Management of Emergency in Dental clinic

Anaphylaxis is a life-threatening reaction with respiratory, cardiovascular, cutaneous, or gastrointestinal manifestations resulting from exposure to an offending agent, usually a food, insect sting, medication, or physical factor. It causes approximately 1,500 deaths in the United States annually. Occasionally, anaphylaxis can be confused with septic or other forms of shock, asthma, airway foreign body, panic attack, or other entities. Urinary and serum histamine levels and plasma tryptase levels drawn after onset of symptoms may assist in diagnosis. Prompt treatment of anaphylaxis is critical, with subcutaneous or intramuscular epinephrine and intravenous fluids remaining the mainstay of management. Adjunctive measures include airway protection, antihistamines, steroids, and beta agonists. Patients taking beta blockers may require additional measures. Patients should be observed for delayed or protracted anaphylaxis and instructed on how to initiate urgent treatment for future episodes.

Anaphylaxis and anaphylactoid reactions are life-threatening events. A significant portion of the U.S. population is at risk for these rare but deadly events which cause approximately 1,500 deaths annually.  Anaphylaxis is mediated by immunoglobulin E (IgE), while anaphylactoid reactions are not. Both lead to the release of mast cell and basophil immune mediators (Table 1). Because of their clinical similarities, the term anaphylaxis will be used to refer to both conditions.

TABLE 1                                          
Mediators of Inflammation Implicated in Anaphylaxis and Their Effects