In case of doubtful results of skin tests, they can be repeated 2 days after the local response to the previous samples subsided. In case of positive results, it is allowed to repeat skin tests with pollen allergens no more than once a month.
In particularly sensitive patients, a systemic allergic reaction and anaphylactic shock may occur. In this regard, in the office, where specific diagnostics and specific immunotherapy of patients are carried out, there should be pharmacological preparations and tools for emergency care.
Assisting with general reactions and anaphylactic shock
After the introduction of the allergen, symptoms of clinical manifestations of hypersensitivity to the allergen may develop. With parenteral administration of an allergen, it is possible to develop an immediate-type reaction, incl. anaphylaxis, which manifests itself in the form of urticaria and vascular edema, laryngeal edema, shortness of breath and suffocation. These symptoms often occur after feeling generalized itching, burning sensation, skin flushing, and a sense of fear of death.
As a result of anaphylactic shock, non-occuring bronchospasm, asphyxia due to edema of the upper respiratory tract, and collapse can develop.
In this case, urgent medical measures are required.
Prehospital care for anaphylactic shock
1. Immediately stop the introduction of the allergen that caused the reaction, put the patient on the couch (head below the legs), turn the head to the side, push the lower jaw, remove the existing dentures.
2. Apply the tourniquet in place above the injection of the allergen, if possible.
3. Finish the injection site with 0.3-0.5 ml of the adrenaline solution (1 ml 0.1% solution of adrenaline diluted in 3-5 ml of sodium chloride solution).
4. Apply an ice pack to the injection site.
5. Enter 0.3-0.5 ml of 0.1% solution of adrenaline (children 0.05-0.1 ml / year of life) in / m or IV with an interval of 5-10 minutes. The multiplicity and dose of adrenaline administered depends on the severity of the shock and blood pressure. The total dose of epinephrine should not exceed 1 ml of 0.1% solution. Repeated administration of small doses of epinephrine is more effective than single administration of a large dose.
6. Provide access to fresh air or give oxygen. If the rhythm of breathing is disturbed or if it is difficult, perform artificial ventilation (IVL).
7. Urgent call the doctor, simultaneously called the resuscitation team.
Hospital care for anaphylactic shock
1. In the extremely serious condition of the patient and with severe violations of hemodynamics, slowly inject 5 ml of 0.01 ml% solution of adrenaline, when the effect is achieved, the administration is stopped. Children 0.1 ml / kg 0.01% r-ra slowly for several minutes.
2. If BP does not stabilize, urgently begin intravenous drip introduction of norepinephrine (phenylephrine, dopamine) 0.2% 1.0-2.0 ml per 500 ml of a 5% solution of glucose or sodium chloride solution of 0.9% for injection.
3. Intravenously struino enter glucocorticosteroids: prednisolone 60-180 mg (children 5 mg / kg), dexamethasone - 8-20 mg (children 0,3-0,6 mg / kg), hydrocortisone - 200-400 mg (children 4-8 mg / kg). As of the introduction of hormones, repeat and continue at least 4-6 days to prevent allergic reactions by immunocomplex or delayed type.
4. Only with the stabilization of blood pressure intramuscularly enter 2.0 ml of a 2% solution of chloropyramine (children 0.1-0.15 ml / year of life) or 0.1% klemastina.
5. Symptomatic therapy according to indications. When bronchospasm is injected intravenously, 10.0 ml of a 2.4% solution of aminophylline on a 0.9% sodium chloride solution for injections (children 1 ml / year of life). If necessary, enter cardiac glycosides, respiratory analeptics.
6. If necessary, suck from the respiratory tract accumulated secret and vomit, begin oxygen therapy.
7. Patients receiving β-adrenoceptor blockers, additional administration of salbutamol and / or glucagon to / in 1 ml is indicated.
All patients with anaphylactic shock are subject to compulsory admission for a period of at least 10 days in order to continue monitoring and treatment. in 2-5 % patients who have experienced anaphylactic shock, there are late allergic reactions.
Doses of drugs administered and the tactics of the doctor are determined by the clinical picture, but in all cases it is necessary, first of all, the introduction of adrenaline, glucocorticosteroid preparations. The administration of preparations of phenothiazine series and calcium preparations is contraindicated.
Before the arrival of the resuscitation team, it is necessary to provide medical care and carry out constant monitoring of hemodynamic parameters and the state of the function of external respiration (FVD).