Anafilassi

L’anafilassi è una reazione allergica grave e pericolosa per la vita. Può accadere pochi minuti o ore dopo essere stato esposto a una sostanza allergogena.

EZIOLOGIA – Assunzione di farmaci (penicilline, FANS, mezzi di contrasto radiologici), ingestione di cibo come latte di mucca, frutta a guscio (arachidi, noci, noci del Brasile, anacardi), crostacei,  gamberetti, grano, semi di sesamo, semi di girasole, esposizione o contatto con lattice, punture di insetti (api, vespe, calabroni).

Il polline e altri allergeni respirati raramente causano anafilassi. Possono causare sintomi allergici, ma le probabilità che pollini o altre allergie ambientali causino anafilassi sono molto basse.

FISIOPATOLOGIA – Nell’anafilassi, il sistema immunitario rilascia un’ondata di sostanze chimiche, soprattutto istamina, che possono causare uno shock.

EPIDEMIOLOGIA: l’anafilassi interessa il 0,05-2% della popolazione attiva. Le persone che soffrono di asma e che hanno avuto in precedenza una grave reazione allergica sono maggiormente a rischio di anafilassi.

SINTOMATOLOGIA –  i sintomi appaiono entro pochi minuti o alcune ore e comprendono:

• un brusco calo pressorio,
• broncospasmo con dispnea e respiro corto
• tachicardia,
• polso accelerato e debole,
• eruzione cutanea,
• crampi gastro-addominali,
• nausea e vomito
• diarrea
• dolore addominale
• dolore toracico
• gonfiore della gola e della lingua
• occhi gonfi
• difficoltà a deglutire, prurito e senso di oppressione alla gola
• Prurito e congestione nasale
• voce rauca
• respiro sibilante,  rumoroso
• tosse
• senso di stanchezza e confusione
• vertigini, sincope
• cute fredda con chiazze blu
• labbra o lingua blu, grigie o pallide

L’anafilassi può presentare una gradualità della sintomatologia in fasi per cui si può suddividere in quattro categorie:

• Fase uno: modesta  sintomatologia: eruzioni cutanee o arrossamenti, prurito o orticaria.
• Fase due: anafilassi moderata; si verifica quando una persona presenta sintomi più diffusi ed estesi come eruzioni cutanee e orticaria che si stanno diffondendo o un lieve gonfiore alle labbra o alla lingua.
• Fase tre: grave anafilassi che si manifesta con difficoltà respiratoria, gonfiore esteso, polso debole o vertigini; è una condizione di shock anafilattico .
• Fase quattro: forma di anafilassi pericolosa per la vita. Il paziente presenta una marcata ipotensione arteriosa, lipotimia, sincope, edema polmonare e respiro sibilante e corto. Richiede un immediato intervento farmacologico per evitare la morte.
• pressione sanguigna presenta improvviso e marcato calo, edema polmonare e successiva insufficienza cardio-respiratoria. L’anafilassi grave è potenzialmente molto più pericolosa nelle persone cardiopatiche e/o sofferenti di asma.

ANAFILASSI BIFASICA – L’anafilassi bifasica si verifica quando si ha una seconda ondata di sintomi dopo la scomparsa dei primi sintomi. Questa seconda ondata può avvenire ore o addirittura giorni dopo la prima ondata. Circa il 20% delle persone che soffrono di anafilassi sviluppano anafilassi bifasica.

TERAPIA –

• Ossigeno
• Antistaminici (Zirtec®, Trimeton® fl ev/im/sc, Ayrinal® cpr, Panifur® cpr) e cortisonici (Urbason® 40 mg fl im/ev) per via endovenosa per ridurre l’infiammazione delle vie aeree e migliorare la respirazione.
• ß-agonista (come l’albuterolo) per alleviare i sintomi respiratori
• Epinefrina (adrenalina) fiale, EpiPen® fl precaricata da 150, 300 µg, iniettata nel quadricipite femorale in caso di grave anafilassi. In caso di grave dispnea si ricorre a intubazione e, in casi estremi, tracheostomia. Se non viene trattata immediatamente, l’anafilassi può causare la morte del paziente.
• Reactifargan crema, Prilagin crema per le manifestazioni cutanee

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