Anafilaxia

CURRENT THERAPY




Management Protocol for Anaphylaxis

Rohit Sharma, MDS,* Ramen Sinha, MDS,†
P.S. Menon, MDS, FIBOMS,‡ and Deepika Sirohi, MD§

There is no universal agreement on the definition of anaphylaxis or the criteria for establishing its diagnosis, although it has been known to the field of emergency medicine formore than 100 years. Two meetings were convened by the National Institute of Allergy and Infectious Disease and Food Allergy and Anaphylaxis Network in April 2004 and July 2005. Representatives from 16 different organizations and government bodies, including representatives from developed nations, continue working toward a universally accepted definition, criteria for diagnosis, andmanagement of anaphylaxis. This article presents the latest concepts on anaphylaxis in the literature including the research needs in this area.
© 2010 American Association of Oral and Maxillofacial Surgeons
J Oral Maxillofac Surg 68:855-862, 2010


Anaphylaxis was described more than 100 years ago but continues to be one of the most alarming disor- ders encountered inmedicine, with no universal agreement on its definition or criteria for diagnosis. This has hindered research in its epidemiology, patho- physiology, and management, and has led to confu- sion on the part of first responders, emergency per- sonnel, primary care physicians, and patients, as well as failure to diagnose and treat anaphylaxis in a con- sistent manner.1-3 In an attempt to resolveproblems regarding this issue, this article presents the new concepts of defining and managing anaphylaxis based on the latest literature in the field of emergency med- icine.


Definition

The term anaphylaxis is derived from the Greek words a (against) and phylaxis (immunity, protec- tion). Anaphylaxis is a type I immune-mediated, life- threatening severe systemicallergic reaction. It is a specific immunoglobulin IgE–mediated, antigen-


*Major and Graded Specialist, Maxillofacial Surgery, Military Den- tal Center, Jalandhar, India.
†Colonel, Professor, and Head of Department, Department of
Dental Surgery, Armed Forces Medical College, Pune, India.
‡Colonel, Director “E” and “S”, Office of the Director General
DentalServices, Army Headquarters, New Delhi, India.
§Lt Colonel and Classified Specialist, Pathology, Military Hospital, Jalandhar, India.
Address correspondence and reprint requests to MAJ Sharma: Mil- itary Dental Center, Jalandhar, India.
© 2010 American Association of Oral and Maxillofacial Surgeons
0278-2391/10/6804-0023$36.00/0 doi:10.1016/j.joms.2009.06.008
induced reaction to variousallergens resulting in mast cell degranulation and basophil activation.4 The inci- dence of anaphylaxis is unknown but is estimated to be 1/10,000 in the general population per year with an increased risk in women of 3-10:1.
Anaphylactoid reactions present with an identical clinical picture involving similar mediators but with- out IgE involvement. Various mechanisms are respon- sible:● Generation of kinins with activation of coagula- tion or fibrinolysis
● Activation of complement cascade (eg, gelo- fusine)
● Modulation of arachidonic acid metabolism (eg, aspirin)
● Direct histamine release (eg, opioids, contrast injections).


Etiology

Anaphylactic (IgE) reactions may have any of the following etiologies:

● Food
● Drugs
●Local anesthetics containing methyl paraben
● Vaccines
● Venoms
● Allergen extracts
● Foreign proteins
● Parasites
● Latex
● Hormones, enzymes
● Muscle relaxants
● Exercise and food triggers


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Anaphylactoid (non-IgE) reactions may derive from any of the following:

● Muscle relaxants
●...