Anafilasisi

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Anafilasisi
Classification and external resources

Wiwu awọ-ara ti oju eyiti o jẹ wipe ọmọdekunrin naa ko le e la oju rẹ. Eyi waye nipasẹ nini ikọlu si nkan ti ara korira.
ICD-10 T78.2
ICD-9 995.0
DiseasesDB 29153
MedlinePlus 000844
eMedicine med/128
MeSH D000707

Anafilasisi jẹ nkan ti ara korira si ti o l’ewu kan ti o ma nyara waye ti o si le fa iku.[1] O maa nni awọn abajade aami aiṣan ti o ni ara to njanijẹ gan-an, ọọfun ti o nwu, ati riru ẹjẹ ti o lọ silẹ ninu. Awọn okunfa ti o wọpọ julọ ni ki kokoro j’ẹni/t’ani, ounjẹ, ati oogun.

Lori ipele nipa ayipada ti aiṣan ṣe okunfa ati ẹkọ nipa wọn, anafilasisi maa nwaye nipa jijọwọ awọn olulaja kan lati awọn oriṣi sẹẹli ẹjẹ funfun ti a taji yala nipa ajẹsara tabi awọn eto ti ko nii fiṣe pẹlu ajẹsara. A maa nṣe ayẹwo rẹ nipa awọn aami ti o nfarahan lọwọ lọwọ. Ọna itọju akọkọ ni nipa fi fun ni l’abẹrẹ efinifirini, pẹlu awọn ọna miiran ti o nṣiṣẹ papọ pẹlu rẹ.

Ni gbogbo agbaye, awọn eniyan ti o to 0.05–2% ni o ni anafilasisi ni ipo kan igbe aiye wọn ati pe iye yii jọ wipe o npọ sii. Ọrọ naa wa lati ἀνά ana, Giriki lodi si, ati φύλαξις filasi,idaabobo.


Awọn aami aiṣan[àtúnṣe | àtúnṣe àmìọ̀rọ̀]

Awọn aami aiṣan anafilasisi. Anafilasisi fi oriṣiriṣi aami aiṣan han laarin iṣẹju tabi wakati [2][3] pẹlu iye 5 si 30 ni ibẹrẹ pẹpẹ  iṣẹju bi nini ifarakan ba jẹ ninu iṣan ati 2 wakati fun awọn ounjẹ.[4] Ibi ti o wọpọ julọ lati ni ikọlu ni: Awọ-ara (80–90%), mimi (70%), ifun (30–45%), ọkan ati ọpa ti o ngbe ẹjẹ kiri ara (10–45%), ati eto iṣakoso awọn iṣan (10–15%)[3] pẹlu l’ọpọlọpọ igba nkan meji tabi ju bẹẹ lọ ninu eyi.[5]

Awọ-ara[àtúnṣe | àtúnṣe àmìọ̀rọ̀]

Wiwu ti o pọn to nyun ni eyiti o nwaye nitori ikorira ara si nkankan ati pipọn oju lẹyin ẹniti o ni anafilasisi

Aami aiṣan ni ninu kokoro ara, ara ti njanijẹ, pipọn oju tabi ètè wiwu.[6]Awọn ti wọn ni wiwu tabi wiwu awọ-ara le ṣe apejuwe imọlara ijọna kan l’ara yatọ si ara ti o njanijẹ.[4] Wiwu ahọn tabi ọnafun ni bii 20% awọn eyi ti o waye.[7] Awọn nkan miiran le ni ninu imu ti o nṣe ikun ati wiwu kọnjutifa.[8] Ara naa tun le ni ti o ni àwọ̀ -bulu nitori laisi atẹgun ti a nmi sinu.[8]

Mimi[àtúnṣe | àtúnṣe àmìọ̀rọ̀]

Awọn aami aiṣan ti o rọ mọ mimi le wa, ti o ni ninu aile mi delẹ, mimi ti o ngbọn tabi [idiwọ ọnafun]].[6] Eemi ti o ngbọn maa nsaba nwaye nipasẹ gbigbọn ti ẹdọ foo eyiti sisunki awọn iṣan maa nfa[9] nigbati mimi ti o wa lati idiwọ ọnafun (stridor) ni asopọ pẹlu didi ọna alafo atẹgun ti oke eyiti o ṣe igbakeji si wiwu.[8] Ohùn kikẹ, irora pẹlu gbigbe nkan mi, tabi ikọ tun le waye.[4]


Nipa ọkan[àtúnṣe | àtúnṣe àmìọ̀rọ̀]

Gbigbọn ọpa to ngbe ẹjẹ kuro lati ọkan le ṣẹlẹ pẹlu myocardial infarction, aidun deedeti o tẹle, tabicardiac arrest.[3][5] Awọn ti o ni aiṣan ti ko han sita ninu ọpa ti o ngbe ẹjẹ kiri ara wa ninu ewu ti o gaju nipa ọkan lati ọwọ anafilasisi.[9] Gbigbọn ọpa ti o ngbe ẹjẹ kiri ara nii fiṣe pẹlu wíwà awọn sẹẹli kan ti njọwọ hisitamini sinu ọkan.[9] Nigbati ọkan ti o nyara sáré ti o waye nipase riru ẹjẹ ti o lọ silẹ jẹ eyiti wọpọ,[8] a ti ṣe apejuwe Bezold–Jarisch reflex ni 10% awọn iṣẹlẹ, nibiti ọkan ti o nlọra sáré ti ni asopọ pẹlu riru ẹjẹ ti o lọ silẹ.[10] Lilọ silẹ riru ẹjẹ tabi ijaya (yala [[ ijaya ti o lo kaakiri ara|ti o lo kaakiri ara] tabi [[ijaya ọkan|ti ọkan]) le mu lọwọ imọlara fifuyẹ tabi pipadanu òye ìwàláàyè.[9] Lilọ silẹ riru ẹjẹ kii saba jẹ aami kansoso fun anafilasisi.[7]

