[Management of anaphylaxis : part 2: treatment and emergency equipment]. / Management der Anaphylaxie : Teil 2: Therapie und Notfallausrüstung.

Anaphylaxis is an extreme form of allergic reaction that can be life-threatening. Early treatment of circulatory and pulmonary disturbances is decisive for prognosis. Initial management of anaphylaxis comprises, where possible, interrupting allergen exposure; ensuring a stable airway; summoning emergency services; placing the patient in a safe position, obtaining venous access and monitoring vital signs. Adrenaline, histamine-antagonists and glucocorticoids have proven effective, as has administration of oxygen and volume substitutes. Many anaphylaxis patients are unable to successfully avoid the elicitor and the feasibility of self-treatment is limited if the patient is inadequately informed. An educational program for adult patients and parents of children with a high risk of anaphylaxis has been developed by the German Working Group for Anaphylaxis Training and Education (AGATE). This program aims to help prevent anaphylactic attacks, foster optimal first-line treatment and offer psychological and social support for anaphylaxis patients. Preliminary results confirm the efficacy of the AGATE approach. This article presents an overview of the stage-wise management of anaphylaxis in accordance with the S2 position paper of the German allergological societies and international guidelines.

[Management of anaphylaxis. Part 1: Causes and pathophysiology]. / Management der Anaphylaxie. Teil 1: Ursachen und Pathophysiologie.

Anaphylactic reactions reveal the maximal grade of allergic reactions and are potentially life-threatening. The most common agents involved in anaphylactic reactions are drugs, food, Hymenoptera, aeroallergens, Latex, and physical stress. Anaphylactic reactions are induced by the liberation of various mediators. Symptoms are determined by the kind, quantity, and relation of these mediators and by the individual predisposition of the patient. In general, symptoms occur at the skin, the lungs, the cardiovascular system and the gastrointestinal tract. Early treatment of circulatory and pulmonary disturbances is decisive for the prognosis of the patient. Adequate therapy has to be given immediately according to the severity of symptoms in a step-wise approach. In the specific drug-therapy, a few substances have proved to be reliable, e.g. adrenalin, histamine antagonists, glucocorticosteroids, oxygen and volume substitutes. This article provides an overview of prevalence, symptoms and therapeutic options for managing anaphylaxis.

Quality of life after simultaneous pancreas-kidney transplantation.

Even recipients with satisfactory function of transplanted pancreas and kidney may show physical and/or social disability due to diabetic complications. Our aims were to evaluate diabetic complications influencing recipient quality of life and to assess patients' psychosociological status. Nineteen patients with functioning grafts who consented to take part in the study, underwent clinical evaluation and answered questions regarding their quality of life. Results showed excellent endocrine pancreatic function in 17 patients. In most recipients, insulin activity and C-peptide levels were elevated owing to systemic venous drainage. Opthalmological examination revealed blindness in 7 patients (in 4 cases with onset following SPKTx) and retinopathy in 13 patients (in 5 cases it appeared after SPKTx). Assessment of the cardiovascular system revealed satisfactory cardiac function in 16 of 19 patients; 4 patients underwent amputation of a lower limb following SPKTx. All 19 recipients admitted to a great benefit of transplantation; most patients declared ability to organize their life activity and social functions and 4 had regular employment. Conversely, most patients were afraid of graft loss, and half were often sad and even depressed.