Luo Hailun
0906601J
Nur Izzati Maidin
0906664H
Bernice Pan Jia Qi
0906602H
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Jamaliah Mohd Ramzan
0906605A
Hamad
0806420F
http://www.youtube.com/watch?v=TTcL7u05aUU
http://www.youtube.com/watch?v=NaKQDaAN08s
http://www.5min.com/Video/Food-Allergies---Anaphylaxis-Treatment-155909460
http://www.nlm.nih.gov/medlineplus/ency/imagepages/19320.htm
http://www.nlm.nih.gov/medlineplus/ency/article/000844.htm
http://www.medicinenet.com/anaphylaxis/article.htm
http://www.youtube.com/watch?v=eVBqMXMIFnM&feature=related
http://www.youtube.com/watch?v=olFD1R5Gu-A
http://www.mja.com.au/public/issues/185_05_040906/bro10212_fm.html
http://www.bio.davidson.edu/courses/immunology/Students/spring2006/Witcher/Anaphylaxis.html
http://www.cmaj.ca/cgi/content/full/169/4/307
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1423394/
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Mechanism for How Epinephrine Relaxes Smooth Muscles
- Epinephrine helps control relaxation and contraction of smooth muscle cells. Contraction occurs through binding of calmodulin to Calcium ions. The Calcium-Calmodulin complex then activates the myosin light chain kinase (MLCK), which in turn phosphorylates the myosin light chains to cause contraction.
- When epinephrine binds to an epinephrine receptor it activates adenylyl cyclase, which produces cyclic AMP(cAMP) from ATP. Then cAMP activates a protein kinase, which phosphorylates Myosin Light Chain Kinase (MLCK). Phosphorylation inactivates MLCK so it has a lower affinity for the Calcium-Calmodulin complex.
- This stops the downstream signal for muscle contraction, and thus, relaxes the smooth muscle tissue. Epinephrine also decreases the release and membrane permeability of histamine to reduce the effects of histamine (Bunting, 2000).
Mechanism for How Epinephrine Raises Blood Pressure
- In the mechanism of raising blood pressure, epinephrine binds a beta-adrenergic receptor, which changes shape and activates a G-Protein, which activates Adenylyl Cyclase to convert ATP to cAMP. cAMP activates cAMP-dependent protein kinase (PKA).
- In cardiac muscle, PKA phosphorylates calcium channels in the plasma membrane and myosin heads. Phosphorylated calcium channels remain open longer and allow more calcium into the myocyte, which uncovers more myosin-binding sites on actin. This results in more cross-bridges formed, which creates a stronger force in myocyte contraction and a high blood pressure (Davidson College Biology Department, 2006).
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- The most important drug in treating anaphylaxis is epinephrine, which must be administered immediately. Epinephrine reverses the effects of anaphylaxis because it makes the heart pump faster, relaxes smooth muscle, widens air passages in the lung, contracts blood vessels, stops itching and hives, and relieves gastrointestinal cramping.
- After administering epinephrine, aminophylline, cortisone drugs, or antihistamines can be given to prevent acute symptoms from returning. Oxygen, intravenous fluids, and cardiac monitoring will help stabilize the heart, lungs, and blood pressure. Vasopressors and endotracheal intubation are other methods of treatment for anaphylaxis.
- Patients with anaphylaxis should be monitored overnight for at least six hours because there is a small chance of having a second anaphylactic reaction.
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Must be familiar with the use of emergency anaphylaxis treatment kits and always have them with you.
Emergency measure and prevention are central to management.
Best treated by avoidance measures.
- Call emergency service.
- Place a conscious person lying down and elevate the feet if possible.
- Stay with the person until help arrives.
- Give CPR if the person stops breathing or does not have a pulse ( only if trained.)