Omiiran[àtúnṣe | àtúnṣe àmìọ̀rọ̀]

Awọn aami aiṣan ninu ifun le ni pajapaja ninu inu rirun, igbẹ-ọrin, ati eebi bίbὶ.[6] Idamu le wa, ipadanu akoso apo-ὶtợ tabi irora egungun ibadi ti o jọ ti pajapaja niiṣe pẹlu ile-ọmọ.[6][8] Lilanu silẹ ọpa ti o ngbe ẹjẹ ni ayika ọpọlọ le fa ẹfọri.[4] Imọlara iporuru ọkan tabi "ewu kan ti o nbo wa" ni a ti ṣe apejuwe rẹ ri.[5]

Awọn okunfa[àtúnṣe | àtúnṣe àmìọ̀rọ̀]

Anafilasisi le waye ni esi si eyikeyi ohun ajeji.[11] Ohun ti o le faa ti o wọpọ ni ninu orólati jijẹni ati titani kokoro, awọn ounjẹ, ati ogun lilo.[10][12] Ounjẹ ni o wọpọ julọ ti o ma nfaa ninu awọn ọmọde ati ọdọ ṣugbọn ogun lilo ati jijẹni ati titani kokoro ni o wọpọ julọ laarin awọn agbalagba.[5] Awọn okunfa ti ko wọpọ nί ninu: awọn nkan ti eniyan le f’ojuri, nkan ti o niiṣe pẹlu nkan ẹlẹmi bii àtọ̀, oje, ayipada ti o niiṣe pẹlu homoni, awọn afikun ounjẹ bii iyọ oyinbo lati inu ireke ati àwợ ounjẹ (food colors), ati awọn ogun lilo kan.[8]Awọn nkan ti a le f’ojuri bii ṣiṣe idaraya (eyiti a mọ si anafilasisi ti idaraya ṣe okunfa rẹ) tabi iwọn gbigbona tabi titutu (yala gbigbona tabi titutu) le tun ṣe okunfa nipa ipa wọn ni taara lori sẹẹli masiti.[5][13] Awọn nkan ti idaraya ṣe okunfa maa nni asopọ pẹlu jijẹ awọn ounjẹ kan.[4] Nigba kikunni loorun fun iṣẹ abẹ, neuromuscular blocking agents, oogun aporo, ati oje lo wọpọ julọ ti o nfaa.[14] Ninu 32-50% awọn iṣẹlẹ, ohun ti o ṣe okunfa jẹ eyiti a ko mọ idi rẹ, eyiti a npe ni "anafilasisi ti idiopatiki".[15]


Ounjẹ[àtúnṣe | àtúnṣe àmìọ̀rọ̀]

Ọpọlọpọ ounjẹ lo le ṣe okunfa anafilasisi; eyi le waye ni igba akoko ti a mọ ti a jẹ ounjẹ yii.[10] Awọn ounjẹ ti o nṣe okunfa kaakiri agbaye yatọ si ara wọn. Ni Iwọ oorun, jijẹ tabi nini ifarakan si ẹpa, wheat, ẹpa ara igi,shellfish, ẹja, wara-olomi, ati ẹyin jẹ awọn okunfa ti o gbalẹ julọ.[3][5] Ekuku ni o wọpọ julọ ni Middle East, nigbati irẹsi ati chickpea maa njẹ orisun anafilasisi ti awọn ara Asia maa nsaba dojukọ.[5] Iṣẹlẹ ti o l’ewu julọ maa nwaye nipa jijẹ ohun ti ara korira (allergen),[10] ṣugbọn awọn eniyan maa nni iriri ti o l’ewu nigbati wọn ba ni ifarakan. Awọn ọmọde le dagba ki wọn bọ lọwọ ohun ti ara wọn korira. Ni bii ọjọ-ori 16, ida awọn ọmọde ti o to 80% ti o ni anafilasisi si wara-olomi tabi ẹyin ati ida 20% ti o ni iriri anafilasisi si ẹpa le farada awọn ounjẹ wọnyii.[11]

Oogun lilo[àtúnṣe | àtúnṣe àmìọ̀rọ̀]

