Shock anafilattico
Table of Contents
Definizione
Loshock anafilatticoè la reazione allergica, l’evento allergico più temuto e può portare anche all’exitus. Davanti ad una reazione anafilattica bisogna avere una certa prontezza di intervento e conoscere i sintomi e i segni per arrestare gli eventi che possono portare alla morte del paziente. Lo shock anafilattico si presenta in soggetti che sono sensibilizzati e che quindi presentano IgE nei confronti di un allergene. Si possono avere anche delle reazionianafilattoidiche dal punto di vista clinico hanno gli stessi segni e sintomi dello shock anafilattico ma non sono sostenuti da un meccanismo IgE mediato, quindi non richiedono alcuna precedente fase di sensibilizzazione per potersi verificare. La reazione antigene-anticorpo in un soggetto che sviluppa uno shock anafilattico provoca una liberazione massiva, in un primo momento, di mediatori neoformati tra cui sicuramente il principale è l’istamina.
Sintomi
L’istamina, a livello dei vari organi e apparati ha un’azione diversa: talvolta si può avere inizialmente interessamento:
- cutaneo
- respiratorio
- cardiocircolatorio
- del SNC
Talvolta ci sono segni e sintomi che vanno a progredire, mentre altre volte l’esposizione ad un allergene può direttamente provocare un improvviso calo pressorio e quindi perdita di coscienza del paziente in maniera immediata.
La reazione a livello cutaneo,dovuta alla liberazione di istamina, si presenta come un eritema cutaneo, con la comparsa improvvisa dipomfi,caratteristici dell’orticaria e si può avere l’angioedemache si manifesta a livello dellepalpebre, dellelabbraoppure anche al livello dellaglottide , questo evento è il più preoccupante perché se interessa la glottide può provocare una chiusura dello spazio respiratorio e quindi può provocare lamorte per asfissia. Talvolta la liberazione di istamina agisce a livello dei vasi e provoca una vasodilatazione che darà un quadro diipotensioneed anche una situazione distravaso a livello periferico.
A livello bronchialel’istamina ha un’azione dibroncocostrizione e il paziente presenterà dispnea in acuto, rumori striduli, fino ad un’insufficienza respiratoria. Al livello del SNC l’evento più comune è la perdita di conoscenza dovuta al calo pressorio o anche alla presenza di stravaso al livello del SNC, quindi edema acuto.
A livello delle vie aree superiori:
- raucedine
- disfagia
- incapacità di parlare
- sensazione di “nodo serrato” alla gola
- Incapacità di tossire
Quali sono le cause che possono scatenare lo shock anafilattico?
L’allergia alimentare può causare uno shock anafilattico, si possono avere reazioni immediate o anche entro un’ora dall’esposizione all’ allergene. Gli allergeni che nell’adulto provocano allergia sono:
- arachidi
- frutta a guscio
- crostacei
- pesce ( Es. merluzzo)
- soia
- pesche
- grano
Nei bambini proteine del latte vaccino, proteine dell’uovo (soprattutto albume)
I farmaciche provocano una reazione IgE mediata sonopenicilline V e G e cefalosporine. I mezzi di contrasto radiologici possono dare reazionianafilattoidi.
Insettiche appartengono alla famiglia degli imenotteri che sono apidi o vespidi. Possono dare con una singola puntura shock anafilattico e anche morte. Nel veleno di apidi e vespidi ci sono, a parte le ammine biogene che danno prurito e lieve dolore, ci sono delle sostanze allergizzanti, tipiche del veleno di ape (la mellitina per esempio) e altre tipiche del veleno di vespa che possono dare reazioni fatali.
Il latticee tutti i presidi in lattice, sia in ambito sanitario ma anche nella vita sociale. L’allergia al lattice è una manifestazione clinica in crescente aumento scatenata dalle numerose proteine contenute nel lattice. Si tratta di reazioni che coinvolgono la cute, l’apparato respiratorio e cardiovascolare, in alcuni casi di estrema gravità, con casi anche mortali.
Cosa fare in caso di shock anafilattico?
Allertare subito i soccorsi.
Per il trattamento acuto di shock anafilattico il farmaco elettivo è l’adrenalinache riesce a contrastare i sintomi dello shock anafilattico perché:
- a livello periferico ha un’azione vasocostrittiva;
- a livello cardiaco ha un’azione inotropa e cronotropa positiva;
- ha un’azione anche sugli ioni calcio a livello cellulare;
- ha anche un’importante azione broncodilatatrice.
A livello cardiaco però può portare anche effetti collaterali:
- battito cardiaco pesante, accelerato o irregolare
- capogiri
- debolezza
- difficoltà respiratorie
- dolori al petto
- mal di testa
- nausea
- nervosismo, ansia o irrequietezza
- pallore
- sudorazioni
- tremori incontrollabili
- vomito
E’ un farmaco salvavita.
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