Cannabinoids-Adjunct Treatment for Anaphylaxis or Reaction

Anaphylactic or Reaction

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Anaphylaxis is the most severe form of allergic reaction and is potentially life threatening.  It must be treated as a medical emergency, requiring immediate treatment and urgent medical attention.
Anaphylaxis is a generalized allergic reaction, which often involves more than one body system (e.g. skin, respiratory, gastro-intestinal, and cardiovascular).  A severe allergic reaction usually occurs within 20 minutes of exposure to the trigger and can rapidly become life threatening.

Anaphylaxis is highly likely to be occurring when any ONE of the following happens within minutes to hours after ingestion of the food allergen:

1. A person has skin symptoms or swollen lips and either:

  • Difficulty breathing, or
  • Reduced blood pressure (e.g., pale, weak pulse, confusion, loss of consciousness)

2. A person was exposed to a suspected allergen, and two or more of the following occur:

  • Skin symptoms or swollen lips
  • Difficulty breathing
  • Reduced blood pressure
  • Gastrointestinal symptoms (i.e., vomiting, diarrhea, or cramping)

3. A person was exposed to a known allergen, and experiences:

  • reduced blood pressure

Signs and Symptoms

Mild to moderate allergic reaction

  • Tingling of the mouth
  • Hives, welts or body redness (see example images
  • Swelling of the face, lips, eyes (see example images
  • Vomiting, abdominal pain

Severe allergic reaction- ANAPHYLAXIS

  • Difficulty and/or noisy breathing
  • Swelling of the tongue
  • Swelling or tightness in the throat
  • Difficulty talking or hoarse voice
  • Wheeze or persistent cough
  • Loss of consciousness and/or collapse
  • Pale and floppy (children)

An anaphylactic reaction may begin with a tingling sensation, itching, or a metallic taste in the mouth.  Other symptoms can include hives, a sensation of warmth, wheezing or other difficulty breathing, coughing, swelling of the mouth and throat area, vomiting, diarrhea, cramping, a drop in blood pressure, and loss of consciousness.  These symptoms may begin within several minutes to two hours after exposure to the allergen, but life-threatening reactions may get worse over a period of several hours.

In some reactions, the symptoms go away, only to return one to three hours later.  This is called a “biphasic reaction”.  Often these second-phase symptoms occur in the respiratory tract and may be more severe than the first-phase symptoms.  Studies suggest that biphasic reactions occur in about 20% of anaphylactic reactions.

Anaphylaxis can present with many different symptoms due to the systemic effects of histamine release.  These usually develop over minutes to hours.  The most common areas affected include skin (80% to 90%), respiratory (70%), gastrointestinal (30% to 45%), heart and vasculature (10% to 45%), and central nervous system (10% to 15%).

Skin

Skin involvement may include generalized hives, itchiness, flushing, and swelling of the lips, tongue, or throat.

Respiratory

Respiratory symptoms may include shortness of breath, wheezes, and low oxygen.  Hyperventilation is also recorded

Gastrointestinal

Gastrointestinal symptoms may include crampy abdominal pain, diarrhea, and vomiting.

Cardiovascular

Due to the presence of histamine-releasing cells in the heart, coronary artery spasm may occur with subsequent myocardial infarction or dysrhythmia.

Nervous system

A drop in blood pressure may result in a feeling of lightheadedness and loss of consciousness.  There may be a loss of bladder control and muscle tone, and a feeling of anxiety and "impending doom"
Anaphylaxis is a severe allergic reaction that occurs rapidly and causes a life-threatening response involving the whole body.  This reaction can lead to difficulty breathing and shock ultimately leading to death.
For an anaphylactic reaction to occur, you must have been exposed in the past to the substance that causes the reaction, called the antigen.  This is called "sensitization”.

A bee sting, for example, may not cause an allergic reaction the first time.
Another bee sting may produce a sudden, severe allergic reaction known as anaphylaxis or anaphylactic shock.
These reactions usually occur within seconds to minutes of exposure.  Occasionally, they are delayed.
You may develop sensitivity and anaphylaxis to a substance that you have been exposed to many times in the past without a reaction, and often people do not recall the previous exposure.

 

What happens after the symptoms begin?

There are three possible outcomes:
The signs and symptoms may be mild and fade spontaneously or be quickly ended by administering emergency medication.  In this outcome, the symptoms do not subsequently recur from this particular exposure.
After initial improvement, the symptoms may recur within 4 to 12 hours (late phase reaction), require additional treatment, and close observation.  Recent evidence suggests that a late phase reaction occurs in fewer than 10% of cases.
Lastly, the reaction may be persistent and more severe, thus requiring intensive medical treatment and hospitalization.  This may occur up to 20% of the time with certain exposures.

