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anglais vers swahili: Anaphylaxis(TwB)_2{[1].doc General field: Médecine Detailed field: Médecine : soins de santé
Texte source - anglais
==Diagnosis==
Anaphylaxis is diagnosed based on clinical facts. When any one of the following three occurs within minutes/hours of exposure to an allergen, it is very likely that the person has anaphylaxis:
# Involvement of the skin or mucosal tissue plus either respiratory difficulty or a low blood pressure
# Two or more of the following symptoms:-
#: a. Involvement of the skin or mucosa
#: b. Respiratory difficulties
#: c. Low blood pressure
#: d. Gastrointestinal symptoms
# Low blood pressure after exposure to a known allergen
If a person has a bad reaction to an insect sting or a medication, blood tests for tryptase or histamine (released from mast cells) might be useful in diagnosing anaphylaxis. However these tests are not very useful if the cause is food or if the person has a normal blood pressure, and they cannot rule out a diagnosis of anaphylaxis.
===Classification===
There are three main classifications of anaphylaxis. Anaphylactic shock happens when blood vessels get wider throughout most of the body (systemic vasodilation), which causes low blood pressure that is at least 30% lower than the person's normal blood pressure or 30% below standard values.{{cite journal|last=Limsuwan|first=T|coauthors=Demoly, P|title=Acute symptoms of drug hypersensitivity (urticaria, angioedema, anaphylaxis, anaphylactic shock).|journal=The Medical clinics of North America|date=2010 Jul|volume=94|issue=4|pages=691–710, x|pmid=20609858|url=http://smschile.cl/documentos/cursos2010/MedicalClinicsNorthAmerica/Acute%20Symptoms%20of%20Drug%20Hypersensitivity%20(Urticaria,%20Angioedema,%20Anaphylaxis,%20Anaphylactic%20Shock).pdf}} Biphasic anaphylaxis is diagnosed when symptoms return within 1–72 hours even though the person has had no new contact with the allergen that caused the first reaction. Some studies claim that as many as 20% of anaphylaxis cases are biphasic. The symptoms return they typically return within 8 hours. The second reaction is treated in the same way as the original anaphylaxis. Pseudoanaphylaxis or anaphylactoid reactions are older names for anaphylaxis that is not due to an allergic reaction, but is due to direct injury to mast cells (mast cell degranulation).{{cite journal|last=Lee|first=JK|coauthors=Vadas, P|title=Anaphylaxis: mechanisms and management.|journal=Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology|date=2011 Jul|volume=41|issue=7|pages=923–38|pmid=21668816}} The current name used by the World Allergy Organization is “non-immune anaphylaxis” . Some people recommend that the older terms should no longer be used.
===Allergy testing===
[[Image:Allergy skin testing.JPG|thumb|Skin allergy testing being carried out on the right arm]]
Allergy testing may help to determine what caused a person’s anaphylaxis. Skin allergy tests (such as patch tests) are available for certain foods and venoms. Blood tests for specific antibodies can be useful to confirm milk, egg, peanut, tree nut and fish allergies. Skin tests can confirm penicillin allergies, but there are no skin tests for other medications. Non-immune forms of anaphylaxis can only be diagnosed by checking the person’s history or by exposing the person to an allergen that may have caused a reaction in the past. There are no skin or blood tests for non-immune anaphylaxis.
===Differential diagnosis===
It can sometimes be difficult to distinguish anaphylaxis from asthma, fainting due to lack of oxygen (syncopy), and panic attacks. People with asthma typically do not have itching or stomach or intestine symptoms. When a person faints, the skin is pale and does not have a rash. A person who is having a panic attack may have flushed skin but does not have hives. Other conditions that may have similar symptoms include food poisoning from spoiled fish (scombroidosis) and infection from certain parasites (anisakiasis).
