ANAPHYLACTIC SHOCK - MECHANISMS AND TREATMENT

This paper reviews the mechanisms of anaphylactic shock in terms of th e immunoglobulin and non-immunoglobulin triggering events, and the cel lular events based on the rise in intracellular cyclic AMP and calcium that release preformed granule-associated mediators and the rapidly f ormed, newly synthesized mediators predominantly based on arachidonic acid metabolism. These primary mediators recruit other cells with the release of secondary mediators that either potentiate or ultimately cu rtail the anaphylactic reaction. The roles of these mediators in the v arious causes of cardiovascular collapse are examined. The treatment o f anaphylactic shock involves oxygen, adrenaline and fluids. The impor tance and safety of intravenous adrenaline are discussed. Combined H-1 and H-2 blocking antihistamines and steroids have a limited role. Glu cagon and other adrenergic drugs are occasionally used, and several ne w experimental drugs are being developed.