Anaphylactic shock is a potentially life-threatening systemic allergic reaction. The primary goal of treatment is to immediately relieve symptoms such as airway obstruction and hypotension, and to prevent subsequent recurrent episodes. The main treatment is epinephrine injection, which can rapidly constrict blood vessels, relax bronchial smooth muscles, and inhibit the release of allergic mediators. It is currently the only first-line treatment proven to significantly reduce mortality.
Treatment should follow the principle of "time is life." Patients or bystanders should administer epinephrine within 15 minutes of symptom onset and seek emergency medical care immediately. Subsequent treatments may include antihistamines, corticosteroids, and monitoring vital signs to prevent recurrence.
Main treatments are divided into acute management and long-term management. The core of acute management is intramuscular epinephrine, which works through mechanisms including:
Long-term management involves allergen avoidance, self-epinephrine auto-injector education, and carrying preloaded epinephrine auto-injectors (such as EpiPen) to reduce the risk of recurrence.
Applicable to diagnosed patients with anaphylactic shock, presenting symptoms such as difficulty breathing, throat swelling, hypotension, and widespread skin rash. Common triggers include:
This treatment is not suitable for non-allergic hypotension or non-systemic allergic reactions. The decision should be made by a physician based on the severity of symptoms.
During the acute phase, administer 0.01-0.3 mg of epinephrine via intramuscular injection into the outer thigh, repeating every 5-15 minutes until symptoms improve. Pediatric doses are calculated based on body weight, but in emergencies, prioritize administration and adjust dosage accordingly.
For long-term management, patients should carry preloaded auto-injectors and store them at room temperature. After use, immediate medical attention is necessary, with at least 4 hours of hospitalization observation to prevent rebound phenomena.
Epinephrine can significantly improve blood pressure and respiration within 3-5 minutes, reducing mortality by over 90%. Its advantages include:
Long-term management strategies can reduce recurrence by more than 70%.
Possible side effects include tachycardia, dizziness, and headache, which are usually temporary and reversible. Serious risks:
Contraindications: Cautious use in patients with hypovolemic shock without medical evaluation and in severe coronary artery disease. Confirm that symptoms are indeed caused by allergy before use, to avoid misuse for other similar symptoms (e.g., panic attacks).
Those carrying auto-injectors should regularly check expiration dates and undergo annual proper usage training. Asthma patients should inform their physicians, as dose adjustments may be necessary.
Concurrent use with β-blockers (e.g., metoprolol) may exacerbate cardiovascular side effects, as epinephrine may not counteract the blockade. Use with monoamine oxidase inhibitors (MAOIs) requires informing the physician, as it may increase blood pressure fluctuations.
Multicenter studies show that timely use of epinephrine reduces mortality from 6.7% to 1.2%. A 2019 systematic review indicated that patients not treated with epinephrine had a hospitalization rate 3.2 times higher than those treated. However, delayed administration beyond 30 minutes significantly decreases efficacy.
Long-term follow-up indicates that combining allergen immunotherapy (such as SLIT for peanut allergy) can reduce recurrence rates by up to 40%, but epinephrine remains the first-line emergency response.
If epinephrine is contraindicated, consider:
However, it is emphasized that these alternatives are not first choices and should only be used under specific medical conditions.
Yes. Even if symptoms improve after using epinephrine, immediate hospital evaluation is necessary. Anaphylactic shock can recur, and medical staff need to assess whether additional medication or monitoring is required to prevent secondary episodes.
How to confirm the effectiveness of the medication when carrying an epinephrine auto-injector long-term?Regularly check the appearance of the medication for cloudiness or cracks, and pay attention to the expiration date. Environmental temperature also affects efficacy; avoid storing the injector in high or low temperatures (such as in a car or freezer). Expired medication should be replaced immediately to ensure safety during emergency use.
What activities should patients avoid in daily life after treatment for anaphylactic shock?Patients should avoid known allergens, such as specific foods or medications. Additionally, vigorous exercise, hot environments, or emotional stress may trigger symptoms. It is recommended to develop a safe activity plan under medical guidance and carry a medical alert card indicating allergy history.
What are the possible side effects after epinephrine injection and how to respond?Common side effects include palpitations, trembling, or dizziness, which usually resolve within minutes to hours. If severe discomfort such as chest pain or difficulty breathing occurs, seek medical attention immediately. Confirm that the patient has no history of cardiovascular disease before use to reduce risks.
What should be noted when administering vaccines to patients with allergic shock?Inform healthcare providers of allergy history and medication use before vaccination. Some vaccines (e.g., tetanus vaccine) may contain allergens such as calcium modulators, requiring administration under medical supervision. Observe for 30 minutes post-vaccination to ensure no acute reactions occur before leaving.
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