==Prevention==
The recommended way to prevent anaphylaxis is to avoid whatever caused the reaction in the past. When this is not possible, there may be treatments to make the body stop reacting to a known allergen (desensitization). Treatment of the immune system (immunotherapy) with Hymenoptera venoms is effective at desensitizing 80–90% of adults and 98% of children against allergies to bees, wasps, hornets, yellowjackets, and fire ants. Oral immunotherapy may be effective at desensitizing some people to certain foods including milk, eggs, nuts and peanuts; however these treatments often have bad side effects. Desensitization is also possible for many medications, however most people should simply avoid the problem medication. In those who react to latex, it may be important to avoid foods that contain substances that are similar to the one that caused the immune response (cross-reactive foods), such as avocados, bananas, and potatoes among others.
==Management==
Anaphylaxis is a medical emergency that may require lifesaving measures such as airway management, supplemental oxygen, large volumes of intravenous fluids, and close monitoring. Epinephrine is the treatment of choice. Antihistamines and steroids are often used in addition to epinephrine. Once a person has returned to normal, they should be watched in the hospital for 2 to 24 hours to make sure symptoms do not return, as they might if the person has biphasic anaphylaxis.{{cite web|url=http://www.resus.org.uk/pages/reaction.pdf |title=Emergency treatment of anaphylactic reactions – Guidelines for healthcare providers|month=January | year=2008 |accessdate=2008-04-22 |format=PDF |work= |publisher=Resuscitation Council (UK)}}
===Epinephrine===
[[Image:Epipen.jpg|thumb|An old version of an EpiPen auto-injector]]
Epinephrine (adrenaline) is the primary treatment for anaphylaxis. There is no reason why it should not be used (no absolute contraindication). It is recommended that an epinephrine solution be injected into the muscle of the mid anterolateral thigh as soon as anaphylaxis is suspected. The injection may be repeated every 5 to 15 minutes if the person is not responding well to the treatment. A second dose is needed in 16 to 35% of cases. More than two doses are rarely required. Injection into the muscle (intramuscular administration) is preferred over injection under the skin (subcutaneous administration), where the medication may be absorbed too slowly.{{cite journal|last=Simons|first=KJ|coauthors=Simons, FE|title=Epinephrine and its use in anaphylaxis: current issues.|journal=Current opinion in allergy and clinical immunology|date=2010 Aug|volume=10|issue=4|pages=354–61|pmid=20543673}} Minor problems from epinephrine include tremors, anxiety, headaches, and palpitations.
Epinephrine may not work in people who are taking B-blockers. In this situation, if epinephrine is not effective, intravenous glucagon can be administered. Glucagon has a mechanism of action that does not involve β-receptors.
If necessary, epinephrine can also be injected into a vein (intravenous injection) using a dilute solution. Intravenous epinephrine, however, has been linked to irregular heartbeats (dysrhythmia) and heart attacks (myocardial infarction).{{cite journal|last=Mueller|first=UR|title=Cardiovascular disease and anaphylaxis.|journal=Current opinion in allergy and clinical immunology|date=2007 Aug|volume=7|issue=4|pages=337–41|pmid=17620826}} Epinephrine autoinjectors, which allow people with anaphylaxis to inject epinephrine into a muscle themselves, are typically available in two doses, one for adults or children who weight more than 25 kg and one for children who weight 10 to 25 kg.{{cite journal|last=Sicherer|first=SH|coauthors=Simons, FE, Section on Allergy and Immunology, American Academy of, Pediatrics|title=Self-injectable epinephrine for first-aid management of anaphylaxis.|journal=Pediatrics|date=2007 Mar|volume=119|issue=3|pages=638–46|pmid=17332221}}
===Adjuncts===
Antihistamines are commonly used in addition to epinephrine. They were thought to be effective based on theoretical reasoning, but there is very little evidence that antihistamines actually are effective in anaphylaxis treatment. A 2007 Cochrane review did not find any good-quality studies that could be used to recommend them. {{cite journal |author=Sheikh A, Ten Broek V, Brown SG, Simons FE |title=H1-antihistamines for the treatment of anaphylaxis: Cochrane systematic review|journal=Allergy |volume=62 |issue=8 |pages=830–7 |year=2007 |month=August |pmid=17620060 |doi=10.1111/j.1398-9995.2007.01435.x |url=}} Antihistimines are not believed to have an effect on fluid buildup or spasms in the airway. Corticosteroids are unlikely to make a difference if a person is currently having an episode of anaphylaxis. They may be used in the hope of decreasing the risk of biphasic anaphylaxis, but their effectiveness in preventing future anaphylaxis is uncertain.{{cite journal |author=Lieberman P |title=Biphasic anaphylactic reactions |journal=Ann. Allergy Asthma Immunol.|volume=95 |issue=3 |pages=217–26; quiz 226, 258 |year=2005 |month=September |pmid=16200811 |doi= 10.1016/S1081-1206(10)61217-3|url=}} Salbutamol that is given through a breathing device (nebulizer) may be effective when epinephrine does not relieve bronchospasm symptoms. Methylene blue has been used in those not responsive to other measures because it may relax smooth muscle.
