Must Read: Algorithm for Emergency Care for Anaphylaxis

Anaphylaxis – is a pathological condition characterized by the development of an acute allergic systemic life-threatening reaction in previously sensitized patients.

Insect bites, food and medications are the most common causes of anaphylaxis.

The work of a cosmetologist is necessarily associated with the risk of developing anaphylactic shock. Therefore, each specialist must be fluent in the algorithm for providing emergency care to patients with this pathological condition.

This article on estet-portal.com presents the basics of caring for patients with anaphylaxis, which meet the latest international guidelines and postulates of evidence-based medicine.

Anaphylaxis: Correct positioning of the patient and immediate administration of epinephrine

A patient with signs of anaphylactic shock should immediately be placed in a horizontal position with legs elevated (in order to increase cardiac preload). If possible, provide the patient with oxygen.

Drug treatment of anaphylaxis with systemic manifestations (hypotension, airway obstruction) consists of immediate intramuscular injection of epinephrine into the anterolateral thigh.

The dose of adrenaline for adults is 0.3-0.5 ml (in the form of a 1:1000 solution). Multiplicity of administration: every 5-15 minutes.

It is extremely important to conduct a timely and adequate assessment of airway patency, since anaphylactic shock is associated with the risk of developing airway obstruction. Cricotomy may be required if intritoral stridor develops.

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Anaphylaxis: intensive intravenous administration of saline

In order to ensure the redistribution of intravascular volume between venous vessels and interstitial tissue in a patient with anaphylactic shock, intravenous administration of saline at a rate of 5-10 ml / kg during the first five minutes of infusion is required.

Infusion of 1 to 2 liters of saline is required to compensate for the loss of intravascular fluid.

If there is no pulse and breathing, a complex of cardiovascular resuscitation is necessary. In this case, it is necessary to inject adrenaline intravenously every 5 minutes at a dose of 1 mg (in the form of a solution of 1: 10,000).

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Algorithm for the treatment of severe hypotension in patients with anaphylaxis

If a patient experiences a persistent decrease in blood pressure after several doses of intramuscular adrenaline and saline infusion, then this condition should be considered as severe hypotension.

In case of severe hypotension, intravenous epinephrine 1 mg (in a 1:10,000 dilution) every 5 minutes is indicated.

If anaphylactic shock has occurred in a patient who has a history of coronary artery disease and is taking beta-blockers, then the use of epinephrine will be somewhat difficult.

Beta-blockers limit the heart rate, thereby counteracting the effects of adrenaline.

In such cases, international protocols recommend the use of glucagon, but, nevertheless, there is a risk of developing tachycardia that is detrimental to a patient with severe CAD.

Respiratory symptoms that develop in the presence of anaphylaxis can be treated by inhaling beta-2 agonists, such as salbutamol 5mg every 20 minutes (up to 3 doses), and then every 1-4 hours as needed.

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Anaphylaxis: when to use antihistamines

Prescribing antihistamines is indicated to relieve symptoms of anaphylaxis such as pruritus, rhinorrhea, and urticaria.

It should be remembered that antihistamines are not effective for shock and airway obstruction because they develop slowly.

In order to eliminate the symptoms of mild manifestations of anaphylaxis (urticaria, rhinorrhea), it is recommended to intravenously / intramuscularly inject diphenhydramine at a dose of 50 mg, after which (after 5 minutes) – ranitidine IV/IM 50 mg.

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To be or not to be corticosteroids in the development of anaphylaxis

A Cochrane review found no strong evidence to support the use of corticosteroids for the treatment of anaphylaxis. Therefore, corticosteroids should not be used to relieve the symptoms of anaphylactic shock.

At the same time, corticosteroids can be used to prevent the development of a biphasic reaction, but after the main manifestations of – as preventive stabilization.

The use of corticosteroids involves intravenous administration of methylprednisolone at a dose of 1 mg/kg/s to the patient.

Thus, the work of a cosmetologist is necessarily associated with the risk of developing anaphylaxis, including anaphylactic shock and airway obstruction. Therefore, every specialist working in the field of aesthetic medicine must be familiar with the modern algorithm for providing emergency care to a patient with anaphylaxis.

Each beauty parlor must be equipped with all the necessary equipment to provide emergency care to a patient with anaphylaxis.

Timely recognition of anaphylaxis and competent assistance to the patient is the main condition for preventing the development of lethal outcomes in this condition.

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