Eyikeyi oogun fun lilo le fa anafilasisi. Eyiti o wọpọ julọ ni oogun aporo β-lactam (bii pẹnisilini) ti asipirini tẹle ati NSAIDs.[3][16] Awọn oogun aporo miiran kii saba faa, ati ni ọpọ igba bi ara ṣe nṣe si NSAIDS dale lori ohun ti o nṣiṣẹ ni pato eyiti o tumọ si wipe bi ara eniyan ba ni ikọkira si NSAID kan wọn le fi ara da omiiran.[16] Awọn o nfa miiran ti ko wọpọ ni kẹmotẹrapi, awọn ajẹsara, protamini ati awọn agbo ti a pese.[5][16] Awọn oogun (fankomaisin, mọfini,x-ray contrast laarin awọn miiran) maa nfa anafilasisi nipasẹ ti ta sẹẹli masiti ji ti o si ntaji ni taara bi awọn sẹẹli masti ṣe njọwọ granuli.[10] Bi ara ṣe nṣe si nkan kan dale lori bi a ti ṣe nlo ni apakan ati ni apakan awọn abuda ti nkan yii ni ninu.[17] Anafilasisi si pẹnisilini tabisẹfalosiporini nikan maa nwaye lẹyin ti wọn ba sopọmọ awọn protini ninu ara ti awọn nkan kan maa ntete sopọmọ pẹlu irọrun ju awọn miiran lọ.[4] Anafilasisi si pẹnisilini maa nwaye ni ẹẹkan ninu 2,000 si 10,000 iṣẹlẹ fun itọju, ti iku si maa waye ni eyiti o kere ju ookan ninu 50,000 iṣẹlẹ fun itọju.[4] Anafilasisi si aspirini ati awọn NSAID maa nwaye ni bii ẹẹkan ninu eeyan 50,000.[4] Bi ẹnikan kan ba ni bi ara rẹ ṣe nṣe si pẹnisilini ti ko dara ewu bi ara wọn yoo ṣe ṣe si sẹfalosporini yoo gaju ṣugbọn yoo si kere sii ookan ninu 1000.[4] Awọn nkan ayẹ ara wo atijọ maa nmu bi ara ṣe nṣiṣẹ lodi ni 1% awọn iṣẹlẹ nigbati awọn titun maa nmu bi ara ṣe nṣiṣẹ lodi ni 0.04% awọn iṣẹlẹ wa.[17]

Oró[àtúnṣe | àtúnṣe àmìọ̀rọ̀]

Oró lati ara awọn kokoro ti nt’ani tabi j’ẹni bii Hymenoptera (oyin ati agbọn) tabi Triatominae (kissing bugs) le fa anafilasisi ninu awọn eniyan ti wọn ni ailera sii.[3][18] Awọn [[Aiṣan_to ntan kaa kiri gbogbo ara|Ṣiṣẹ iṣẹ lodi to tan kaa kiri gbogbo ara], eyiti o jẹ ohunkohun ti o ju bi ara ṣe ṣe ni ayika ibi ti kokoro ti t’ani lọ, eyiti o le jẹ ewu okunfa fun anafilasisi ọjọ iwaju;[19][20] ẹwẹ, idaji eyiti o ja si iku ko ni bi ara ṣe nṣe lodi ti o tan kaa kiri ara tẹle.[21]

Awọn nkan to nfa Ewu[àtúnṣe | àtúnṣe àmìọ̀rọ̀]

Awọn eniyan ti o ni awọn aiṣan nini iha si nini awọn nkan ti ara korira bii ikọ-ifee, lapalapa, tabi allergic rhinitis wa ninu ewu ti o ga lati ni anafilasisi lati inu ounjẹ, oje, ati nkan ti a fi nwo bi nkan ṣe ri ninu ara lai nii lati ara oogun ti a fun ni nipasẹ abẹrẹ tabi kokoro to t’ani.[5][10] Ẹkọ kan ninu awọn ọmọde ṣe iwadi pe 60% ti ni itan aiṣan nini iha si nini awọn nkan ti ara korira tẹle, ati pe fun awọn ti o ku lati ọwọ anafilasisi awọn ti o gaju 90% ni ikọ-ifee.[10] Awọn ti wọn ni masitosaitosisi tabi ti ipo iṣuna owo wọn ga wa ninu ewu ti o pọ.[5][10] Bi iye akoko ti eniyan fi ni ifarako si nkan ti a ti tọka si pe o nfaa ṣe pẹ si bẹẹ ni ewu rẹ ṣe lọ silẹ si.[4]

Ayipada ti aiṣan ṣe okunfa ati ẹkọ nipa wọn[àtúnṣe | àtúnṣe àmìọ̀rọ̀]

Anafilasisi jẹ bi ara ṣe nṣe si nkan ti ara korira ti o nira gan-an ti o le ṣe okunfa oniruru idena fun eto bi ara ṣe nṣiṣe.[1][22] Eyi dale lori jijọwọ awọn olulaja to nfa aiṣe deede ati saitokinisi lati ara awọn sẹẹli masiti ati awọn basofili, ti dale lori bi ara ṣe nṣiṣe ajẹsara ṣugbọn nigbamii lori awọn eto ti ko niiṣe pẹlu ajẹsara ara.[22]

Ti ajẹsara[àtúnṣe | àtúnṣe àmìọ̀rọ̀]

Ninu eto ajẹsara, immunoglobulin E (IgE) maa nsopọ mọ antigini (nkan ajeji ti o ru bi ara ṣe nṣe lodi si nkan ti o korira). Antigini-ti o sopọ mọ IgE yoo wa mu olugbaFcεRI ṣiṣẹ lori awọn sẹẹli masiti ati basofili. Eyi yoo wa ṣe okunfa jijọwọ awọn olulaja nkan ti ko tọ bii histamini. Awọn olulaja yii maa njẹ ki ẹdọ-foo ki iṣan didan sunki, ta fifẹ awọn ọpa ti o ngbe ẹjẹ kiri ara ji, maa njẹ ki jijo omi lara ẹjẹ inu ọpa-ẹjẹ pọ, ki o si fa irẹwẹsi iṣan ọkan.[4][22] Eto ajẹsara kan tun wa ti ko da lori IgE, ṣugbọn a ko mọ boya eyi nwaye ninu eniyan.[22]

