Tag: anaphylaxis

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Can Adrenaline Auto-injectors Prevent Fatal Anaphylaxis?

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Individuals at risk of anaphylaxis are often prescribed adrenaline (epinephrine) autoinjectors such as EpiPens. A recent review published in Clinical & Experimental Allergy finds that these autoinjectors, which people use to self-administer adrenaline into the muscle, can deliver high doses of adrenaline into the blood, but these levels are short-lived and may not be sufficient to save lives in cases of fatal anaphylaxis.

Anaphylaxis is an acute systemic hypersensitivity reaction to an allergen or trigger, typically associated with skin reactions, nausea/vomiting, difficulty breathing, and shock.

Investigators noted that data from animal and human studies suggest that intravenous adrenaline infusions delivered directly into the blood can prevent fatal anaphylaxis, but adrenaline autoinjectors may have little impact in such deadly cases.

“For effective management of the most severe allergic reactions, adrenaline given by continuous intravenous infusion, with appropriate fluid resuscitation, is likely to be required—how this is safely achieved in the pre-hospital setting remains to be determined,” the authors wrote. This challenge stems from the fact that fatal anaphylaxis is unpredictable and fast. Fortunately, fatality is rare, with a population incidence of 0.03–0.51 per million per year.

Source: Wiley

Categories : AllergiesTags :

BP and Temperature Drop in Anaphylaxis Could be due to Nervous System

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Anaphylactic shock can occur in response to food allergies or bites from insects or venomous animals. A key feature of this severe allergic reaction is an abrupt drop in blood pressure and body temperature, causing fainting and, if left untreated, potentially death.

That response has long been attributed to a sudden dilation and leakage of blood vessels. Duke Health researchers have found that this response, especially body temperature drop, requires an additional mechanism: the nervous system.

Published in the journal Science Immunology, the mouse-based study could point to new targets for therapies to prevent or treat anaphylactic shock. “This finding for the first time identifies the nervous system as a key player in the anaphylactic response,” said senior author Soman Abraham, PhD, professor at Duke University School of Medicine.

“The sensory nerves involved in thermal regulation – especially the nerves that sense high environmental temperatures – send the brain a false signal during anaphylaxis that the body is exposed to high temperatures even though it is not the case,” Abraham said. “This causes a rapid drop in body temperature as well as blood pressure.”

Abraham and colleagues, including first author Chunjing “Evangeline” Bao, a Ph.D. candidate in Abraham’s lab at Duke, tracked the sequence of events when allergens activate mast cells — the immune cells that trigger the chemical reactions leading to swelling, difficulty breathing, itchiness, low blood pressure and hypothermia.

The researchers found that one of the chemicals mast cells unleash when they are activated is an enzyme that interacts with sensory neurons, notably those involved in the body’s thermoregulatory neural network.

When stimulated as part of an allergic reaction, this neural network gets the signal to immediately shut down the body’s heat generators in the brown fat tissue, causing hypothermia. The activation of this network also causes a sudden drop in blood pressure.

The researchers validated their findings by showing that depriving mice of the specific mast cell enzyme protected them against hypothermia, whereas directly activating the heat sensing neurons in mice induced anaphylactic reactions such as hypothermia and hypotension.

“By demonstrating that the nervous system is a key player – not just the immune cells – we now have potential targets for prevention or therapy,” Bao said. “This finding could also be important for other conditions, including septic shock, and we are undertaking those studies.”

Source: Duke University Medical Center