===Preparing===
People who are at risk for anaphylaxis are advised to have an "allergy action plan". Parents should inform schools of their children's allergies and what to do in case of an anaphylactic emergency. The action plan usually includes use of epinephrine auto-injectors, the recommendation to wear a medical alert bracelet, and counseling on how to avoid triggers.{{cite journal|last=Martelli|first=A|coauthors=Ghiglioni, D, Sarratud, T, Calcinai, E, Veehof, S, Terracciano, L, Fiocchi, A|title=Anaphylaxis in the emergency department: a paediatric perspective.|journal=Current opinion in allergy and clinical immunology|date=2008 Aug|volume=8|issue=4|pages=321–9|pmid=18596589}} Treatment to make the body less sensitive to the substance that is causing the allergic reaction (allergen immunotherapy) is available for certain triggers. This type of therapy may prevent future episodes of anaphylaxis. A multi-year course of subcutaneous desensitization has been found effective against stinging insects, while oral desensitization is effective for many foods.
==Outlook==
There is a good chance of recovery when the cause is known and the person is treated quickly.{{cite book|last=Harris|first=edited by Jeffrey|title=Head and neck manifestations of systemic disease|year=2007|publisher=Informa Healthcare|location=London|isbn=9780849340505|pages=325|url=http://books.google.ca/books?id=31yUl-V90XoC&pg=PA325|coauthors=Weisman, Micheal S.}} Even if the cause is unknown, if medication is available to stop the reaction, the person usually makes a good recovery. If death occurs, it is usually due to either a respiratory cause (typically closing off of the airway) or a cardiovascular cause (shock). Anaphylaxis causes death in 0.7–20% of cases.{{cite book |title=Rosen's emergency medicine: concepts and clinical practice 7th edition |last=Marx |first=John |authorlink= |coauthors=|year=2010 |publisher=Mosby/Elsevier |location=Philadelphia, PA |isbn=9780323054720|page=15111528 }}{{cite journal|last=Triggiani|first=M|coauthors=Patella, V, Staiano, RI, Granata, F, Marone, G|title=Allergy and the cardiovascular system.|journal=Clinical and experimental immunology|date=2008 Sep|volume=153 Suppl 1|pages=7–11|pmid=18721322|url=http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2515352/?tool=pubmed|pmc=2515352}} Some deaths have happened within minutes. People who have exercise-induced anaphylaxis typically have good outcomes, with fewer and less severe episodes as they get older.{{cite book|last=editor|first=Mariana C. Castells,|title=Anaphylaxis and hypersensitivity reactions|year=2010|publisher=Humana Press|location=New York|isbn=9781603279505|pages=223|url=http://books.google.ca/books?id=bEvnfm7V-LIC&pg=PA223}}
==Likelihood==
The incidence of anaphylaxis is 4–5 per 100,000 persons per year, with a lifetime risk of 0.5%–2%.{{cite journal|last=Simons|first=FE|coauthors=World Allergy, Organization|title=World Allergy Organization survey on global availability of essentials for the assessment and management of anaphylaxis by allergy-immunology specialists in health care settings.|journal=Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology|date=2010 May|volume=104|issue=5|pages=405–12|pmid=20486330|url=http://www.csaci.ca/include/files/WAO_Anaphylaxis_Guidelines_2011.pdf}} Rates appear to be increasing. The number of people with anaphylaxis in the 1980s was approximately 20 per 100,000 per year, while in the 1990s it was 50 per 100,000 per year.{{cite journal |author=Simons FE |title=Anaphylaxis: Recent advances in assessment and treatment |journal=J. Allergy Clin. Immunol.|volume=124 |issue=4 |pages=625–36; quiz 637–8 |year=2009 |month=October |pmid=19815109 |doi=10.1016/j.jaci.2009.08.025|url=https://secure.muhealth.org/~ed/students/articles/JAClinImmun_124_p0625.pdf}} The increase appears to be primarily for anaphylaxis caused by food.{{cite journal|last=Koplin|first=JJ|coauthors=Martin, PE, Allen, KJ|title=An update on epidemiology of anaphylaxis in children and adults.|journal=Current opinion in allergy and clinical immunology|date=2011 Oct|volume=11|issue=5|pages=492–6|pmid=21760501}} The risk is greatest in young people and females.