Epinephrine, which is also known as "adrenaline”, is a drug that acts immediately to cause the blood vessels to contract, thereby preventing fluid leakage.  It is one of the medications frequently used to treat anaphylaxis.  Epinephrine also helps relax the bronchial tubes, thus relieving breathing difficulty.  It also lessens stomach cramps and stops itching and hives.  More importantly, epinephrine helps prevent the release of more mediators of the allergic reaction.  In addition to epinephrine, other medications and IV fluids and oxygen will probably be administered as well.  The choice of interventions will depend on the severity of the reaction the patient experiences.

Are there any disorders that appear similar to anaphylaxis?
Several disorders may appear similar to anaphylaxis.  Fainting (vaso-vagal reaction) is the reaction that is most likely to be confused with anaphylaxis.  The key differences are that in a fainting episode, the affected person has a slow pulse, cool and pale skin, and no hives or difficulty breathing.  Other conditions, such as heart attacks, blood clots to the lungs, septic shock, and panic attacks can also be confused with anaphylaxis.

How common is anaphylaxis?

The exact prevalence of anaphylaxis is unknown.  The available statistics probably underestimate the true frequency because reactions are not always reported.  Milder reactions may be attributed to an asthma attack or a sudden episode of hives.  More serious, fatal episodes might be reported as a heart attack since the indicative signs of hives, swollen throat, and asthma can fade quickly.  Thus, it is quite possible that even the true incidence of fatalities due to anaphylaxis is both under- recognized and under-reported.  The importance of awareness, early recognition, and prompt treatment of this disorder must be stressed.

What causes Anaphylaxis

Common triggers of anaphylaxis include:

Food

Milk, eggs, peanuts, tree nuts, sesame, fish, crustaceans and soy are the most common food triggers, which cause 90% of allergic reactions, however, any food can trigger anaphylaxis.  It is important to understand that even trace amounts of food can cause a life-threatening reaction.  Some extremely sensitive individuals can react to even the smell of a food (e.g. fish)

Insect Venom
Bee, wasp and jumper ant stings are the most common causes of anaphylaxis to insect stings.  Ticks and fire ants also cause anaphylaxis in susceptible individuals.

Medication

Medications, both over the counter and prescribed, can cause life threatening allergic reactions.  Individuals can also have anaphylactic reactions to herbal or ‘alternative’ medicines.

Other

Other triggers such as latex or exercise induced anaphylaxis are less common and occasionally the trigger cannot be identified despite extensive investigation.

The causes of anaphylaxis are divided into two major groups:
IgE mediated: This form is the true anaphylaxis that requires an initial sensitizing exposure, the coating of mast cells and basophils (cells in the blood and tissue that secrete the substances that cause allergic reactions, known as mediators) by IgE, and the explosive release of chemical mediators upon re-exposure.

Non-IgE mediated: These reactions, the so-called "anaphylactic" reactions, are similar to those of true anaphylaxis, but do not require an IgE immune reaction.  They are usually caused by the direct stimulation of the mast cells and basophils.  The same mediators as occur with true anaphylaxis are released and the same effects are produced.  This reaction can happen, and often does, on initial as well as subsequent exposures, since no sensitization is required.

The terms anaphylaxis and anaphylactic (meaning "like anaphylaxis") are both used to describe this severe, allergic reaction.  Anaphylaxis is used to describe reactions that are initiated by IgE and anaphylactic is used in reference to reactions that are not caused by IgE.  The effects of the reactions are the same, however, and are generally treated in the same manner.  Often, they cannot be distinguished initially.
Although it may appear that IgE mediated anaphylaxis occurs upon a first exposure to a food, drug, or insect sting, there must have been a prior, and probably unwitting, sensitization from a previous exposure.  You may not remember an uneventful sting or be aware of "hidden" allergens in foods.

Medications

Epinephrine - Given in severe allergic reactions, epinephrine is extremely effective and fast acting; it acts by constricting blood vessels, which increases blood pressure, and widening the airway.  Epinephrine is given by injection into the muscle, through an IV line, or by injection under the skin.

