ANAPHYLAXIS

A presentation by:
 Zahra Saeed
 Kamilah Kiran
 Isra Mehboob
 Khadija Ahmed
 Ayesha Janjua
 Mahwish Erkin
 Zainab Rauf
 WHAT IS ANAPHYLAXIS?
• Ana (without) phylaxis (protection)

• Anaphylaxis is defined as "an acute, potentially life-threatening

hypersensitivity reaction, involving the release of mediators from mast-cells,
basophils and recruited inflammatory cells.

• It is a type I hypersensitivity reaction

• A hypersensitivity reaction is a pathogenic immune reaction in response to a

stimulus.
CAUSES OF ANAPHYLAXIS

A common cause in dental clinics

 WHAT HAPPENS EXACTLY?
(PATHOGENESIS)
• Mast cells get sensitized on exposure to a particular allergic stimulus

• Antigen specific IgE molecules bind to Fc receptors on mast cells

• A signalling pathway is activated

•
• Leads to release of inflammatory mediators
ANAPHYLAXIS IN THE
DENTAL CLINIC
 COMMON CAUSES

• Drugs such as:

Antibiotics (penicillin)
NSAIDs
Aspirin
• Anaesthetic agents (rare)
• Latex gloves
• Dental materials
 RISK FACTORS
• Known allergies.
• Cardiovascular disease.
• Substance abuse.
• Asthma and other respiratory diseases.
• Initial exposure to the allergen by injection (intravenous [IV] medication).
• Frequent exposure to the allergen, particularly if exposure is followed by a
long delay and then a re-exposure.
CLINICAL FEATURES
SIGNS AND SYMPTOMS

SKIN
• Itching
• Flushing
• Hives
• Swelling

EYES
• Itching
• Redness
• Periorbital swelling

NOSE AND MOUTH

• Sneezing
• Itching
• Runny nose
• Nasal congestion
SIGNS AND SYMPTOMS
RESPIRATORY SYSTEM
• Choking
• Dysnea
• Tightness of chest
• Increased mucous production
• coughing
GENERAL
• Weakness
• Fainting
• Low BP
• Irregular heart rate
• Anxiety
• Confusion
• Nausea
• Vomiting
 MANAGEMENT
INITIAL MANAGEMENT
• if possible remove the offending agent.

Perform primary survey ABCDE

Call for help.
Lay patient flat. Do not allow them to stand or walk. If breathing is difficult,
allow them to sit.
Perform secondary survey
• Head to toe examination
 MANAGEMNT
After primary survey :

 Administer adrenaline IM doses of 1:1000 adrenaline (repeat after 5 min if

needed)
 Administer OXYGEN
 IV fluid administration
 Histamine should be administered
 MONITOR
• Pulse
• ECG
• BP
 TREATMENT
• Epinephrine (adrenaline) to reduce your body's allergic response

• Oxygen, to help compensate for restricted breathing

• Intravenous (IV) antihistamines and cortisone to reduce inflammation of your

air passages and improve breathing

• A beta-agonist (such as albuterol) to relieve breathing symptoms

 WHAT TO DO IN CASE OF AN
ANAPHYLACTIC EPISODE
• Recognition and early treatment
• Investigate
• Specialist follow up
• Education – avoid trigger
• Consider auto-injector
 PREVENTION
• Anyone with severe allergies should carry an allergy card/ wear a medical
emergency tag or bracelet at all times.

• Always inform your doctor about your allergies.

• Carry an emergency kit at all times.

 AN EMERGENCY KIT FOR
ANAPHYLAXIS

• The equipment on your emergency trolley should include:

• Adrenaline 1:1000 (consider adrenaline autoinjector availability in rural locations

for initial administration by nursing staff)
• 1ml syringes; 21 gauge needles
• Oxygen
• Airway equipment, including nebuliser and suction
• Defibrillator
• Manual blood pressure cuff
• IV access equipment (including large bore cannulae)
• Pressure sleeve (aids rapid infusion of fluid under pressure)
• At least 3 litres of normal saline
 CONCLUSION

• Anaphylaxis is a medical emergency that requires immediate recognition

and intervention. Basic equipment and medication should be readily
available in the physician’s office.
• Treatment as stated in the slideshow should be carried out and the patient
should be kept under observation.
• The patient should be instructed as to prevent any episodes in the future.
 CASE
• This case follows a death in Cumbria in 2009 where a male patient suffered
an anaphylactic shock in response to chlorhexidine. Chlorhexidine had been
administered to irrigate a tooth socket, resulting again in anaphylactic
shock. The emergency was recognised and managed appropriately;
adrenaline was administered. Unfortunately, the patient anaphylactic
reaction was so severe that the patient suffered respiratory arrest and died
later in hospital.

Lesson learnt should be that anaphylaxis is a common condition and should

be suspected in case of a medical emergency. Also, a proper history to
prevent and a proper emergency kit to manage anaphylaxis is necessary.
 REFRENCES
• http://www.the-dentist.co.uk/article/1327/anaphylactic-shock
• http://www.allergy.org.au/health-professionals/papers/acute-management-
of-anaphylaxis-guidelines
• https://www.resus.org.uk/anaphylaxis/emergency-treatment-of-
anaphylactic-reactions/
• http://emedicine.medscape.com/article/135065-treatment