Currently, anaphylaxis leads to 500–1,000 deaths per year (2.4 per million) in the United States, 20 deaths per year in the United Kingdom (0.33 per million), and 15 deaths per year in Australia (0.64 per million). Death rates have decreased between the 1970s and 2000s.{{cite journal|last=Demain|first=JG|coauthors=Minaei, AA, Tracy, JM|title=Anaphylaxis and insect allergy.|journal=Current opinion in allergy and clinical immunology|date=2010 Aug|volume=10|issue=4|pages=318–22|pmid=20543675}} In Australia, anaphylaxis deaths due to food occur primarily in women while deaths due to insect bites primarily occur in men. Death from anaphylaxis is most commonly triggered by medications.
==History==
The term "aphylaxis" was coined by Charles Richet in 1902 and later changed to "anaphylaxis" because it sounded nicer.{{cite journal|last=Boden|first=SR|coauthors=Wesley Burks, A|title=Anaphylaxis: a history with emphasis on food allergy.|journal=Immunological reviews|date=2011 Jul|volume=242|issue=1|pages=247–57|pmid=21682750}} He was later awarded the Nobel Prize in Medicine and Physiology for his work on anaphylaxis in 1913. The reaction itself, however, has been reported since ancient times.{{cite journal|last=Ring|first=J|coauthors=Behrendt, H, de Weck, A|title=History and classification of anaphylaxis.|journal=Chemical immunology and allergy|year=2010|volume=95|pages=1–11|pmid=20519878|url=http://media.wiley.com/product_data/excerpt/42/04708611/0470861142.pdf}} The term comes from the Greek language|Greek words ἀνά ana, ''against'', and φύλαξις phylaxis, ''protection''.{{cite web|url=http://www.merriam-webster.com/dictionary/anaphylaxis|title=anaphylaxis |accessdate=2009-11-21|publisher=merriam-webster.com }}
==Research==
The are ongoing efforts to develop epinephrine that can be applied under the tongue (sublingual epinephrine) to treat anaphylaxis. Subcutaneous injection of the anti-IgE antibody omalizumab is being studied as a method of preventing recurrence, but it is not yet recommended.{{cite journal|last=Vichyanond|first=P|title=Omalizumab in allergic diseases, a recent review.|journal=Asian Pacific journal of allergy and immunology / launched by the Allergy and Immunology Society of Thailand|date=2011 Sep|volume=29|issue=3|pages=209–19|pmid=22053590}}
==References==
{{Reflist|colwidth=30em}}
Traduction - swahili
==Utambuzi==
Anaphylaxis hutambiliwa kwa misingi ya ukweli wa vipimo. Wakati mojawapo ya mambo haya matatu hutokea katika muda wa dakika chache/saa chache wa kukaribiana na kizio, ni wazi kuwa mtu huyu ana maradhi ya anaphylaxis:
# Kuguswa kwa ngozi au ngozi laini ya makamasi halafu ama kushindwa kupumua vizuri au shinikizo la chini la damu
# Dalili mbili au zaidi ya zifuatazo:-
#: a. Kuhusika kwa ngozi au sehemu laini zinaweza kutoa makamasi
#: b. Shida za kupumua
#: c. Shinikizo la damu la chini
#: d. Dalili za shida za tumbo na mkondo wa chakula
# Shinikizo la chini la damu baada ya kukaribiana na kizio kinachjulikana
Ikiwa mtu atapata madhara mabaya kutokana na kuumwana na mdudu au kunywa dawa, uchunguzi wa damu kubaini kuwepo kwa tryptase au histamine (inayotolewa na chembechembe za mast) unaweza kuwa muhimu katika utambuzi wa anaphylaxis. Hata hivyo, uchunguzi huu hauna matokeo yenye umuhimu sana kama kinachosababisha ni chakula au mtu anayechunguzwa ana shinikizo la kawaida la damu, na hawawezi kupuuzilia mbali uwezekano wa utambuzi wa anaphylaxis.