Ti ko niiṣe pẹlu ajẹsara[àtúnṣe | àtúnṣe àmìọ̀rọ̀]

Eto ti ko niiṣe pẹlu ajẹsara ni ninu awọn nkan ti o nfa ni taara bi sẹẹli ṣe njọwọ granuli fun awọn sẹẹli masiti ati basofili. Eyi ni ninu awọn nkan bii nkan ti a fi nwo bi nkan ṣe ri ninu ara, opioids, iwọn gbigbona tabi tutu (gbigbona tabi tutu), ati gbigbọn.[13][22]

Ayẹwo[àtúnṣe | àtúnṣe àmìọ̀rọ̀]

A maa nṣe ayẹwo anafilasisi lori awọn abuda aiṣan.[5] Nigbati eyikeyi ninu awọn nkan mẹta wọnyi ba waye laarin iṣẹju/wakati si nini ifarakan si awọn ohun ti ara korira nigba naa o ṣe e ṣe ki anafilasisi wa:[5]

  1. Lilọwọsi awọ-ara tabi ti tisu mukosa pẹlu yala inira pẹlu mimi tabi riru ẹjẹ ti o lọ silẹ.
  2. Meji tabi ju bẹẹ lọ ninu awọn aami aiṣan wọnyi:-
    a. Lilọwọsi awọ-ara tabi mukosa
    b. Inira pẹlu mimi
    c. Riru ẹjẹ ti o lọ silẹ
    d. Aami aiṣan inu ifun
  3. Lilọ silẹ riru ẹjẹ lẹyin ti eniyan ba ni ifarakan si nkankan ti ara korira

Ni igba ikọlu kan, ayẹwo ẹjẹ fun tryptase tabi hisitamini (ti jọwọ lati ọwọ awọn sẹẹli masiti) le wulo lati ṣe ayẹwo anafilasisi nitori titani kokoro tabi abojuto. Yatọ si eyi, awọn ayẹwo yii ni ko wulo to bi okunfa ba jẹ ounjẹ tabi bi ẹni naa ba ni riru ẹjẹ ti o ṣe deedee,[5] wọn kii sii ṣe mọ ni pato fun ayẹwo.[11]

Eto Pinpin[àtúnṣe | àtúnṣe àmìọ̀rọ̀]

Oriṣi anafilasisi mẹta lo wa. Ayajija ti o niiṣe pẹlu anafilasisi ni asopọ pẹlu fifẹ awọn ọpa ti o ngbe ẹjẹ kiri arati o tan kaa kiri gbogbo ara ti o nfa riru ẹjẹ ti o lọ silẹ eyiti o fi 30% lo silẹ ju ila ti o kere julọ tabi iwọn odiwọn itumọ lọ.[7]Anafilasisi ti baifasiki jẹ fifi ara han pada awọn aami aiṣan laarin wakati 1–72 laisi ifarako nkan ti ara korira siwaju.[5] Agbejade iṣẹlẹ yatọ si ara wọn, ti awọn ẹkọ kan njẹwọ irufẹ iṣẹlẹ ti o pọ to 20%.[23] Fifi ara han pada yii maa nsaba waye laarin wakati 8.[10] A maa nṣe abojuto rẹ ni ọna kanna pẹlu anafilasisi.[3] Anafilasisi ti kii ṣe e tootọ tabi abajade anafilasisi ti ko mu awọn aami aiṣan lọwọ jẹ oriṣi anafilasisi ti ko ni awọn abajade nkan ti ara korira ṣugbọn ti o wa ni taara lati ọwọ bi sẹẹli ṣe njọwọ granuli awọn sẹẹli masiti.[10][24]Anafilasisi ti ko niiṣe pẹlu ajẹsara jẹ ọrọ ti World Allergy Organization nlo lọwọlọwọ [24] pẹlu imọran pe ki a ma lo awọn ọrọ atijọ mọ.[10]

Ṣiṣayẹwo nkan ti ara korira[àtúnṣe | àtúnṣe àmìọ̀rọ̀]

Ṣiṣayẹwo nkan ti awọ-ara korira ti a nṣe lori apa ọtun

Ṣiṣayẹwo nkan ti ara korira le ṣe iranlọwọ nipa mimọ ohun ti o nfaa. Ṣiṣayẹwo nkan ti awọ-ara korira (fun apẹẹrẹ patch testing) wa fun awọn ounjẹ kan ati oró.[11] Ṣiṣayẹwo ẹjẹ fun IgE ni pato le wulo lati jẹrisi wara-olomi, ẹyin, ẹpa, ẹpa igi ati awọn nkan ti ara korira ninu ẹja.[11] Ṣiṣayẹwo awọ-ara wa lati jẹrisi awọn nkan ti ara korira bii pẹnisilini ṣugbọn ko si fun awọn itọju miiran.[11] Iru anafilasisi ti ko niiṣe pẹlu ajẹsara ṣee mọ nipa itan ati ikọlu si nkan ti ara korira nikan, ti kii si ṣe nipa ayẹwo awọ-ara ati ayẹwo ẹjẹ.[24]

Ayẹwo Dida aiṣan mọ yatọ[àtúnṣe | àtúnṣe àmìọ̀rọ̀]

