Sedating antihistamines asthma

In 1902, Charles Richet and Paul Portier first described the phenomenon of anaphylaxis, which literally means 'against protection', aboard Prince Albert of Monaco's yacht in the Mediterranean.

They reported on their attempts to immunise dogs against jellyfish stings (Portuguese Man-of-War), which resulted in the sudden death of a number of the animals.

In a study of fatal anaphylaxis, the median time to cardiac or respiratory arrest was 30 minutes for food allergens, 15 minutes for insect venom and 5 minutes for medications or radiological contrast reagents (Pumphrey, 2000).

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The immunobiology and pathophysiology of anaphylaxis are basically the same, irrespective of the initial trigger, although there may be subtle differences in the responses.

The term 'anaphylactoid' has been used to represent the identical clinical pictures seen as a result of the degranulation of mast cells and basophils, but which are not mediated through Ig E.

On recognition, immediate injection of intramuscular adrenaline is the treatment of choice, the response to which is often dramatic and potentially life-saving.

The use of adrenaline in the treatment of acute anaphylaxis is well established.

The treatment for both of the mechanisms is identical, and the misinterpretation of anaphylactoid reactions has resulted in fatal re-exposure of the patient to the allergen concerned (Fischer, 1995).

The release of cell mediators during anaphylaxis leads to end-organ responses in the skin, respiratory, cardiovascular, gastrointestinal, and central nervous systems.A clinical presentation of anaphylaxis in its extreme or classical form is easily recognised.In reality, it is often far more difficult to identify, with variable target organ involvement and expression of symptoms.Dr Andrew Bentley Consultant in Respiratory and Critical Care Medicine South Manchester University Hospital Trust Wythenshawe Hospital Manchester, M23 9LT, UK Dr Dermot Ryan GPIAG Clinical Research Fellow Department of Primary Care, University of Aberdeen General Practitioner, Woodbrook Medical Centre, Loughborough, LE11 1NH, UK Dr David Luyt Consultant in Paediatric Medicine, Leicester Royal Infirmary, Leicester, LE1 5WW, UK Anaphylaxis creates fear and uncertainty throughout the medical profession and general public alike.It occurs unexpectedly and may progress rapidly in patients of all ages, often in the young and otherwise healthy.Identifying these severe features aids clinical diagnosis.

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