===Uainishaji===
Kuna aina tatu kuu za anaphylaxis. Anaphylaxix itokanayo na mshtuko- hutokea wakati ambapo mishipa ya damu hupanuka katika sehemu nyingi za mwili (systemic vasodilation), jambo ambalo husababisha shinikisho la chini la damu ambalo ni takribani asilimia 30 chini ya kiwango sanifu.{{cite journal|last=Limsuwan|first=T|coauthors=Demoly, P|title=Acute symptoms of drug hypersensitivity (urticaria, angioedema, anaphylaxis, anaphylactic shock).|journal=The Medical clinics of North America|date=2010 Jul|volume=94|issue=4|pages=691–710, x|pmid=20609858|url=http://smschile.cl/documentos/cursos2010/MedicalClinicsNorthAmerica/Acute%20Symptoms%20of%20Drug%20Hypersensitivity%20(Urticaria,%20Angioedema,%20Anaphylaxis,%20Anaphylactic%20Shock).pdf}} Biphasic anaphylaxis hutambuliwa wakati dalili zinajirudia kati ya saa 1–72 hata kama mhusika hajakaribiana na kizio kinachosababisha mmenyuo wa kwanza. Baadhi ya uchunguzi umetoa madai kwamba takriban asilimia 20% ya visa vya anaphylaxis ni biphasic. Dalili zake hurudia mhusika baada ya saa 8 Mmenyuo wa pili hutibiwa kwa njia sawa na jinsi anaphylaxis hutibiwa mwanzo. Tatizo la Pseudoanaphylaxis au anaphylactoid ni sawa tu ila ni maneno ya zamani yanaomaanisha anaphylaxis isiyotokana na mmenyuo wa mzio, bali inayotokana na ile inayosababishwa na kujeruhiwa kwa chembe-chembe za mast (mast cell degranulation).{{cite journal|last=Lee|first=JK|coauthors=Vadas, P|title=Anaphylaxis: mechanisms and management.|journal=Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology|date=2011 Jul|volume=41|issue=7|pages=923–38|pmid=21668816}} Neno la kisasa linalotumiwa na shirika la Mizio Ulimwenguni yaani ‘World Allergy Organization’ ni anaphylaxis isiyohitaji kinga ya mwili yaani “non-immune anaphylaxis” . Baadhi ya watu wamependekeza kwamba maneno ya zamani yasitumiwe sasa.
===Kuchunguza Mzio===
[[Picha:Kuchunguza mzio wa ngozi.JPG|thumb|Uchunguzi wa mzio wa ngozi ambao ungali unaendelea kwenye mkono wa kulia]]
Kuchunguza mzio kunaweza kusaidia kubaini kilichosababisha mtu-husika kupata maradhi ya anaphylaxis. Kuchunguza mzio wa ngozi (kama vile kuchunguza vipande vya ngozi) hupatikana kwa aina fulani ya chakula au sumu. Uchunguzi wa damu ili kubaini chembe-chembe mahususi ni muhimu katika kuthibitisha vizio vinavyotokana na maziwa, mayai, njugu, mafuta ya miti na samaki. Uchunguzi wa ngozi unaweza kuthibitisha uwepo wa vizio vya penicillin, hata hivyo hakuna uchunguzi wa ngozi kwa minajili ya matibabu mengine. Anaphylaxis isiyohitaji kinga ya mwili, inaweza kuchunguzwa tu kwa kupekua historia ya mhusika au kumweka karibu na kizio ambacho yamkini kilisababisha mmenyuo hapo awali. Hakuna uchunguzi wa damu au ngozi kwa anaphylaxis isiyohitaji kinga.