O le ṣoro nigba miiran lati da anafilasisi mọ yato si ikọ-ifee, didaku, ati awọn ikọlu ijaya.[5] Ṣugbọn ikọ-ifee kii saba ni ara ti njanijẹ tabi aami aiṣan ti ifun ninu, didaku ma nwaye pẹlu ara ti o funfun dipo ara ti njanijẹ, ati ikolu ijaya le ni ara ti o pọn ṣugbọn kii ni wiwu ti o pọn to nyun ni eyiti o nwaye nitori ikorira ara si nkankan.[5] Awọn nkan miiran ti o le waye tun ni ninu: skrombroidosisi ati aiṣan ti o nwaye nipa jijẹ ẹja ti a ko sè.[10]

Awọn iwadi okunfa iku[àtúnṣe | àtúnṣe àmìọ̀rọ̀]

Ninu ẹniti anafilasisi pa, iwadi nipa iku le fi "ọkan ti o ṣofo" kan han eyiti o waye nipasẹ oro ti o dinku lati ọwọ fifẹ awọn ọpa ti o ngbe ẹjẹ kiri ara ati ti tun tan kaa kiri omi ti o wa ninu awọn iṣan si awọn apo to wa lerefe.[25] Awọn aami miiran ni kikorajọpọ omi ninu awọn alafo ara, eosinofilia ninu ẹdọ-foo, ọkan ati awọn tisu, ati ẹri myokadial haipopafusion.[26] Awọn iwadi imọ-ijinlẹ le ṣe awari ipele sẹrọmu ti o pọ si tryptase, pipọsi ni akotan ati ipele sẹrọmu IgE ni pato.[26]

Didena[àtúnṣe | àtúnṣe àmìọ̀rọ̀]

A gba ni niyanju lati yẹra fun okunfa anafilasisi. Ni awọn ipo ti eyi ko ti ṣee ṣe, didin bi ara ṣe nṣiṣẹ lodi si nkan ku tabi mimu kuro le jẹ eyiti a yan. Ọna abojuto to nlo ajẹsara ara ẹni pẹlu awọn oro Hymenoptera jẹ eyiti o f’ẹsẹ mulẹ lati dinku tabi mimu kuro bi ara ṣe nṣiṣẹ lodi si nkan ninu 80–90% awọn agbalagba ati 98% ninu awọn ọmọde l’odi si awọn nkan ti ara korira oyin, agbọn, agbọn, yelojakẹti, ati tana tana. Ọna abojuto to nlo ajẹsara ara ẹni lati ẹnu le munadoko lati dinku tabi mu kuro bi ara ṣe nṣiṣẹ lodi si nkan ninu awọn eniyan si awọn ounjẹ kan ti o ninu wara-olomi, ẹyin, ẹpa; ṣugbọn awọn nkan ti ko dara si wọpọ. Ọna abojuto to nlo ajẹsara ara ẹni tun ṣee ṣe fun awọn abojuto ti o pọ, ṣugbọn a gba ọpọ eniyan nimọran lati saa yẹra fun nkan ti o nṣe okunfa naa. Fun awon ti ara won nsise l’odi si oje, o le ṣe pataki lati yẹra fun awọn ounjẹ to nfa ṣiṣe iṣẹ lodi bi pia, ọgede, potato laarin ọpọ ounjẹ miiran.[5]

Iṣakoso[àtúnṣe | àtúnṣe àmìọ̀rọ̀]

Anafilasisi jẹ pajawiri iṣegun oyinbo kan ti o le nilo titaniji bii iṣakoso ibiti atẹgun ngba, afikun atẹgun ti a nmi, ọpọlọpọ omi ti o nwa laarin iṣan, ati abojuto ti o ga gan-an.[3] Fi fun ni ni efinifirini jẹ ààyò abojuto pẹlu alodi si hisatanini ati awọn sitẹriọdu ti a maa nsaba lo gẹgẹ bii asopọmọ.[5] Agba ni nimọran yiyẹniwo fun wakati 2 si 24 ni ile-iwosan fun awọn eniyan l’ọgan ti wọn ba pada si ipo nitori aibalẹ ọkan anafilasisi baifasiki.[10][23][27][4]

Efinifirini[àtúnṣe | àtúnṣe àmìọ̀rọ̀]

Ẹya abẹrẹ atijọ ti EpiPen kan

Efinifrini (adrenaline) jẹ ọna itoju akọkọ fun anafilasisi laisi ewu ti o gba ẹmi kankan lati lòó.[3] A gba ni niyanju ki a fun ni ni efinifirini olomi lati inu iṣan si inu itan ni kete ti a ba kiyesi ayẹwo. Bi ko ba si abajade ti o dara to, a tun le tun abẹrẹ naa fun ni ni gbogbo iṣẹju 5 si 15 si ara wọn.[5] A nilo fifun ni ẹlẹẹkeji ninu 16 si 35% awọn iṣẹlẹ[10] ninu eyiti fifun kọja eemeji kii saba nilo.[5] Ọna lilo ti a ngba fun ni nipasẹ iṣan jẹ eyiti a yan ṣaaju ọra abẹ́ awọ nitori ti eyiti ti o keyin le ma tete ṣee fa sinu ara.[28] Awọn nkan ti ko dara diẹ nipa lilo efinifirini ni ninu gbigbọn, aibalẹ ọkan, efọri, ati iro ọkan ti ko ṣe deede.[5]

