The Multisystem Physiologic Progression that Occurs in Anaphylactic Shock
Anaphylactic shock is a distributive shock that is caused by the response of the body towards an allergen (Hammer & McPhee, 2014). It is different from the normal shock since it is an accelerated form of allergic reaction that leads to large release of histamine, which causes massive vasodilation.
Read also Circulatory Shock and Its Treatment
The anaphylactic shock results from a hypersensitive reaction called anaphylaxis. Anaphylaxis physiologic alteration is the vasodilation and hypovolemia, which leads to impaired cellular metabolism and tissue perfusion (Huether & McCance, 2012). According to the authors, there are other effects that rapidly involve the body. The process begins when an allergic individual is exposed to an allergen. The most common allergens that cause anaphylaxis are venom form insects, latex, shellfish, medications such as penicillin and peanuts.
When the sensitized individual is exposed to the allergen, a vigorous humoral immune response is initiated, which results in production of large quantities of immunoglobulin E (IgE) antibody (Huether & McCance, 2012). The allergen that is bound to the immunoglobulin E causes the degranulation of the mast cells. Consequently the mast cells release large number of vasoactive and inflammatory cytokines. This triggers inflammatory and extensive immune responses, which include increased vascular permeability, and vasodilation, which causes peripheral blood pooling and edema.
The peripheral pooling of blood leads to precipitous drop in blood pressure and weakened pulse that is hard to detect. Laryngeal angioedema associated with the condition, leads to obstruction of the airway and can be life-threatening (Grossman & Porth, 2014). The onset of anaphylactic shock is sudden and progression to the death can occur unless emergency treatment is given to the affected person.
When to Refer Patients to Emergency Care versus Treating as an Outpatient
Anaphylactic shock is a medical emergency which needs fast recognition and intervention. Once a patient is received, the causative agent must be discontinued immediately and epinephrine is administered (Grossman & Porth, 2014). The epinephrine should be offered through the intramuscular injection into the vastus literalis muscle.
There is no precise time as to when to release patient as an outpatient after treatment. This remains the judgment call of the physician administering treatment since anaphylactic shock is prone to relapse. A patient who shows good response to the epinephrine can be treated as outpatients. However, if a patient shows no response on administration of 3 doses of epinephrine at an interval of 3-15 minutes, such a patient should be transferred to the emergency care immediately (Keir, 2014).
How Genetics and Age Might Impact the Process of Anaphylactic Shock
The severity of the anaphylactic shock can greatly differ based on genetic makeup and age of individuals. Genetically predisposed individuals often experience severe humoral immune response when they are exposed to the allergens. Food related induced anaphylactic shock is more common among children compared to adults. According to (Rudders, Banerji, Clark, & Camargo, 2011) peanuts and milk are major triggers of anaphylactic shock among infants, while adults report allergic reactions towards tree nuts, latex, fruits, and vegetables.
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