2. Prof. DR.Dr.Ariyanto Harsono
SpA(K)
2
Definition
Anaphylaxis: Reactions sudden life-
threatening because the process
immonologic of allergen-antibody
reaction
Anaphylactoid Reaction causing physical
the same symptoms but caused no
immunological reaction
3. Prof. DR.Dr.Ariyanto Harsono
SpA(K)
3
Alergen
APC MHC-II
Th0
IL-12/ IL-1
Th-2
Th.1
IL-1
TNF-β, IFN-γ
IL-2, IFN-γ
B-Cell
IL-4
IL-5
SEL PLASMASEL MEMORI
IL-6
IL-10
CTL
MHC-I
L
MEMORY CELLS
Aktifasi
Komplemen
Blocking Antibody
Precipitatigng
Aglutinating AB
Anafilaksis
27. Prof. DR.Dr.Ariyanto Harsono
SpA(K)
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Prevention
1. Pre vaccination screening:
(1)history of allergy to component of vaccines:
-egg,
-gelatin,
-antibiotics.
(2) healthy.
2. Anticipation
• Patient should be kept under supervision for
at least 15’.
• Ready Anaphylactic equipment
28. Prof. DR.Dr.Ariyanto Harsono
SpA(K)
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Management
1. Primary treatment
Adrenaline 1:1000 with a dose of 0.001 ml / kg
maximum: 0.3 ml subcutaneously
Tourniquet on the proximal shock / injection
Adrenaline can be repeated 3X every 15-20 '
Sprong oxygen nose / hoad box 2-3 L / min
Free the airway, neck hyper-extension position,
head tilted, suction mucus, monitor vital
signs
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•Place the patient at shock position
•Pulmonal Ressuscitation
•Oropharyngeal airway
•Tube endotrakeal
•Tracheostomy
•Cardiac compression
30. Prof. DR.Dr.Ariyanto Harsono
SpA(K)
30
Adrenaline HCL Dose 1:1000
according age
Age Dose
2-6 Bulan 0.07 ml
12 Bulan 0.1 ml
18-48 Bulan 0.15 ml
5 Tahun 0.2 ml
6-9 Tahun 0.3 ml
10-13 Tahun 0.4 ml
>14 Tahun 0.5 ml
31. Prof. DR.Dr.Ariyanto Harsono
SpA(K)
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2. Complementary treatment
Intended for complications:
Seizures: diazepam, phenobarbital
Bronchial Spasm : Aminophylline 7 mg
dissolved in 10-20 ml of 0.9% NaCl
followed 9 mg/kg/24 hours (divided into 3
doses)
b-2 agonist: Ventolin nebulizer
32. Prof. DR.Dr.Ariyanto Harsono
SpA(K)
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3. Additional treatment
•Antihistamine (H1 Receptor antagonist): Benadril 2 mg/kg
i.m. continued with 3 mg/kg/24 jam oral (dibagi 3 dosis)
•H-2 receptor antagonist : Cimetidine
•Corticosteroid: Solukortef 4-7 mg/kg i.v. continued with 4-7
mg/kg/24 hour oral (devided 3 doses)
H1
H2
H3
H4
H1-antagonist
H2-antagonist
Histamin
35. Prof. DR.Dr.Ariyanto Harsono
SpA(K)
35
Fluid therapy
• Kristaloid
• Koloid
“The most important is not the composition, but
rather the rate of administration”
In children: 30ml/kg hour I
Cardiac output
Dopamine 2-20 mg/kg/menit
36. Prof. DR.Dr.Ariyanto Harsono
SpA(K)
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NB
• Tourniquet is released every 3 minutes
until symptoms resolved shock
• If the vaccine subcutaneously, may be
added adrenaline 0.005 ml / kg (max: 0.3
ml) at the injection site, one time only!