Awọn eniyan ti o nlo β-blockers le ṣiṣẹ lodi si iṣẹ efinifirini.[10] Ni ipo yii bi efinifirini ko ba ṣiṣe nipasẹ iṣan a le fun ni ni glukagoni eyiti o ni bi o ṣe maa nṣiṣe ti ko da lori β-receptor.[10]

Bi o ba nilo, a tun le fun ni ni fifi nkan sinu iṣan nipa lilo efinifirini olomi ti a ti là. Ṣugbọn a ti ri asopọ mọ dysrhythmia ati myocardial infarctionninu efinifirini ti a fun ni nipasẹ iṣan.[29] Abẹrẹ to nfun ni ni efinifirini fun ra rẹti a nlo fun fifun ara ẹni ni abẹrẹ ni eemeji, ọkan fun awọn agbalagba tabi ọmọde ti iwọn wọn kọja 25 kg ati ọkan fun awọn ọmọde ti iwọn wọn to 10 si 25 kg.[30]

Awọn asopọmọ[àtúnṣe | àtúnṣe àmìọ̀rọ̀]

Antihistamines (H1 ati H2), bi o tile jẹ wipe wọn loo ti wọn nro wipe o dara nitori ero ṣugbọn ẹri iwadi ko kin eyi lẹyin to. Atunyẹwo Cochrane kan ni ọdun 2007 ko ri eyikeyi ẹkọ ti o dara lati gbani niyanju rẹ[31] a ko si gbagbọ pe wọn ni nkan ti wọn nṣe lori edema tabi gbigbon ọna atẹgun.[10] Kọtikositẹrọidu le ma le mu iyatọ wa lọwọ yii nipa ipo anafilasisi, ṣugbọn o ṣee lo ni ireti wipe yoo din ewu anafilasis bafasiki ku. Mimunado wọn lati dena tabi dẹkun nkan ko yọranti to ni awọn ipo yii.[23] Ti a sọ di alatẹgun salbutamol le munadoko fun sisunki ẹdọ foo ti efinifirini ko yanju.[10] A ti lo Methylene blue lara awọn ti ko ṣe daradara si awọn ọna miiran nitori ero wipe o ntu iṣan lara.[10]


Abojuto[àtúnṣe | àtúnṣe àmìọ̀rọ̀]

Awọn eniyan ti o le tete ni anafilasisi ni agba ni imọran lati ni "eto iṣẹ fun nkan ti ara korira si", awọn obi ni agba ni imọran lati fi to awọn ile-iwe awọn ọmọ wọn leti nipa ikọrira ara ati awọn nkan ti o ye ki wọn ṣe bi pajawiri anafilatiki ba ṣẹlẹ.[32] Eto iṣẹ maa nni ninu lilo fifun ara ẹni ni abẹrẹ efinifirini, igbani niyanju lati wọ ẹ̀gbà-ọwọ́ itaniji to niiṣe pẹlu iṣegun oyinbo kan, ati imọran lati yẹra fun awọn ohun ti o nṣe okunfa.[32] Ọna abojuto to nlo ajẹsara ara ẹni wa fun awọn ohun ti o nṣe okunfa lati dena anafilasisi ọjọ iwaju. Ẹkọ onilọpọ ọdun nipa didinku tabi mimu kuro bi ara ṣe nṣiṣẹ lodi si nkan ninu ọra ni ati ri wipe o munadoko lodi si awọn kokoro ti njẹ ni nigbati dinku tabi mimu kuro bi ara ṣe nṣiṣẹ lodi si nkan lati ẹnu munadoko fun ọpọlọpọ ounjẹ.[3]

Sisọtẹlẹ[àtúnṣe | àtúnṣe àmìọ̀rọ̀]

Ninu awọn ti a mọ okunfa wọn ti itoju si wa ni kiakia, asọtẹlẹ rẹ dara.[33] Bi o ti le jẹ wipe a ko mọ okunfa rẹ, bi awọn itọju lati dẹkun ba wa, asọtẹlẹ ma ndara.[4] Bi iku ba waye, o maa nsaba jẹ yala nipa eto mimi (paapaa àìlèmí) tabi ti ọkan (ijaya),[10][22] pẹlu 0.7–awọn isẹlẹ 20% ma nfa iku.[4][9] Awọn isẹlẹ fifarahan iku laarin iṣẹju ti wa.[5] Awọn abajade ninu awọn to ni anafilasisi ti idaraya nṣe okunfa maa ndara, pẹlu abajade ti o nira ti o kere tabi ti ko nira bi awọn eniyan ti ndagba.[34]


Ẹkọ nipa ajakalẹ arun[àtúnṣe | àtúnṣe àmìọ̀rọ̀]

wiwaye anafilasisi jẹ 4–5 ninu awọn eniyan 100,000 l’ọdun,[10]pẹlu ewu fun igbe-aiye ti 0.5–2%.[5]O jọ wipe o npọ sii: wiwaye ni awọn ọdun 1980 sunmọ 20 ninu 100,00 l’ọdun, nigbati o di awọn ọdun 1990 o jẹ 50 ninu 100,000 l’ọdun.[3] O jọ wipe anafilasisi ti ounjẹ ṣe okunfa rẹ npọ sii.[35]Ewu naa pọju lọ ni aarin awọn ọdọ ati awọn obinrin.[3][10]

