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CTB 8: anaphylaxis: a cardiovascular-respiratory problem

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Lecture notes from Imperial College London, Medical Biosciences BSc, 2nd year, cardiovascular and thoracic biology (CTB) module. CTB 8 on anaphylaxis: a not uncommon allergic, potentially life-threatening condition that involves both the respiratory and cardiovascular systems. learning objectives: LO1: List the cardinal signs of acute inflammation and anaphylaxis and describe the physiological mechanisms that bring these about. LO2: Summarise the progress of an immune response to an antigen, including switching of immunoglobulin class. LO3: Describe the production of IgE and how it is involved in activation and degranulation of mast cells. LO4: Explain the symptoms of an anaphylactic reaction in terms of antibody type, mediating cell type, secreted signalling molecules, and target tissues. LO5: Describe the pathways for production of lipid mediators and the various pathophysiological activities of these different mediators. LO6: Explain why adrenaline is the drug of choice for first line treatment of anaphylactic shock. LO7: Provide the rationale behind the development of new drugs to treat anaphylaxis.

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Anaphylaxis: cardiovascular-respiratory pb
- anaphylaxis/ anaphylactic ‘shock’: life-threatening allergic reaction
=> often young people & females
=> 50-200 episodes per 100,000 person-years
=> lifetime prevalence of 0.05-2% (% of individuals at some pt in their life)
=> up to 1500 deaths per year in the USA
=> rates are increasing: 3-fold increase 1994-2004 in adults & 5-fold increase in children

What is anaphylaxis?
- 4 signs of acute inflammation (by Celsus): - rubor (redness): vasodilation
- calor (heat): vasodilation
from post-capillary venules
- tumor (swelling): plasma exudation into tissues
- dolor (pain): activated sensory nerves
- 5th sign (by Galen): loss/ disturbance of function
- anaphylaxis features:
=> rapid onset (~10-30min)
=> swelling (urticaria/ angio-oedema)
=> itching & tingling (picotements) of the skin (pruritus)
=> reddening (erythema): red rashes (éruption cutanée)
=> rhinitis (runny nose), conjunctivitis (runny eyes)
=> nausea, abdominal pain...
=> breathing difficulty (laryngeal oedema, airway constriction)
=> hypotension => fainting, dizziness...
=> tachycardia
- treatment: injections of adrenaline (epinephrine) => Epipen

Inducers of anaphylaxis
- antigen/ allergen: ‘innocuous’ protein/ chemical that triggers anaphylaxis reaction
=> food (especially children): nuts, milk, eggs, soya, blue cheese...
=> venom: bees/ wasps stings
=> drugs (especially old people): muscle relaxants (anaesthetics), antibiotics (penicillin), non-
steroidal antiinflammatory drugs (NSAIDs), aspirin

(also latex, hair dye...)

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Uploaded on
September 26, 2023
Number of pages
3
Written in
2022/2023
Type
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Duncan rogers
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