What is anaphylactic shock?

An anaphylactic shock is defined as severe allergic reaction in which involved more organs (gastrointestinal tract, the respiratory organs and the cardiovascular system, such as the skin) - and which quickly become life-threatening can affect. Symptoms show up within minutes or hours of contact with the trigger (allergen). If you experience an allergy shock, you have to dial 112 immediately.

In addition to insecticides, anaphylactic shock can also be caused by drugs (e.g. penicillin), natural latex or foods such as nuts or shellfish. In children, foods such as peanuts or nuts often cause allergic shock.

Anyone who has ever had a life-threatening anaphylactic shock after a wasp sting must therefore always carry an emergency kit with an adrenaline auto-injector with them. This is a kind of pre-filled syringe against the shock symptoms that the person concerned can inject himself if necessary. It also contains an antihistamine that counteracts the symptoms of allergies, cortisone, which is supposed to prevent late reactions, and possibly an asthma spray that dilates the bronchial tubes. If a doctor prescribes such an emergency kit, he explains to the patient in detail when and how to use this medication.

Anaphylactic shock: symptoms

If the immune system reacts extremely violently to certain substances, it forms so-called IgE antibodies on first contact and places them on the mast cells, which are part of the body's own defense system. If the allergens combine with it the next time they come into contact, they burst, whereupon the body releases inflammatory substances such as histamine. These trigger the anaphylaxis symptoms in the skin, gastrointestinal tract, the cardiovascular system and the respiratory organs : water is stored in the tissue, the mucous membranes swell and the blood vessels widen. As a result, the blood pressure fall, the pulse becomes fast and flat and the blood flow to the organs decreases. Depending on the allergen, there may be different symptoms and combinations of symptoms.

Doctors differentiate between four degrees of severity in allergic shock. The following symptoms occur :

Severity 1: There is no danger to life. Since the course is difficult to predict, the person affected must be monitored.

• Symptoms of the onset of anaphylactic shock include headache and a scratchy or lumpy sensation in the throat . Sometimes those affected have to cough or have a runny nose (runny nose ). A metallic taste in the mouth, tingling hands and sweating can also herald an anaphylactic shock.
• The skin can become reddened over large areas (flush) and itchy , and wheals sometimes form . In around 90 percent of those affected, the skin on the mouth and eyes swells.

• Many sufferers feel vague fears. Dizziness often occurs, and in children there is also noticeable restlessness .

Severity level 2:
In addition to the general and skin symptoms, gastrointestinal, heart and breathing difficulties occur.

• In the case of a food allergy , symptoms such as abdominal cramps, nausea, vomiting and diarrhea are typical .
• Some people with anaphylactic shock feel weak, blood pressure drops, and the pulse becomes fast and flat.
• Palpitations and arrhythmias are some of the serious symptoms of anaphylactic shock.

Severity 3:
Now there is shock and shortness of breath. The situation is becoming threatening.

• Warning signs of worsening anaphylactic shock include disorientation, bluish lips, noticeable paleness, and cool, marbled skin .
• The face can swell severely and the airways constrict . Hoarseness, wheezing and shortness of breath (especially problems breathing out) are the result.

Severity 4:
There is an acute danger to life.

• Those affected can react so strongly to the allergen within a short period of time that they suffer a circulatory collapse and respiratory failure .
• An allergy shock is therefore always a medical emergency!

ATTENTION: Because the symptoms of anaphylactic shock often set in a few minutes after contact with the allergen (for example after an insect bite) and the development is difficult to predict, those affected or bystanders should contact an emergency doctor immediately (112). In some cases, the severity of the symptoms also depends on what other illnesses the person affected has, whether they are taking medication such as beta-blockers and whether they have just exerted themselves physically or are under psychological stress .

Anaphylactic shock: first aid

Anaphylactic shock: what to do? In addition to the patients themselves, this is primarily the question asked by relatives, friends and parents of those affected. Strictly speaking, it concerns us all, because allergy shock can hit anyone. The answer is always: If symptoms such as swelling and shortness of breath appear after someone has come into contact with an allergen, give first aid immediately.