Lọwọlọwọ, anafilasisi nfa iye iku 500–1,000 l’ọdun (2.4 ninu miliọnu) ni orilẹ-ede Amẹrika, iye iku 20 l’ọdun ni orilẹ-ede Gẹẹsi (0.33 ninu miliọnu), ati iye iku 15 l’ọdun ni Ọsirelia (0.64 ninu miliọnu).[10]Iye iku ti dinku laarin awọn ọdun 1970 ati 2000.[36] Ni Ọsirelia, iku anafilasisi ti ounjẹ nfa maa nsaba waye laarin awọn obinrin nigbati iku ti o nwaye nitori kokoro ti o jẹ ni maa nsaba waye laarin awọn ọkunrin.[10] Ogun lilo ni o wọpọ julọ ti o nfa anafilasisi.[10]

Itan[àtúnṣe | àtúnṣe àmìọ̀rọ̀]

Charles Richet ni o ṣẹda ọrọ "afilasi" ni ọdun 1902 ti o tun wa yipada si "anafilasisi" nitori bi o ti ṣe dun ni sisọ l’ọrọ.[11] O gba aami ẹyẹ Aami ẹ̀yẹ Nobel fun Iṣẹ iṣegun ati ẹkọ imọ ijinlẹ ṣiṣe iṣẹ ẹya ara nkan ẹlẹmi (Nobel Prize in Medicine and Physiology fun iṣẹ rẹ lori anafilasisi ni ọdun 1913.[4] Iṣẹlẹ naa jẹ eyiti a ti ṣe apejuwe rẹ lati igba lailai.[24]Ọrọ naa wa lati Giriki ἀνά ana, alodi si, ati φύλαξις filasisi, idaabobo.[37]

Iwadi ijinlẹ[àtúnṣe | àtúnṣe àmìọ̀rọ̀]

Awọn iṣẹ kan nlọ lọwọ lati ṣẹda efinifirini sublingual lati ṣe itọju anafilasisi.[10] Abẹrẹ si abẹ ọra ara ti o lodi si IgE (anti-IgE) antibody omalizumab ni a nṣe ayẹwo gẹgẹ bii ọna lati dẹkun pipada, ṣugbọn a ko ti gba ni niyanju lilo rẹ.[5][38]

Awọn itọkasi[àtúnṣe | àtúnṣe àmìọ̀rọ̀]

