Homework assignment

Article-1 Alexandra Werner-Busse,Torsten Zuberbier,Margitta Worm

Article Title- The allergic emergency-management of severe allergic reaction
Journal name-JDDG(Journal der Deutschen Dermatologischen Gesellschaft
:May 2014; Vol.12, Issue 5: Pages 379-388.

Article-2 Steven M.Houser,MD; Catherine Weng,MD; Yi-Chun Liu, MD

Title-A Patient with an Allergy Emergency
Journal name-JAMA Otolaryngol Head Neck Surgery.2015;141(4):382-385.

Article-3 Triggiani,Massimo,Montagni,Marcello;
Parente,Roberta;Ridolo,Erminia
Title-Anaphylaxis and cardiovascular diseases: a dangerous liaison
Journal name-Current Opinion in Allergy & Clinical Immunology:August 2014-
Volume 14-Issue 4 p 309-315

Article-4 Aziz Sheikh ,BSc MBBS DCROG DCH MD MSc FRCGP FRCP
Title-Emergency management of anaphylaxis: current pharmacotherapy and
future directions
Journal name-Expert Opinion on Pharmacotherapy: Volume 14,2013 Issue
7,page 827-830

Article-5 Lorenzo Hernandez MD, MS, Sarah Papalia MD and George G.A.
Pujalte MD
Title-Anaphylaxis
Journal name-Primary Care: Clinics in Office Practice,2016-09-01,Volume
43,Issue 3,Pages 447-485
Summary of Article for Article-5(Anaphylaxis)
Anaphylaxisisanacute,shocklike,andpotentiallyfatalstate.Itoccursowingtothe
releaseofbioactivefactorsfrommastcellsandbasophilsandisaresponsetoantigenic
sensitivity.ItisIgEmediatedhypersensitivityreaction. Downstreameffectsincludesystemic
smoothmusclecontraction,vasodilation,andbronchioleconstriction,whichgivewayto
hypotensiveshockandasphyxiation,themaincausesofmorbidityandmortality.Riskfactors
includemainlygeneticfactorsandnumerousotherindividualfactorshavebeenshownto
influencetheseverityofthereaction.Medicationssuchasbetablockers,angiotensinconverting
enzymeinhibitors,diuretics,andantihypertensivesinaggregateincreasetheriskforsevere
reactionsowingtocompoundedhypotensionandbronchospasm. InWesterncountries,food
inducedanaphylaxis,inparticular,hasincreasedatleast2foldinprevalenceoverthepast20
years.Clinicalfeaturesareimportantinthediagnosisofanaphylaxis.Characteristicsymptomsand
signsofanaphylaxiscaninvolveseveraldifferentorgansystems,andtheydifferfromonepatient
toanother.9Theseorgansystemsincludetherespiratory,gastrointestinal,cardiovascular,and
centralnervoussystems.Amongothertriggerfactors,foodisthemaincausebothinadult(32%)
andpediatric(85%). Skinsignsarepresentin80%to90%ofallpatientsand,whentheyare
absent,anaphylaxisismoredifficulttorecognize.Respiratorytractinvolvementisseeninupto
70%ofpatients,whilethegastrointestinaltractandcardiovascularsystemarepresentinupto
45%.Centralnervoussysteminvolvementisseeninupto15%ofpatients.Duringanaphylaxis,
histamine,leukotrienes,plateletactivatingfactorandothermediatorsreleasedfromcardiacmast
Most common differential diagnosis include acute asthma,syncope and anxiety/panic
attack.Diagnosisofanaphylaxisismainlyclinical. Aclinicaldiagnosisofanaphylaxisis
basedonconsiderationofthepatientspresentingsymptomsandsignsandonrulingout
othersuddenonsetmultisystemdiseases.Laboratorytestfortryptaselevelandhistamine
levelarenotuniversallyavailableandnotperformedonemergencybasis. Anaphylaxisisa
medicalemergencythatrequiresasystemicapproachinbothassessmentandmanagement. .
Thereshouldalsobeanassessmentofthepatientscirculation,airways,breathing,mental
status, skin, and body weight (mass).The patient should also be given epinephrine
(adrenaline)intramuscularlyinthemiddleanterolateralaspectofthethigh,0.01mg/kgofa
1:1000(1mg/mL)solution,toamaximumof0.5mg(adult)or0.3mg(child).Thetimeof
thedoseshouldberecordedandarepeatinjectionmaybegivenin5to15minutes,if
needed;mostpatientsrespondto1or2doses.Patientshouldbemonitoredfrequentlyand
regularly.Anti histamine,beta blocker and glucocorticoid should be given. Patients with
moderated respiratory orcardiovascular compromise should be monitored forat least 4
hours and, if indicated, for 8 to 10 hours or longer; patients with severe or partnered
anaphylaxis might require monitoring and interventions for days.For prevention,
medications can be used to prevent additional episodes. This includes providing
selfinjectableepinephrine/adrenalinefromanautoinjector. Anemphasisontheimportance
of followup investigations, preferably by an allergy or immunology specialist. An
assessmentofsensitizationtoallergensisanotherkeypreventativemeasure. Longtermrisk
reduction measures include avoidance and/or immune modulation. In cases of food
triggeredanaphylaxis,patientsshouldbeadvisedtopracticestrictavoidanceofrelevant
foods.