* a) The determination of the initial dose is carried out by the method of allergometric titration.
b) In patients with high sensitivity (high severity of skin tests), treatment is initiated at the doctor's discretion, with a dilution of 1: 100,000 or 1: 1 000 000.
Precautions for use.
In cases where, during the introduction of the allergoid or during follow-up for 60 minutes, the patient experiences general weakness or agitation,a feeling of fever throughout the body, redness of the face, rash, cough, shortness of breath, abdominal pain, the following measures should be taken:
Pre-hospital care for anaphylactic shock.
1. Immediately stop the introduction of the allergoid from the house dust, 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 allergoid injection, if possible.
3. Finish the injection site with 0.3-0.5 ml of adrenaline solution (1 ml of 0.1% solution of epinephrine diluted in 3-5 ml of sodium chloride solution 0.9%).
4. Apply an ice pack to the injection site.
5. Enter 0.3-0.5 ml of 0.1 % solution of adrenaline (children 0.01 mg / kg, maximum to 0.3 mg, if necessary, the administration of these doses is repeated every 15 minutes (up to 3 times)) IM or IV with an interval of 10-20 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 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.
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).
Hospital care for anaphylactic shock.
1. In extremely serious condition of the patient and with severe hemodynamic disorders, 5 ml of 0.01% solution of epinephrine are injected slowly into IV, when the effect is achieved, the administration is stopped. Children 0.1 ml / kg 0.01% solution slowly for a few 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 5 % glucose solution for infusion or sodium chloride solution of 0.9%.
3. Intravenously strontically enter glucocorticosteroids: prednisolone 60-180 mg (children 5 mg / kg) or dexamethasone 8-20 mg (children 0.3-0.6 mg / kg), or 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 inject 2.0 ml of a 2% solution of chloropyramine (5-6 years - 0.5 ml, 7-18 years - 0.5-1.0 ml) or 0.1% klemastin (children 0,025 mg / kg / day for two injections).
5. Symptomatic therapy according to indications. In bronchospasm, 10.0 ml of a 2.4% solution of aminophylline on a 0.9% sodium chloride solution (2-3 mg / kg for children) is injected intravenously. 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 13-adrenoblockers showed additional administration of salbutamol and / or glucagon to / in 1 ml.
8. In acute edema of the larynx, intubation or tracheotomy 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% of patients who had anaphylactic shock, 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.