  1. 1.0 1.1 Tintinalli, Judith E. (2010). Emergency Medicine: A Comprehensive Study Guide (Emergency Medicine (Tintinalli)). New York: McGraw-Hill Companies. pp. 177–182. ISBN 0-07-148480-9. 
  2. Oswalt ML, Kemp SF (May 2007). "Anafilasisi: office management and prevention". Immunol Allergy Clin North Am 27 (2): 177–91, vi. doi:10.1016/j.iac.2007.03.004. PMID 17493497. "Clinically, anafilasisi is considered likely to be present if any one of three criteria is satisfied within minutes to hours" 
  3. 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 3.11 Simons FE (October 2009). "Anaphylaxis: Recent advances in assessment and treatment". J. Allergy Clin. Immunol. 124 (4): 625–36; quiz 637–8. doi:10.1016/j.jaci.2009.08.025. PMID 19815109. https://secure.muhealth.org/~ed/students/articles/JAClinImmun_124_p0625.pdf. 
  4. 4.00 4.01 4.02 4.03 4.04 4.05 4.06 4.07 4.08 4.09 4.10 4.11 4.12 4.13 4.14 Marx, John (2010). Rosen's emergency medicine: concepts and clinical practice 7th edition. Philadelphia, PA: Mosby/Elsevier. p. 15111528. ISBN 978-0-323-05472-0. 
  5. 5.00 5.01 5.02 5.03 5.04 5.05 5.06 5.07 5.08 5.09 5.10 5.11 5.12 5.13 5.14 5.15 5.16 5.17 5.18 5.19 5.20 5.21 5.22 5.23 Simons, FE; World Allergy, Organization (2010 May). "World Allergy Organization survey on global availability of essentials for the assessment and management of anaphylaxis by allergy-immunology specialists in health care settings.". Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology 104 (5): 405–12. doi:10.1016/j.anai.2010.01.023. PMID 20486330. http://www.csaci.ca/include/files/WAO_Anaphylaxis_Guidelines_2011.pdf. 
  6. 6.0 6.1 6.2 6.3 Sampson HA, Muñoz-Furlong A, Campbell RL, et al. (February 2006). "Second symposium on the definition and management of anafilasisi: summary report—Second National Institute of Allergy and Infectious Disease/Food Allergy and Anafilasisi Network symposium". J. Allergy Clin. Immunol. 117 (2): 391–7. doi:10.1016/j.jaci.2005.12.1303. PMID 16461139. 
  7. 7.0 7.1 7.2 Limsuwan, T; Demoly, P (2010 Jul). "Acute symptoms of drug hypersensitivity (urticaria, angioedema, anafilasisi, anaphylactic shock).". The Medical clinics of North America 94 (4): 691–710, x. doi:10.1016/j.mcna.2010.03.007. PMID 20609858. http://smschile.cl/documentos/cursos2010/MedicalClinicsNorthAmerica/Acute%20Symptoms%20of%20Drug%20Hypersensitivity%20(Urticaria,%20Angioedema,%20Anafilasisi,%20Anaphylactic%20Shock).pdf. 
  8. 8.0 8.1 8.2 8.3 8.4 8.5 Brown, SG; Mullins, RJ, Gold, MS (2006 Sep 4). "Anafilasisi: diagnosis and management.". The Medical journal of Australia 185 (5): 283–9. PMID 16948628. 
  9. 9.0 9.1 9.2 9.3 9.4 Triggiani, M; Patella, V, Staiano, RI, Granata, F, Marone, G (2008 Sep). "Allergy and the cardiovascular system.". Clinical and experimental immunology 153 Suppl 1: 7–11. doi:10.1111/j.1365-2249.2008.03714.x. PMC 2515352. PMID 18721322. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2515352/?tool=pubmed. 
  10. 10.00 10.01 10.02 10.03 10.04 10.05 10.06 10.07 10.08 10.09 10.10 10.11 10.12 10.13 10.14 10.15 10.16 10.17 10.18 10.19 10.20 10.21 10.22 10.23 10.24 10.25 Lee, JK; Vadas, P (2011 Jul). "Anafilasisi: mechanisms and management.". Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology 41 (7): 923–38. doi:10.1111/j.1365-2222.2011.03779.x. PMID 21668816. 
  11. 11.0 11.1 11.2 11.3 11.4 11.5 11.6 Boden, SR; Wesley Burks, A (2011 Jul). "Anaphylaxis: a history with emphasis on food allergy.". Immunological reviews 242 (1): 247–57. doi:10.1111/j.1600-065X.2011.01028.x. PMID 21682750. 
  12. Worm, M (2010). "Epidemiology of anafilasisi.". Chemical immunology and allergy 95: 12–21. doi:10.1159/000315935. PMID 20519879. 
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  14. Dewachter, P; Mouton-Faivre, C, Emala, CW (2009 Nov). "Anafilasisi and anesthesia: controversies and new insights.". Anesthesiology 111 (5): 1141–50. doi:10.1097/ALN.0b013e3181bbd443. PMID 19858877. 
  15. editor, Mariana C. Castells, (2010). Anafilasisi and hypersensitivity reactions. New York: Humana Press. pp. 223. ISBN 978-1-60327-950-5. http://books.google.ca/books?id=bEvnfm7V-LIC&pg=PA223. 
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  17. 17.0 17.1 Drain, KL; Volcheck, GW (2001). "Preventing and managing drug-induced anafilasisi.". Drug safety : an international journal of medical toxicology and drug experience 24 (11): 843–53. PMID 11665871. 
  18. Klotz, JH; Dorn, PL, Logan, JL, Stevens, L, Pinnas, JL, Schmidt, JO, Klotz, SA (2010 Jun 15). ""Kissing bugs": potential disease vectors and cause of anafilasisi.". Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 50 (12): 1629–34. doi:10.1086/652769. PMID 20462351. 
  19. Bilò, MB (2011 Jul). "Anafilasisi caused by Hymenoptera stings: from epidemiology to treatment.". Allergy 66 Suppl 95: 35–7. doi:10.1111/j.1398-9995.2011.02630.x. PMID 21668850. 
  20. Cox, L; Larenas-Linnemann, D, Lockey, RF, Passalacqua, G (2010 Mar). "Speaking the same language: The World Allergy Organization Subcutaneous Immunotherapy Systemic Reaction Grading System.". The Journal of allergy and clinical immunology 125 (3): 569–74, 574.e1-574.e7. doi:10.1016/j.jaci.2009.10.060. PMID 20144472. 
  21. Bilò, BM; Bonifazi, F (2008 Aug). "Epidemiology of insect-venom anafilasisi.". Current opinion in allergy and clinical immunology 8 (4): 330–7. doi:10.1097/ACI.0b013e32830638c5. PMID 18596590. 
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  23. 23.0 23.1 23.2 Lieberman P (September 2005). "Biphasic anaphylactic reactions". Ann. Allergy Asthma Immunol. 95 (3): 217–26; quiz 226, 258. doi:10.1016/S1081-1206(10)61217-3. PMID 16200811. 
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  25. Anafilasisi, Author: Stephen F Kemp, MD, FACP; Chief Editor: Michael A Kaliner, MD;http://emedicine.medscape.com/article/135065-overview#showall
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  28. Simons, KJ; Simons, FE (2010 Aug). "Epinephrine and its use in anafilasisi: current issues.". Current opinion in allergy and clinical immunology 10 (4): 354–61. doi:10.1097/ACI.0b013e32833bc670. PMID 20543673. 
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  30. Sicherer, SH; Simons, FE, Section on Allergy and Immunology, American Academy of, Pediatrics (2007 Mar). "Self-injectable epinephrine for first-aid management of anafilasisi.". Pediatrics 119 (3): 638–46. doi:10.1542/peds.2006-3689. PMID 17332221. 
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  34. editor, Mariana C. Castells, (2010). Anaphylaxis and hypersensitivity reactions. New York: Humana Press. pp. 223. ISBN 978-1-60327-950-5. http://books.google.ca/books?id=bEvnfm7V-LIC&pg=PA223. 
  35. Koplin, JJ; Martin, PE, Allen, KJ (2011 Oct). "An update on epidemiology of anaphylaxis in children and adults.". Current opinion in allergy and clinical immunology 11 (5): 492–6. doi:10.1097/ACI.0b013e32834a41a1. PMID 21760501. 
  36. Demain, JG; Minaei, AA, Tracy, JM (2010 Aug). "Anafilasisi and insect allergy.". Current opinion in allergy and clinical immunology 10 (4): 318–22. doi:10.1097/ACI.0b013e32833a6c72. PMID 20543675. 
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Awọn asopọmọ ode[àtúnṣe | àtúnṣe àmìọ̀rọ̀]