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Anaphylaxis + Mast Cell Activation


Our immune system is pretty amazing. It is innate, it's something we are born with. However, some of it is actually acquired through exposure of an antigen and then subsequent neutralizing antibody development. It arguably starts with the skin (on the surface) and gets much more complex under the surface as the system fights foreign invaders on a daily basis. Proteins, cells, tissues, and organs all work together in a concerted effort to keep you free from disease.... or combat a disease once it enters.


It is important to note though, that sometimes our immune systems have an overwhelming response that can cause us some acute harm. When our immune systems mobilize, they can sometimes go into overdrive, triggering a destructive over-reaction called a cytokine storm. This surge can be hard to stop, and many times healthy cells and organs can be damaged in the process.



What to look for:


An acute onset of an illness (keep in mind this could range from minutes to 1-2hours) with/without involvement of the skin* (urticaria, pruritus, flushing) and/or mucosa (angioedema/swelling of lips, tongue, larynx)


  1. Plus at Least One of the Following:

  2. Respiratory involvement (dyspnea, wheezing, stridor, reduced peak flows or hypoxemia);

  3. Reduced blood pressure and associated symptoms of end-organ dysfunction (syncope, fecal or urinary incontinence, hypotonia/collapse);

  4. Severe gastrointestinal symptoms (severe crampy abdominal pain, severe diarrhea, repetitive vomiting).


BOTTOM LINE: In anaphylaxis, more than (1) organ system will be involved!!


One of the mechanisms:


The foreign invader (antigen) binds to an antibody (IgE) on the surface of the mast cell. This causes de-granulation. The mast cells activate and spill its contents (histamine) amongst other things and the process gets started as cytokines generate. Histamine and the rest of the mediators are mostly responsible for the life-threatening physiologic findings that occur next. Those are vasodilation and bronchoconstriction. Epinephrine and its alpha and beta properties prove to be lifesaving as they combat the cardiorespiratory collapse.





As first responders is important to quickly recognize anaphylaxis so it can be promptly treated with epinephrine, the first-line treatment for anaphylaxis. Epinephrine is a hormone made by the adrenal glands. It works within minutes to prevent progression and reverse the symptoms of anaphylaxis. DON'T HESITATE - when in doubt -- give it.


People may wonder if they should administer epinephrine if they suspect — but aren’t sure — that they are having an anaphylactic reaction. The answer is yes. Epinephrine should be administered without delay if there is any concern or suspicion of anaphylaxis, because the risk of an untreated severe allergic reaction outweighs the risk of inappropriately receiving epinephrine.


There is no substitute for epinephrine, which is the only first-line treatment for anaphylaxis. Neither antihistamines nor glucocorticoids work as quickly as epinephrine, and neither can effectively treat the severe symptoms associated with anaphylaxis.

However, antihistamines such as diphenhydramine (Benadryl) or cetirizine (Zyrtec), glucocorticoids like prednisone, or a combination, may be used in addition to epinephrine in some cases of anaphylaxis, after epinephrine is administered.



January 8, 2024

Author: Joshua Ishmael, MBA, MLS(ASCP)CM, NRP

Pass with PASS, LLC.

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