Anaphylactic shock

IgE-dependent and IgE-independent hypersensitivity reactions, the latter du e to physical, chemical or hyperosmolar stimuli, may evolve as anaphylaxis or an anaphylactoid reaction, by an escalating release of mediators from ma st cells and basophils. Without immediate treatment, anaphylaxis goes along with substantial morbidity (shock, multiple organ failure) and mortality; within minutes this explosive clinical response can be fatal. The severity of anaphylactic/ anaphylactoid reactions is graded from stages 0 to IV in o rder to guide the management of this disease, stage III corresponding to an aphylactic shock. Severe anaphylactic reactions may take a progressive cour se despite adequate therapy; even in the case of an initial favourable resp onse to treatment measures life-threatening symptoms may recur; there may b e late-phase reactions 6 to 12 hours after the initial reaction. For the in itial emergency management a differentiation between IgE-mediated and IgE-i ndependent anaphylactoid reactions is not required. These are the pertinent principles of therapy in hypotensive and hypoxic patients: removal of the likely noxious agent at the site of introduction, provision of a patent air way, 100% oxygen supplementation, intravenous fluid therapy and pharmacolog ical support with catecholamines. After primary care the monitoring and the rapy of the patient with anaphylactic shock has to be continued on the inte nsive care unit. Guidelines for management of acute anaphylaxis referring t o both the stage of disease including shock and the main clinical manifesta tion (cutaneous, pulmonary, cardiovascular) have been established by a Germ an interdisciplinary consensus conference and were published in 1994; conse nsus guidelines for emergency medical treatment have been communicated by t he ILCOR (1997) and the Project Team of the Resuscitation Council (UK) (199 9).