Anaphylaxis (Chemical Immunology and Allergy, Vol. 95) by Johannes Ring

By Johannes Ring

Anaphylaxis is the main dramatic and in all likelihood life-threatening manifestation of an immediate-type allergy response. even if recognized for over a hundred years, it nonetheless poses many unresolved questions, and its functional administration and acute remedy are usually extra empiric in nature than evidence-based. during this publication, a multidisciplinary team of specialists evaluate the cutting-edge within the pathophysiology, epidemiology, prognosis and medical symptomatology of anaphylaxis. Its etiology with reference to diversified elicitors reminiscent of insect venoms, radiocontrast media, analgesics, common and native anesthetics is tested intimately. ultimately, therapy modalities for anaphylaxis are mentioned either for acute reactions and as common administration concepts for sufferers in danger. supplying thorough and up to date assurance of this usually underestimated challenge, this ebook is of curiosity not just to allergologists and immunologists, but in addition to all physicians and affected sufferers.

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A major characteristic of anaphylaxis is the rather rapid onset of symptoms after contact with the elicitor. The interval varies between a few seconds or minutes until 1 or 2 h, partly dependent upon the route of application (rapid onset after intravenous allergen exposure) and degree of sensitization. Experience in insect sting anaphylaxis in 6 Ring · Behrendt · de Weck Table 3. Classification of anaphylactic reactions according to severity of clinical symptoms [35] Grade Symptoms skin abdominal respiratory cardiovascular I pruritus flush urticaria angioedema II pruritus flush urticaria angioedema (not mandatory) nausea cramping rhinorrhea hoarseness dyspnea tachycardia (Δ >20 beats/min) blood pressure change (Δ >20 mm Hg systolic) arrhythmia III pruritus flush Urticaria angioedema (not mandatory) vomiting defecation diarrhea laryngeal edema bronchospasm cyanosis shock IV pruritus flush urticaria angioedema (not mandatory) vomiting defecation diarrhea respiratory arrest cardiac arrest over 800 patients shows that 90% of symptoms start within the first 30 min and the more rapidly the symptoms occur, the more severe the reaction will end [31, 48].

60 50 40 30 Fig. 2. Venom is the most frequent causes of anaphylaxis in adults. Data from the anaphylaxis registry of Germanspeaking countries (ANA-Net), n = 734. 20 10 0 Insects Drugs Food Unknown SIT Others Latex [16]. The most frequent elicitators of food allergy in children are peanuts and tree nuts [17]. 2% [18]. Furthermore, in this study, food was identified as the most common cause of anaphylaxis. Here the major identified food allergens besides peanuts and tree nuts were shellfish, wheat and lupine flour [18].

Presentation to T-helper cells occurs via MHC-IIcoupled peptide complexes along with costimulatory signals known as CD80/CD86-CD28 and CD40-CD40L, OX40-OX40L and ICOSL-ICOS interactions. self proteins and tumor-associated antigens can also be digested in the same manner. Then peptides were moved to endoplasmic reticulum where MHC class I molecules are coupled to be presented on the cell surface. The role of MHC class I is to present antigens to CD8+ cytotoxic T cells. Almost all host cells can express MHC class I.

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