1. Allergy: anaphylactic shock, nettle rash, Quincke’s edema
Allergy: anaphylactic shock, nettle rash, Quincke’s edema. Toxicallergic affections of skin and mucosa. Etiology, pathogenesis. Diagnostics. Clinical picture. Complications. Principles of treatment. The role of a doctor-dentist in early diagnostics and prophylaxis.
Khabarova N.A.

2. Allergic reactions are sensitivities to substances called allergens that come into contact with the skin, nose, eyes, respiratory tract, and gastrointestinal tract. They can be breathed into the lungs, swallowed, or injected. Allergic reactions are common. The immune response that causes an allergic reaction is similar to the response that causes hay fever. Most reactions happen soon after contact with an allergen.
Many allergic reactions are mild, while others can be severe and life-threatening. They can be confined to a small area of the body, or they may affect the entire body. The most severe form is called anaphylaxis or anaphylactic shock.

4. Causes
Common allergens include:
Animal dander
Bee stings or stings from other insects
Foods, especially nuts, fish, and shellfish
Insect bites
Medications
Plants
Pollens

5. Trends in age and sex standardised admission rates for anaphylaxis, angio-oedema, food allergy, and urticaria, with rate ratios (RR) and 95% confidence intervals, England

6. Control of the immune system by the hypothalamo-pituitary axis during an antigen attack.

7. Formation of sensitised lymphocytes, lymphokines and antibodies
Formation of sensitised lymphocytes, lymphokines and antibodies. B-lymphocytes are involved in acquired, humoral immunity, and T-lymphocytes in congenital, cellular immunity.

8. Anaphylaxis is a severe, systemic allergic reaction
multisystem involvement, including the skin, airway, vascular system, and GI
Severe cases may result in complete obstruction of the airway, cardiovascular collapse, and death
Anaphylactoid or pseudoanaphylactic reactions display a similar clinical syndrome, but they are not immune-mediated. Treatment for the two conditions is similar

9. Etiology Pharmacologic agents
Antibiotics (especially parenteral penicillins and other ß-lactams),
aspirin and nonsteroidal anti-inflammatory drugs
intravenous (IV) contrast agents are the most frequent medications associated with life-threatening anaphylaxis.
Latex
Stinging insects
ants, bees, hornets, wasps, and yellow jackets.
Foods
Peanuts, seafood, and wheat are the foods most frequently associated with life-threatening anaphylaxis.

12. Symptoms
Common symptoms of a mild allergic reaction include:
Hives (especially over the neck and face)
Itching
Nasal congestion
Rashes
Watery, red eyes

13. Anaphylactic reaction as it occurs in mast cells and basophils.

17. Symptoms
Symptoms develop quickly, often within seconds or minutes. They may include the following:
Abdominal pain
Abnormal (high-pitched) breathing sounds
Anxiety
Chest discomfort or tightness
Cough
Diarrhea
Difficulty breathing
Difficulty swallowing
Dizziness or light-headedness 
Hives, itchiness
Nasal congestion
Nausea or vomiting
Palpitations
Skin redness
Slurred speech
Swelling of the face, eyes, or tongue
Unconsciousness
Wheezing

18. Signs and tests Signs include: Abnormal heart rhythm (arrhythmia)
Fluid in the lungs (pulmonary edema)
Hives
Low blood pressure
Mental confusion
Rapid pulse
Skin that is blue from lack of oxygen or pale from shock
Swelling (angioedema) in the throat that may be severe enough to block the airway
Swelling of the eyes or face
Weakness
Wheezing
The health care provider will wait to test for the allergen that caused anaphylaxis (if the cause is not obvious) until after treatment.

21. Treatment
Anaphylaxis is an emergency condition that needs professional medical attention right away. If necessary, begin rescue breathing and CPR.
If the allergic reaction is from a bee sting, scrape the stinger off the skin.
Take steps to prevent shock. Have the person lie flat, raise the person's feet.
endotracheal intubation or tracheostomy or cricothyrotomy.
The person may receive antihistamines, such as diphenhydramine, and corticosteroids, such as prednisone, to further reduce symptoms (after lifesaving measures and epinephrine are given).

23. Allergic Angioedema/Urticaria
Reactions are induced by histamine and mediated by IgE
IgE mediated hypersensitivity reaction
Reaction with allergen induces the release of histamine and other mediators
Result: vasodilatation and edema

25. Allergic Angioedema/Urticaria
Biochemistry:
Dependent on presence IgE molec sp to proteins in causative agent
IgE molec bind to patients mast cells
Trigger rxn upon re-exposure to antigen

26. Allergic Angioedema/Urticaria

27. Allergic Angioedema/Urticaria
Inciting Agents:
Medications
Foods
Latex
Environmental (includes insect bites)

28. Allergic Angioedema/Urticaria
Clinical Presentation:
Highly variable
Depends on:
prev sensitization
type of allergen
+/- urticaria
(pruritic)

29. Allergic Angioedema/Urticaria
Clinical Presentation:
Often seen in patients with other allergic conditions:
Atopic dermatitis
Allergic rhinitis
Asthma

30. Feature Tissues involved Organs affected Duration Symptoms
Angio-oedema
Urticaria
Tissues involved
Subcutaneous and submucosal surfaces.
Epidermis and dermis.
Organs affected
Skin and mucosa, particularly the eyelids, lips and oropharynx.
Skin only
Duration
Transitory (between hours).
Transitory (usually <24 hours).
Symptoms
Pruritus may or may not be present. Often accompanied by pain and tenderness.
Pruritus is usually present. Pain and tenderness are uncommon.
Physical signs
Erythematous or skin-coloured swellings occurring below the surface of the skin.
Erythematous patches and wheals on the surface of the skin.

32. Urticaria
Urticaria

33. Physical urticaria
Solar urticaria
Cold urticaria

34. Physical urticaria
Aquagenic urticaria
Heat urticaria

35. Physical urticaria
Dermatographic
Cholinergic

40. Angioedema

43. Angioedema on tongue

47. Algorithm for diagnosis of angio-oedema due to C1-inhibitor deficiency.

48. Skin Prick Test (SPT)

51. Allergic Angioedema/Urticaria
Management:
As always, airway first
AAE does respond to:
Steroids
H1 and H2 blockers
subcutaneous epinephrine
antihistamines.