When conducting skin tests in highly sensitive patients with the introduction of an allergen, local (hyperemia, edema at the injection site) and general (urticaria, bronchospasm, exacerbation of the underlying disease, anaphylactic shock) reactions may appear.
After each injection of the allergen, the patient should be observed by the doctor for at least 60 minutes. During this time, the doctor should note the skin reaction to the administration of the allergen and the general condition of the patient. In the event of remote reactions, the patient should immediately contact the medical institution and inform the doctor who conducted the allergic test.
In the office, where a specific diagnosis of patients, there should be pharmacological drugs and tools for antishock therapy.
Assisting with general reactions and anaphylactic shock:
In cases where during the introduction of an allergen with a diagnostic purpose the patient develops general weakness or agitation, anxiety, a feeling of fever throughout the body, redness of the face, a rash, cough, shortness of breath, abdominal pain, the following treatment should be carried out:
1. Immediately stop the injection of the allergen; lay the patient (head below the legs); Turn the head to the side, push the lower jaw, remove the existing dentures.
2. Apply the tourniquet above the injection site (every 10 minutes, you need to loosen the tourniquet for 1-2 minutes).
3. In the limb, free from the tourniquet, 0.3-0.5 ml of epinephrine solution 0.1% is injected subcutaneously.
4. Carry out splitting in 5-6 points and infiltration of injection site - 0.3-0.5 ml of epinephrine 0.1% solution with 4.5 ml of sodium chloride solution 0.9%.
5. Apply ice or a hot water bottle to the injection site with cold water for 15 minutes.
If points 1-5 are fulfilled and there is no effect:
1. Introduce epinephrine 0.1% or norepinephrine 0.2% subcutaneously or intramuscularly at a dose of 0.01 ml / kg (children 0.15-0.3 ml, adolescents and adults 0.3-0.5 ml) at intervals of 10-15 minutes. The multiplicity and dose of injected epinephrine depends on the severity of the reaction and the numbers of blood pressure. In severe anaphylactic shock, the epinephrine solution must be administered intravenously in 20 ml of a 40% glucose solution.The total dose of 0.1% epinephrine solution should not exceed 2 ml (children 1 ml).
It should be remembered that repeated administration of small doses of epinephrine is more effective than a single dose of a large dose.
2. If the patient's condition does not improve, then sympathomimetic is administered intravenously in 10 ml of 0.9% sodium chloride solution (0.01 ml / kg epinephrine 0.1 solution% or norepinifrine solution 0.2%, or 0.1-0.3 ml phenylephrine solution 1%). Simultaneously, intramuscularly injected any of the antihistamines in the age dosage.
3. Intramuscularly or intravenously injected glucocorticoid preparations: prednisolone 60-120 mg (children 40-100 mg), dexamethasone - 8-16 mg (children 4 - 8 mg).
4. Intramuscularly inject 2.0 ml (children 0.5-1.5 ml) of the suprastin solution 2.5%.
5. With the development of bronchospasm intravenously injected aminophylline in a dose of 4 mg / kg per 10-20 ml of sodium chloride solution 0.9% or inhalation through the nebulizer ipratropium bromide + fenoteropa or budesonide (intrapia bromide + fenoterop to children under 6 years 5-10 drops per 2 ml of sodium chloride solution 0,9%, for adolescents and adults 20 drops for 2 ml of sodium chloride solution 0,9%; budesonide children 250 μg per 2 ml sodium chloride solution 0,9%, adolescents and adults 500 μg per 2 ml sodium chloride solution 0,9%).
6. Cardiac glycosides, respiratory analeptics (strophanthine, etazole hydrochloride) are administered according to the indications.
7. If necessary, suck off mucus from the respiratory tract, vomit and carry out oxygen therapy.
8. In acute edema of the larynx, intubation or tracheotomy is indicated. Disturbance of breathing and its stopping require intravenous slow administration of lobeline (a solution of 1% in a dose of 0.1-0.3 ml) or cytisine (0.1-0.5 ml), carrying out artificial ventilation.
Help with anaphylactic shock should be provided promptly. Otherwise, death may occur from cardiac arrest or breathing.
All patients with anaphylactic shock are hospitalized. Transportation of patients is made after removal from the threatening state by the resuscitation team, tk. in the course of evacuation, a repeated drop in blood pressure and the development of collapse are possible. After anaphylactic shock, the patient should be observed and examined in a hospital for 10-15 days because of the danger of a two-phase shock current.