatening symptoms that occur during an anaphylactic reaction, it is vital to

administer the epinephrine within a short time frame

monitor its effect (always call an ambulance and get further treatment at hospital) and

keep a second Auto injector at hand.

If possible and reasonable, remove the underlying allergen (this is an advise I consider doubtful, since in most cases, tiny amounts of food trigger the reaction, and we certainly do not want anyone presenting with an allergic shock to vomit forcefully, most certainly not). The literature for advise on discontinuation of the causative agent is inconclusive (1,2,3). Some guidelines promote a mouth rinse, others do not. Depending on the patient’s alert level, severity of reaction and amount of suspected residual food in the oral cavity, the judgement is left to the individual case. In latex allergy or bee venom it makes sense to remove the allergen.

Reference:

1. Resuscitation Council (UK) The emergency medical treatment of anaphylactic reactions for first medical responders and community nurses. Revised Jan 2002, May 2005 (originally published July 1999). http://www.resus.org.uk/pages/reaction.htm.

2. Gavalas M, Sadana A, Metcalf S. Guidelines for the management of anaphylaxis in the emergency department. J Accid Emerg Med 1998. 1596–98.98. [PMC free article] [PubMed]
3. Jackson M, Shaikh T. Emerg Med J. 2007 Dec;24(12):865.Mouthwash for anaphylaxis

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