Syok Anafilaksis

1
Anaphylaxis
• Anaphylaxis is currently defined as a serious
allergic reaction that is rapid in onset and may
cause death
• It is considered to be highly likely when any
one of three clinical criteria are fulfilled
• Initial signs and symptoms in infants and
children with anaphylaxis are more likely to
involve respiratory distress than circulatory
collapse

2
 Risk Factor
• Patient risk factors, including age or
physiologic state-related vulnerability,
concomitant diseases, concurrent
medications, and co-factors, are similar
worldwide
• Vulnerable patients include infants, teenagers,
pregnant women, and the elderly

3
 Triggers and mechanisms
• Foods are consistently reported to be the most
common trigger of anaphylaxis in children and
teenagers
• In infants, sensitization to one or more foods is
common and is not necessarily accompanied by
any symptoms; however, in one population-based
sample, more than 10% of 1-year-olds had oral
challenge-proven clinical reactivity to uncooked
egg, peanut, or sesame

4
• Patients can react clinically to a specific
allergen in different ways, possibly reflecting
the allergen components to which they are
sensitized.
• As an example, in different countries, patients
with elevated serum IgE levels to peanut have
predominant IgE antibodies directed to
different allergen components, associated
with different symptom patterns.

5
Suatu reaksi anafilaktik berat yang
kadang – kadang fatal dengan disertai
tanda-tanda insufisiensi sirkulasi

6
Mechanisms of anaphylactic shock may be divided
into four main categories:
• the events that trigger the anaphylactic reaction;
• the cellular events that then lead to mediator
release;
• the clinical pharmacology of these mediators; and
finally
• the cardiovascular responses of patients to these
mediators.

7
Simons FER et al,.
WAO Journal
2011; 4:13–37
8
Dapat segera timbul atau 1 – 2 jam setelah
kontak dengan antigen
Makin cepat timbulnya gejala klinik  makin
hebat reaksi yang timbul
Pada yang terjadi lambat  dapat didahului
oleh gejala lebih dari 1 sistem organ atau lebih,
yaitu :
Kulit : pruritus, eritema, urtikaria, angio
edema
Saluran nafas : hidung tersumbat, serak,
batuk, rasa sakit di dada, sesak nafas,
stridor, wheezing
9
Mata : gatal, merah atau berair
Kemudian timbul tanda-tanda syok berupa
:
Tekanan darah rendah
Nadi cepat dan lemah
Keringat dingin
Kulit pucat (sianotik)

10
Simons FER et al,.
WAO Journal
2011; 4:13–37
11
12
 Treatment
• Inject epinephrine (adrenaline) 0.01 mg/kg
(0.1 cc/kg)(up to a maximum dose of 0.3 mg
[child] or 0.5 mg [teenager]) intramuscularly;
repeat dose every 5 to 15 minutes if no
improvement

13
14
 Treatment
• Administer high-flow oxygen (6–8 L/min) by
face or oropharyngeal airway
• Give IV fluid challenge, if indicated (child: 0.9%
[isotonic] saline, up to 30 mL/kg in first hour;
teen: 0.9% [isotonic] saline, 1–2 L rapidly [5–
10 mL/kg in first 5 min])

15
 Treatment
• Diphenhydramine IV, 1 mg/kg (maximum
50 mg) to relieve itch/hives persisting despite
epinephrine
• Methylprednisolone IV, 1–2 mg/kg/day
(maximum 60 mg, single dose)
• Nebulized albuterol 1.25–2.5 mg every 20 min
for 3 doses or continuously to relieve
bronchospasm persisting despite epinephrine

16
 Monitoring
• Heart rate and function (ECG)
• Blood pressure
• Oxygen saturation (pulse oximetry)

17
Basic management of anaphylaxis

18
19
20
Makin cepat gejala timbul makin buruk prognosisnya
Bila gejala timbul setelah > 30 menit  prognosis baik
Antigen yang masuk melalui mulut  prognosis yang lebih
baik daripada yang melalui parenteral

21
Thank You

22