First aid: what to do in case of anaphylactic shock

• The first thing to do is to protect the person affected from contact with the allergen . That means, for example, to protect him from further insect bites, to carefully remove a bee sting without squeezing out the poison sac, to stop taking the medication or to take his nut cookies away from the child.
• Those affected without breathing problems put you in the so-called shock position so that the blood remains available for the vital organs of the brain and heart and does not sag in the legs. Means: upper body low, legs high .
• If the person has difficulty breathing , ask them to sit up straight or raise their upper body. This position makes it easier for him to take a breath.
• He or she is unconscious ? Then the stable side position is the safest position until the emergency doctor arrives.
• Since it is difficult to predict how an allergy shock will develop, someone should dial 112 immediately and ask for help.
• Even if it is difficult: Try to calm the person suffering from allergy shock when he is responsive and keep an eye on your breathing, pulse and blood pressure.
• He or she is no longer breathing? Start mouth-to-mouth resuscitation immediately. If cardiovascular arrest occurs, resuscitation ( resuscitation ) is the method of choice .

First aid with an emergency kit

If an adult or a child has already had anaphylactic shock in the past, they usually carry an emergency kit with them that a doctor has prescribed for them. It consists of three to four drugs, depending on the allergy the person is suffering from.

• As a first aid measure, the person concerned must immediately inject the auto-injector (a type of pre-filled syringe) with adrenaline into the outside of the thigh - or have it injected. That goes through the clothes too. Adrenaline works very quickly in anaphylactic shock. Now is the time to call the emergency doctor (this is also important with an emergency kit!), To bring the person affected into a position appropriate to the symptoms and - provided he is not unconscious - to give the medication for the anaphylactic shock:
• Specifically, these are an antihistamine in liquid or tablet form that weakens the allergy symptoms,
• a glucocorticoid / cortisone in liquid or tablet form to prevent late reactions
• and, if necessary, a bronchodilator spray to help those affected against their acute shortness of breath.
• An allergy pass with all the important information about allergies and first aid also makes sense. In it, the doctor describes the reaction that has occurred, notes down allergens that the person concerned must avoid and records which alternatives and precautionary measures are useful in the future.

So that people with a potentially life-threatening allergy can use the medication correctly in an acute case , the Anaphylaxis Training and Education Working Group (AGATE) offers training courses for those affected and their relatives. The prescribing doctor also explains exactly how to use the emergency kit so that those affected can feel more confident about when and how they should inject the adrenaline, for example. If you have a severe allergy, you have to practice again and again how to use the medication from your emergency kit correctly. There are also personal emergency plans for schools and kindergartens so that they know how to provide first aid in the event of an acute anaphylactic shock.

Anaphylactic shock: therapy

Anaphylactic Shock: Which Doctor? First of all, the 112 is the right choice. Because in the case of acute allergy shock, an emergency doctor is required to provide first aid and stabilize the person affected.

• If not already done, the doctor interrupts contact with the allergen and puts the person affected in the most suitable position.
• He then asks questions about possible triggers, measures pulse and blood pressure and administers medication to counteract the symptoms of allergy shock.
• Adrenaline promotes blood circulation, counteracts skin swelling and makes breathing easier.
• If breathing and circulation are weak, he can give the patient oxygen through a breathing mask.
• If fluid enters the spaces between individual cells and organs through the widened vessels, the blood pressure drops. An infusion with volume replacement solution compensates for this and stabilizes it again.
• The larynx rarely swells, which means that the person can no longer breathe. In such a case, the emergency doctor will intubate. That means he pushes a tube into the windpipe so that the patient can get air.
• Very rarely, a tracheotomy is necessary to save the life of an anaphylaxis sufferer. The same goes for resuscitation after cardiovascular arrest.

Anyone suffering from anaphylactic shock must remain in the intensive care unit for 24 hours to be monitored , as symptoms can flare up later.

For further clarification, those affected should contact an allergist . After a detailed conversation to find the trigger and rule out other diseases, he will arrange appropriate tests. For example, antibodies against a specific allergen can be detected using a skin prick test or a blood test.

• In the skin test (prick test) , the doctor applies the suspected allergens in the form of a solution to the forearm with a pipette. In the next step, he slightly scratches the areas so that they get into the skin. If the body reacts, red, itchy wheals form.
• During the blood test , the allergist takes some blood so that it can be examined in the laboratory for antibodies (especially IgE antibodies) that it may have formed against certain allergens.

The doctor can then prescribe appropriate emergency medication and issue an anaphylaxis pass in which he enters personal allergy triggers and specific instructions for action in the event of an emergency. Training courses are also useful.