CLINICAL SIGNS:
* very rapid onset of appearance: <2 min in 95% of cases, (max: 20 min).
* cutaneous signs:
– diffuse urticaria, pruritus of extremities , flushs, erythema, angioedema.
* cardiovascular signs:
– palpitations, malaise, anxiety, anxiety.
– collapse.
– state of shock :
– running pulse, mottling, cold extremities, hypotension <90 mmHg, pallor, sweating.
– angina, arrhythmia, infarction, PAO.
– cardiac arrest.
* respiratory signs:
– cough, laryngeal dyspnoea or polypnea.
– stridor, sibilance, cyanosis.
– respiratory arrest.
* digestive signs:
– epigastric pain.
– nausea, vomiting, diarrhea.
– pruritus of the palate, dysphagia, edema of the tongue, edema of the glottis .
DIFFERENTIAL DIAGNOSIS:
* vagal discomfort.
* cardiogenic or hypovolemic shock.
* anaphylactoid reaction.
* acute asthma.
ETIOLOGY:
* “Idiopathic”.
* Hymenoptera venom (18%): wasp, bee, hornet or snake venom.
* food intake: peanut, crustaceans, strawberries, egg, nuts, fish, …
* after a desensitization sting.
* taking aspirin or analgesics (15%), beta-lactams (9%).
* anesthetic agents (25%), filling solutes (2.5%).
* iodinated contrast product.
ADDITIONAL TESTS:
* scope, SpO².
* ECG: disorders of excitability, conduction, repolarization.
* blood gas.
TREATMENT:
* lengthen the patient, raised legs.
* venous route: filling with crystalloids (Ringer lactate, sodium chloride 0.9%).
* Oxygen therapy mask: 8-10 l / min.
* Adrenaline :
– 1 mg (0.25 mg in children) in 10 ml, inject 1 ml / min IV to obtain a blood pressure> 100 mmHg.
– Then possible relay with the electric syringe: 0.1-0.5 μg / kg / min (0.25-1 mg / h).
– if moderate form or if IV impossible: 0,5 mg in SC or IM to be repeated every 5-10 mn until a TA> 100 mmHg.
– we can also choose the tracheal route or make an injection under the tongue.
– double the doses at least if subject to beta-blocker.
* Solumedrol : 120 mg IV then hydrocortisone hemisuccinate: 200 mg / 4h. IV (1 mg / kg in children).
* if laryngeal dyspnea:
– Dyspne-Inhal: 5 to 15 sprays or aerosol of Adrenaline: 1 mg in 5 ml of isotonic salty.
– aerosols of beta-2-mimetics: 10 sprays in an inhalation chamber.
* possibly: Dobutrex, 1 to 10 μg / kg / min (2 to 25 μg / kg / min in children).
* if laryngeal spasm or vital distress:
– Oro or naso-tracheal intubation and assisted ventilation after possible sedation with Hypnovel and Fentanyl.
* hospitalization: keep at least 24 hours , even if the episode is stopped because of risk of recurrence.
* prescribe a box of Anahelp or Anakit especially if impossible eviction of the allergen (attention to abusive self – medications).
