Anaphylaxis is a severe, multisystem allergic or hypersensitivity reaction that is rapid in onset after contact with an allergen. It is often characterized by life-threatening breathing, airway, and circulatory problems and is associated with changes in the skin and mucosa (Reber, Hernandez, & Galli, 2017). It is considered to be an example of imbalances between cost and benefit of an immune system because the condition can be triggered by tiny amounts of antigen, such as insect stings or certain foods. Anaphylaxis is caused by the immunoglobulin E-mediated (IgE-mediated) mast cell degranulation (Tupper & Visser, 2010). This is a process that happens in the bloodstream by chemicals that can cause different reactions in the body. This results in a release of inflammatory immune mediators causing changes to the blood vessels, mucous secreting cells, and the contraction of smooth muscle in the lungs (Tupper & Visser, 2010). In other words, exposure to an allergen, such as peanuts or bee stings, will trigger a large amount of IgE antibody production in the body that will then attach onto mast cells. Mast cells are immune cells that are present in connective tissues, such as mucosal surfaces of the lungs and gut, throughout the body (Krystel-Whittemore, Dileepan, & Wood, 2015). The IgE antibodies circulate in the bloodstream, the next time an individual is exposed to an allergen, it will bind to the antibodies attached to the mast cells and trigger an allergic reaction by activating the release of chemical mediators from the mast cells affecting the respiratory and gastrointestinal system, circulatory system, and the skin (Goodridge et al., 2014).
Incidence:
Morbidity:
Mortality:
Developmental Considerations:
Incidence:
- Up to 30% of the Canadian population is affected by some sort of allergy (CAI, 2019)
- 1% of all emergency department visits are for allergic reactions, 8% of these are for anaphylaxis specifically (CIHI, 2014)
- Incidence of anaphylaxis is increasing across all age groups (Nwaru & Sheikh, 2015)
Morbidity:
- Estimated that around 2.5 million Canadians live with anaphylaxis, with the number of individuals that do to rise every year (Statistics Canada, 2019)
Mortality:
- From eating the wrong foods, 3500 Canadians experiences anaphylactic shock each year and of those 3500, about 12 individuals will die (CAI, 2019)
Developmental Considerations:
- Risk of morbidity and mortality being disproportionately high in adolescents is contributed largely to modifiable psychosocial factors that manifest during adolescence (Nwaru & Sheikh, 2015). Key barriers to manage the impact of the psychosocial environment during their developmental transition include (Nwaru & Sheikh, 2015):
- Risk-taking behaviours
- Poor judgement of actions during reactions
- Non-compliance to medication and management instructions, ex. prompt self-administration of intramuscular adrenaline (epinephrine)
- Children and infants may have a underdeveloped or weaker immune system that make them more prone to developing anaphylaxis but there is no direct evidence that anaphylaxis develops during childhood (Sampson, 1999).
- Many immunogenic and non-immunogenic mechanisms operate to prevent and target foreign antigens from penetrating the gut barrier and cause hypersensitivity reactions but immaturity of such mechanisms decreases the efficiency of the mucosal barrier (Sampson, 1999)
References
Canadian Anaphylaxis Initiative (CAI). (2019). Raising Awareness for Anaphylaxis. Retrieved from http://cai-allergies.ca/?page_id=631
Canadian Institute for Health Information (CIHI). (2014). Anaphylaxis and Allergy in the Emergency Department. Retrieved from https://secure.cihi.ca/free_products/Anaphylaxis_Infosheet_en.pdf
Goodridge, D., Lewis, S., Goldworthy, S., & Barry, M. (2014) Medical-Surgical Nursing in Canada: Assessment and Management of Clinical Problems (3rd Canadian Ed.). Toronto, ON: Elsevier Canada.
Krystel-Whittemore, M., Dileepan, K. N., & Wood, J. G. (2016). Mast Cell: A Multi-Functional Master Cell. Frontiers in Immunology,6. doi:10.3389/fimmu.2015.00620
Nwaru, B. I., & Sheikh, A. (2015). Anaphylaxis in adolescents. Current Opinion in Allergy and Clinical Immunology,15(4), 344-349. doi:10.1097/aci.0000000000000176
Sampson, H. A. (1999). Food allergy. Part 1: Immunopathogenesis and clinical disorders. Journal of Allergy and Clinical Immunology,103(5), 717-728. doi:10.1016/s0091-6749(99)70411-2
Statistics Canada. (2017, November 14). Chronic Conditions. Retrieved from https://www150.statcan.gc.ca/n1/pub/82-625-x/2018001/article/54983-eng.htm
Tupper, J., & Visser, S. (2010). Anaphylaxis. Canadian Family Physician,56(10), 1009-1011.
Reber, L., Hernandez, J., & Galli, S. (2017). The Pathophysiology of Anaphylaxis. Journal of Allergy and Clinical Immunology,140(2), 335-348. doi:10.1016/j.jaci.2017.06.003
Canadian Anaphylaxis Initiative (CAI). (2019). Raising Awareness for Anaphylaxis. Retrieved from http://cai-allergies.ca/?page_id=631
Canadian Institute for Health Information (CIHI). (2014). Anaphylaxis and Allergy in the Emergency Department. Retrieved from https://secure.cihi.ca/free_products/Anaphylaxis_Infosheet_en.pdf
Goodridge, D., Lewis, S., Goldworthy, S., & Barry, M. (2014) Medical-Surgical Nursing in Canada: Assessment and Management of Clinical Problems (3rd Canadian Ed.). Toronto, ON: Elsevier Canada.
Krystel-Whittemore, M., Dileepan, K. N., & Wood, J. G. (2016). Mast Cell: A Multi-Functional Master Cell. Frontiers in Immunology,6. doi:10.3389/fimmu.2015.00620
Nwaru, B. I., & Sheikh, A. (2015). Anaphylaxis in adolescents. Current Opinion in Allergy and Clinical Immunology,15(4), 344-349. doi:10.1097/aci.0000000000000176
Sampson, H. A. (1999). Food allergy. Part 1: Immunopathogenesis and clinical disorders. Journal of Allergy and Clinical Immunology,103(5), 717-728. doi:10.1016/s0091-6749(99)70411-2
Statistics Canada. (2017, November 14). Chronic Conditions. Retrieved from https://www150.statcan.gc.ca/n1/pub/82-625-x/2018001/article/54983-eng.htm
Tupper, J., & Visser, S. (2010). Anaphylaxis. Canadian Family Physician,56(10), 1009-1011.
Reber, L., Hernandez, J., & Galli, S. (2017). The Pathophysiology of Anaphylaxis. Journal of Allergy and Clinical Immunology,140(2), 335-348. doi:10.1016/j.jaci.2017.06.003