Allergy is also called anaphylactic shock or severe allergic reaction.It is a serious and life-threatening systemic multi system anaphylactic reaction.It is the most urgent event in clinical immunology.Patients can quickly or partially show the following symptoms: systemic itching, urticaria, vascular edema, respiratory distress, laryngeal edema, blood pressure drop, arrhythmia, shock, which is a clinical syndrome involving multiple target organs.
TCM disease name
Pediatric allergy
Foreign name
pediatric anaphylaxis
Alias
Anaphylactic shock、Severe allergic reaction
Visiting department
pediatrics
Common causes
Related to food, vaccination, medicine, exercise, cold, etc
Allergy can be induced by any food, but the most common allergens are milk, egg white, peanuts, nuts and other few foods.
2. Vaccines related to poultry
There are measles, mumps, yellow fever and influenza vaccines. The main causes of adverse reactions are bird protein in vaccines and hydrolyzed gelatin, sorbitol and neomycin in some vaccines.The medical history can often provide relevant clues.
3. Hymenoptera insects
For example, bees can cause local or systemic allergy in sensitized persons.Various bee venoms can be used for skin test diagnosis.
4. Drugs
Among them, β - lactam antibiotics and aspirin/nonsteroidal anti-inflammatory agents are the most common.
5. Skin test and immunotherapy
Because the allergen used is also or may be the allergen of the child's allergy, it is very easy to induce allergy.
6. Sports
Some patients have wheal and other allergic symptoms after exercise, which is called exercise induced anaphylaxis (EIA). Some patients will have exercise after meals, which has nothing to do with the type of food.Other patients responded with exercise only after taking special food, saying that exercise depended on food to induce allergies.
7. Cold
Allergies can also be induced. In mild cases, the whole body will become puffy and itchy when cold, and will disappear soon after warm. In severe cases, systemic allergies can be induced. Such patients should avoid supercooling and swimming. Once symptoms occur, the body should be warmed as soon as possible.
8. Natural rubber
Most latex from oak trees is diagnosed by skin prick test, and latex specific IgE detected in vitro is less sensitive than skin test.Latex is the raw material for manufacturing various rubber gloves, various medical rubber tubes, anesthesia masks, toys, pacifiers, etc.Therefore, any child who has symptoms after sucking a pacifier, blowing balloons, playing with rubber toys or using other latex products should be suspected of being allergic to latex.People who are allergic to latex will also be allergic to a variety of vegetables and fruits.
9. During general anesthesia of operation
Most allergies occur within 3 minutes of intravenous administration, often involving muscle relaxants.Allergic reaction of latex usually occurs in 20~60 minutes.Neuromuscular blocking drugs such as chlorosuccinylcholine (scoline), opioid analgesics, antibiotics or protamine, latex, blood transfusion and anesthetics used during surgery are also easy to induce.
10. Primary recurrent allergy
Many of them have not found the cause of disease for the time being, so their diagnosis is mainly based on exclusion tests.Some patients have severe asthma reactions after meals, which may be caused by metabisulfite in food.Others have recurrent shock of unknown cause, which may be caused by potential penicillin in milk.
clinical manifestation
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The onset, manifestation and process of this syndrome are different, which is related to the strength of allergens, the health status and genetic quality of patients.The general symptoms start quickly, which can occur a few minutes and seconds after exposure to the attractant, or an hour later.Some patients have auras before symptoms appear, but these early symptoms, such as anxiety and dizziness, are often unclear to patients.The symptoms are systemic and vary in severity.Most patients begin with skin symptoms. The skin is flushed and often accompanied by sweating and erythema. Itching is especially common in the hands, feet and groin.Urticaria/angioedema is temporary, generally not more than 24 hours, and cyanosis can be seen in severe cases.The symptoms of the upper respiratory tract include edema of the mouth, tongue, pharynx or larynx, of which laryngeal edema ranges from hoarseness, aphasia to asphyxia, the latter being the main cause of death;Symptoms of lower respiratory tract include tight chest, irritating cough, wheezing, respiratory arrest, etc.Cardiovascular system symptoms include hypovolemic hypotension, arrhythmia, myocardial ischemia, and cardiac arrest.Gastrointestinal symptoms include nausea, vomiting, abdominal colic, and diarrhea. Abdominal pain is often the early manifestation of the disease. Gastrointestinal symptoms are uncommon and will never occur alone.Urogenital system showed urinary incontinence and uterine contraction.Nervous system symptoms include anxiety, convulsions, loss of consciousness, etc. Most patients are tired and weak.In addition, the patient will have some mental symptoms due to temporary cerebral hypoxia.
The above symptoms and signs can exist alone or in combination.Most serious reactions involve respiratory and cardiovascular reactions.People with loss of consciousness can die within a few minutes, or within a few days or weeks. However, the later the symptoms of general allergic reactions start, the lighter the degree of reaction.After the early anaphylactic reaction dissipates for 4 to 8 hours, the late reaction may occur again.
Any route including oral, intravenous, skin, local application, inhalation and mucosal contact can cause allergy.Severe patients are prone to shock, while children are more likely to be involved in respiratory tract.Therefore, severe patients should be especially alert to respiratory symptoms.If the patient has airway obstruction, chest X-ray may show lung hyperinflation and/or atelectasis.
inspect
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1. Non specific inspection
(1) Examination of eosinophils in blood, sputum, nasal mucus and eye secretions;
(2) Determination of histamine content in blood, other body fluids or secretions;
(3) Determination of IgE, IgA, IgG and IgM in serum and secretion;
(4) Pulmonary function measurement;T lymphocyte transformation test;Determination of complement Ch50, Ch2, C3, C4;
(5) Macrophage migration inhibition test;
(6) White blood cell phagocytosis index measurement, etc.
2. In vivo specific diagnostic methods
At present, the most widely used body specific diagnostic method in allergy clinic is skin test, and skin prick test is recommended for children.In addition, there are various test methods other than skin, including nasal mucosa, bronchial mucosa, eye conjunctiva and oral mucosa tests.
3. Other inspection
It includes chest fluoroscopy, radiography, bronchography, paranasal sinus X-ray photography, gastrointestinal radiography, etc. It is also important for some allergic diseases.X-ray examination has special and important value for the diagnosis of allergic pneumonia and allergic sinusitis.B ultrasound, CT and MRI should also be used for auxiliary diagnosis of allergic diseases when necessary.
diagnosis
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Acute attack within a few minutes to several hours, involving skin and mucous membrane symptoms such as systemic erythema, itching, systemic urticaria, lip tongue uvula swelling;Serious allergic reactions should be highly suspected if there are cardiovascular or respiratory symptoms.
treatment
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Since death can occur within a few minutes, rapid treatment is extremely important. The later treatment starts, the higher the death rate.The key to start treatment is to quickly get rid of allergens, maintain airway patency and maintain effective blood circulation.
1. General treatment
Remove or stop the cause or inducement of inducing symptoms as soon as possible;The patients with hypotension should adopt head low and foot high;Oxygen inhalation.Emotionally, the patient's tension and fear should be eliminated.
2. Drug treatment
Rapid intramuscular or subcutaneous injection of adrenaline is the key to treatment.0.02-0.025mg/kg for children each time.If it needs to be reused, the interval shall be 15~30 minutes.If the condition is serious, intravenous infusion can be used to supplement the fluid overflowing from blood vessels into tissues, treat shock and correct acidosis.
After the initial treatment, the patient should be sent to the place where conditions permit to continue treatment.If the symptoms persist or worsen, other measures should be taken on the spot. According to the situation, relevant departments should be invited to consult immediately to participate in the rescue.
