Treatment of anaphylactic shock is
a. Allergic reactions range in severity from mild pruritus and urticaria to anaphylactic shock and death.
b. Inciting agents include antibiotics, contrast agents, blood products, volume expanders, protamine, aprotinin, narcotics, induction agents, muscle relaxants, latex,and, rarely, local anesthetic solutions. Many drug additives and preservatives have also been implicated.
c. True anaphylaxis presents shortly after exposure to an allergen and is mediated by chemicals released from degranulated mast cells and basophils.
d. Manifestations usually include dramatic hypotension, tachycardia, bronchospasm, arterial oxygen desaturation, and cutaneous changes. Laryngeal edema can occur within minutes, in which case the airway should be secured immediately.
e. Treatment involves withdrawing the offending substance and administering oxygen, fluids, and epinephrine, followed by I.V. steroids, bronchodilators, and histamine antagonists. Prolonged intubation and ICU monitoring may be required until symptoms resolve. Appropriate skin and blood testing should be done to identify the causative agent.