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- Detailed medical history
- Selected blood or skin test
- Recall of food and medication ingested
- Any contact with rubber product
| Causes - IgE Mediated | Examples |
|---|---|
| Medications | Penicillin, Cephalosporin, Anesthetics, Streptokinase, Others |
| Insect Stings | Hornet, Wasp, Yellow Jacket, Honey Bee, Fire Ant |
| Foods | Peanuts, Treenuts, Fish, Shellfish, Eggs, Milk, Soy, Wheat |
| Vaccines | Allergy Shots, Egg and Gelatin based vaccines |
| Hormones | Insulin, Possibly Progesterone |
| Latex | Rubber Products |
| Animal/Human Proteins | Horse Serum (used in some snake anti-venoms) |
| Causes - Non IgE Mediated | Examples |
|---|---|
| Medication | Non-steroidal Anti-inflammatories (Aspirin, Motrin, etc.), Morphine, Muscle Relaxants (Robaxin, Norflex, and others), Gamma Globulin |
| X-ray Dye | |
| Preservatives | Sulfites |
| Physical | Exercise, Heat-Induced Urticaria (Hives), Cold- Induced Urticaria |
| Idiopathic | Unknown Cause |
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- Fainting
- In fainting, the affected person has a low pulse, cool and pale skin, and no hives or difficulty in breathing.
- Heart attacks
- Blood clot to lungs
- Panic attack
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- Severity of the reaction varies from person to person.
- Subsequent reactions to the same trigger are typically similar in nature.
- History of allergic disease does not increase the risk of developing lgE mediated anaphylaxis, but does not incline the person to a non-lgE mediated reaction.
- Underlying asthma may result in more severe reaction and can be more difficult to treat.
- Risk of anaphylaxis may diminish over time of there is no repeated exposure or reactions.
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- Whole body allergic reaction to a chemical that has become an allergen.
- After being exposed to a substance such as bee sting venom, the person immune system becomes senitized to it.
- On a later exposure to that allergen, allergic reaction occurs.
- Tissues in different parts if the body release histamine and other substances. This causes the airway to tighten and leads to other symptoms.
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Allergy shot may be suggested to people with wasp, yellow jacket, hornet, honey bee, or fire ant reactions.
- 98% protection against first four insect reaction
- Less protective against fire ant reaction
Pre-medication is most helpful in preventing anaphylaxis from X-ray dyes
- Alternative dyes that are less likely to cause reaction may be available
Desensitization to problematic medications is often effective. This process is accomplished by gradually increasing the amount under controlled conditions.
- Sensitivities to penicillin, sulfa drugs, and insulin have successfully treated this way
| Trigger | Avoidance Principle |
| Drugs/Medications | Advise all health care personnel of your allergies. Ask your doctor whether the prescribed medication contains the drug(s) you are allergic to. Take all drugs by mouth if possible. |
| Insect Stings | Avoid areas such as outdoor garbage, barbecues, and insect nests. Avoid bright clothing, perfume, hair spray or lotion that might attract insects. Wear long sleeved clothing, long trousers, and shoes while outdoors |
| Food | Carefully read all labels. Ask what the ingredients are when eating out. Avoid foods that may cross react such as bananas, kiwi fruit, and avocado. |
| Latex | Avoid all Latex products. Ask if your hospital has Latex safety issues if you need to be hospitalized. |
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May occur within seconds of exposure, or be delayed 15 to 30 minutes, or an hour or more after exposure
- Flushing (warmth & redness of skin)
- Itching (often in the grain/armpit)
- Hive
Often accompanied by
- A feeling of impending doom
- Anxiety
- Rapid, irregular pulse
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More serious, fetal it may cause heart attack.
Common Causes:
Two major group
- lgE mediated
- Non-lgE mediated
lgE mediated
- True anaphylaxis
- Requires initial sensitizing exposure, the coating of mast cells and basophils by lgE and the explosive release of chemical mediators upon re-exposure.
- Similar to true anaphylaxis but do not require lgE immune reaction.
- Usually caused by the direct stimulation of mast cells and basophils.
- This reaction can happen, and often does, on initial as well as subsequent exposures since no sensitization required.
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100 years ago, two Parisian Scientist perform studies on the toxin produced by the tentacles of a local jellyfish, the Portuguese Man of War.
They tried to vaccinate dogs after isolating the toxin in hope of obtaining protection or prophylaxis against the toxin
However, they found out that a very small doses of toxin resulted in a new dramatic illness that involves breathing difficulties resulting in death within 30 mins.
Hence, both scientists termed "Anaphylaxis" or against protection.
They rightly concluded that the immune system first becomes sensitized to the allergen over several weeks and upon re-exposure to the same allergen may result in severe reaction.
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What is Anaphylatic?Rapidly developing and serious allergic reaction that affects a number of different areas of the body at one time.
Severe anaphylatic reaction can be fetal
Triggered by substances that are injected or ingested and thus, gain access into the blood stream. Examples explosive reaction involving skin,lungs,nose, throat and GI tract.
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