===Uchunguzi wa Kutofautisha===
Wakati mwingine ni vigumu kutofautisha kati ya anaphylaxis na asthma, kuzimia kutokana na kutopata ewa safi ya kutosha (syncopy), na kiwewe cha kuvamiwa. Watu wenye asthma kwa kawaida huwa hawaumwi na tumbo au dalili yoyote ya matumbo. Mtu anapozimia, huwa na ngozi iliyosawijika na haina vipele wala vimbimbi. Mtu ambaye amepatwa au kuvamiwa na kiwewe huwa na ngozi iliyojikunja lakini haina vipele. Hali nyingine zinazoweza kuwa na dalili sawa ha hizi ni kula chakula chenye sumu inayotoka na samaki iliyooza (scombroidosis) na magonjwa yanayotokana na wadudu fulani (anisakiasis).
==Kinga==
Njia inayopendekezwa ili kukinga anaphylaxis ni kujiepusha na chochote ambacho kiliwahi kusababisha mmenyuo siku za awali. Ikiwa njia hii haiwezekani, kuna uwezekano wa kupata matibabu yanayoweza kuzuia mwili usiendelee kuathirika na kizio kinachojulikana (desensitization). Kutibu mfumo Kutibu mfumo wa kinga mwilini(immunotherapy) kwa kutumia sumu za Hymenoptera venoms ni mathubuti kwa kati ya asilimia 80–90% kwa watu wazima na asilimia 98% kwa watoto dhidi ya vizio vya nyuki, nyigu, mavu, chungu na wadudu wengine. Kinga ya mwilini kwa njia ya mdomo yaweza kuwa madhubuti pia kwa watu wengine haswa kwa vizio vya vyakula fulani vikiwemo maziwa, mayai, nazi na njugu; ingawa tiba za aina hii zina athari mbaya za kando. Kuzuia mwili usiendelee kuathirika na vizio pia inawezekana kwa kutumia matibabu mengi, hata hivyo ni bora watu kuepukana na shida za matibabu. Kwa wale ambao wanaathiriwa na mafuta ya miti, yaani latex, ni muhimu kujiepusha na vyakula vinavyokaribiana na vinavyoweza kusababisha mmenyuo wa kinga ya mwili (cross-reactive foods), kama vile avocado au parachichi, ndizi, na viazi miongoni mwa vingine.
==Kudhibiti==
Anaphylaxis ni ugonjwa hatari na waweza kuhitaji hatua za dharura za kuokoa maisha kuhakikisha mkondo-ewa uko sawa, kuwekewa ewa safi, kuongezewa maji mwilini, na kuangaliwa kwa karibu. Epinephrine ndiyo chaguo pekee la tiba. Antihistamines na steroids mara nyingi hutumiwa licha ya epinephrine. Wakati mtu-husika amerejelea hali ya kawaida, inafaa aangaliwe kwa kati ya saa 2 na 24 hospitalini ili kuhakikisha kuwa dalili hazimrudii, kwani zaweza kurudi hasa kama mtu ana biphasic anaphylaxis.{{cite web|url=http://www.resus.org.uk/pages/reaction.pdf |title=Emergency treatment of anaphylactic reactions – Guidelines for healthcare providers|month=January | year=2008 |accessdate=2008-04-22 |format=PDF |work= |publisher=Resuscitation Council (UK)}}
===Epinephrine===
[[Picha:Epipen.jpg|thumb|Zamani ikiitwa EpiPen auto-injector]]
Epinephrine (adrenaline) ndiyo tiba ya kimsingi ya anaphylaxis. Hapana sababu ya kutoitumia (haina tatizo lolote). Imependekezwa kuwa mtu adungwe sindano yenye mchanganyiko wa epinephrine katika msuli wa katikati ya paja mara tu anaposhukiwa kuugua maradhi ya anaphylaxis. Sindano hii yaweza kurudiwa kila baada ya dakika 5 mpaka 15 ikiwa mgonjwa hapati nafuu kutokana na matibabu. Dosi ya pili inahitajika katika asilimia 16 hadi 35% ya visa. Si kawaida kwa dosi zaidi ya mbili kuhitajika. Ni bora kudunga sindano kwa msuli (intramuscular administration) kuliko chini tu ya ngozi (subcutaneous administration), ambapo dawa itachukua muda mrefu kusambaa mwilini.{{cite journal|last=Simons|first=KJ|coauthors=Simons, FE|title=Epinephrine and its use in anaphylaxis: current issues.|journal=Current opinion in allergy and clinical immunology|date=2010 Aug|volume=10|issue=4|pages=354–61|pmid=20543673}} Miongoni mwa athari kidogo za epinephrine ni kama vile kutetemeka, wasi wasi, maumivu ya kichwa, na mpigo wa juu wa moyo.