H1-receptor blockers/antihistamines - Usually diphenhydramine (Benadryl); these drugs do not stop the reaction but relieve some of the symptoms.  IV may give them, by injection in the muscle, or by mouth
Inhaled beta-agonists (albuterol) - Used to treat bronchospasm (spasms in the lung) and dilate the airways; inhaled
H2-receptor blockers - Usually cimetidine (Tagamet); given by IV or by mouth
Corticosteroids (examples are prednisone, Solu-Medrol) - These drugs help decrease the severity and recurrence of symptoms; may be given orally, injected in muscle, or by IV line
If low blood pressure does not improve, additional medications, such as dopamine, may be given.

Medical Treatment

The first priority in the emergency department is to protect the airway (breathing) and maintain adequate blood pressure.
The emergency team will make sure that your airway is open and that you are getting adequate oxygen.
Oxygen may be given through tubes into the nose or by facemask.
In severe respiratory distress, mechanical ventilation may be required.  In this situation, a tube is placed via the mouth into the air passages to keep the airway open.  The tube is connected to a ventilator (providing oxygen directly into the lung).
In rare cases, a simple surgery is performed to open an airway.

If blood pressure is dangerously low, medication to increase blood pressure will be given.
An intravenous (IV) catheter may be inserted.
This is used to give saline solution to help boost blood pressure.
The IV line may also be used to give medication.
You may need to be admitted to the hospital for further monitoring and treatment.

Severe Allergic Reaction Treatment

Self-Care at Home

Do not attempt to treat severe reactions or to "wait it out" at home.  Go immediately to the nearest emergency department or call an ambulance.
While waiting for the ambulance, try to stay calm.
If you can identify the cause of the reaction, prevent further exposure.
Take an antihistamine (one to two tablets or capsules of diphenhydramine [Benadryl]) if you can swallow without difficulty.
If you are wheezing or having difficulty breathing, use an inhaled bronchodilator such as albuterol (Proventil) or epinephrine (Primatene Mist) if one is available.  These inhaled medications dilate the airway.
If you are feeling light-headed or faint, lie down and raise your legs higher than your head to help blood flow to your brain.
If you have been given an epinephrine kit, inject yourself as you have been instructed or have someone else perform the injection.  The kit provides a premeasured dose of epinephrine, a prescription drug that rapidly reverses the most serious symptoms of anaphylaxis.
Bystanders should administer CPR to a person who becomes unconscious and stops breathing or does not have a pulse.
Tell medical personnel what medications you take and your allergy history.

When to Seek Medical Care

Act quickly if someone experiences the symptoms of an anaphylactic reaction.  True anaphylaxis is a medical emergency and requires immediate treatment in an emergency department of a hospital, where the person can be watched closely and life-saving treatment can be given.
It is impossible to predict how severe the allergic reaction will be.  Any person who shows symptoms of anaphylaxis must be transported to a hospital emergency department.
If swelling develops rapidly, particularly involving the mouth or throat, and you have trouble breathing or feel dizzy, light-headed, or faint, call 911 for ambulance transport to the hospital.
While awaiting the ambulance, administer self-treatment.  {(Cannabinoid extract spray (nose/mouth)} as adjunct to other medication you might be using (Benadryl).

Outlook

With appropriate and timely treatment, you can expect full recovery.  With severe anaphylaxis, although rare, people may die from low blood pressure (shock) or respiratory and cardiac arrest.

Prevention

Strictly avoid contact with the substance (allergen) that was the trigger.
If the trigger is a food, you must learn to read food labels carefully.  When ordering foods at restaurants or eating in friends' homes, ask about ingredients.  Be aware of ingredients that may contain triggers.  Avoid eating foods if you cannot confirm their ingredients.  If your reactions are severe, contact the manufacturer to assure that the triggering food was not processed in the same area as a food to which you are allergic.
If the trigger is a drug, inform all health care providers of the reaction.  Be prepared to report what happened when you had the reaction.  Wear a tag (necklace or bracelet) that identifies the allergy.

Insect stings are more difficult to avoid.  Wear long-sleeved clothing outdoors.  Avoid bright colors and perfumes that attract stinging insects.  Use caution with sweetened beverages outdoors, such as uncovered soft drinks.
People who are likely to be re-exposed to (or are unable to avoid) an allergen that has caused them a severe anaphylactic reaction in the past should see an allergist for desensitization.  Skin testing may be required to help identify the allergen.

Cannabinoid Facts

PEA an endogenous cannabinoid found in the brain has anti-anaphylactic and anti-inflammatory activity.
Cannabinoids have natural occurring allergenic properties.
Cannabinoids relax smooth muscles.
Endocannabinoids suppress the release of pro-inflammatory mediators.
Cannabinoids are vaso-dilators.
More research should be done using cannabis (medical marijuana) as an adjunct treatment for anaphylaxis or reaction.