Epinephrine huenda isifanye kazi kwa watu wanaotumia dawa ya B-blockers. Katika hali hii, kama epinephrine haifanyi kazi, sindano ya mishipa yenye glucagon yaweza kutumiwa. Glucagon ina njia ya kufanya kazi bila kuhusisha β-receptors.
Ikibidi, epinephrine yaweza kudungwa moja kwa moja kwenye mshipa (intravenous injection) kwa kuichanganya na maji maalum. Hata hivyo, kudunga mshipa dawa ya epinephrine, kumehusishwa na mpigo wa moyo usio wa kawaida (dysrhythmia) na ugonjwa wa moyo (myocardial infarction).{{cite journal|last=Mueller|first=UR|title=Cardiovascular disease and anaphylaxis.|journal=Current opinion in allergy and clinical immunology|date=2007 Aug|volume=7|issue=4|pages=337–41|pmid=17620826}} Sindano maalumu za moja kwa moja za epinephrine yaani ‘epinephrine autoinjectors’, ambazo zinawawezesha watu wenye shida ya epinephrine kujidunga misulini wenyewe ziko kwa dosi mbili; moja ya watu wazima au watoto wenye uzani wa zaidi ya kilo 25 na nyingine ya watoto wenye uzani wa kilo 10 hadi 25 .{{cite journal|last=Sicherer|first=SH|coauthors=Simons, FE, Section on Allergy and Immunology, American Academy of, Pediatrics|title=Self-injectable epinephrine for first-aid management of anaphylaxis.|journal=Pediatrics|date=2007 Mar|volume=119|issue=3|pages=638–46|pmid=17332221}}
===Vijalizo===
Dawa za antihistamines huongezwa licha ya epinephrine. Dawa hizi zilidhaniwa kufanya kazi vyema kwa misingi fikira za kidhahania, lakini kuna ushahidi haba kuwa matumizi ya antihistamines kwa hakika ni madhubuti kwa kutibu anaphylaxis. Uchunguzi wa Cochrane wa mwaka 2007 haukupata manufaa yoyote ya kuzipendekeza. {{cite journal |author=Sheikh A, Ten Broek V, Brown SG, Simons FE |title=H1-antihistamines for the treatment of anaphylaxis: Cochrane systematic review|journal=Allergy |volume=62 |issue=8 |pages=830–7 |year=2007 |month=August |pmid=17620060 |doi=10.1111/j.1398-9995.2007.01435.x |url=}} Dawa za antihistimines haziaminiki kuwa na athari ya kuleta majimaji au mkazo wa ghafla kwenye mkondo-ewa. Kuna uwezekano kidogo wa corticosteroids kuleta mabadiliko kwa mtu ambaye ana tatizo la anaphylaxis sasa. Zinaweza kutumiwa kwa matumaini ya kupunguza uwezekano wa kupata biphasic anaphylaxis, lakini uwezo wao wa kuzuia kupata maradhi ya anaphylaxis siku zijazo haujulikani.{{cite journal |author=Lieberman P |title=Biphasic anaphylactic reactions |journal=Ann. Allergy Asthma Immunol.|volume=95 |issue=3 |pages=217–26; quiz 226, 258 |year=2005 |month=September |pmid=16200811 |doi= 10.1016/S1081-1206(10)61217-3|url=}} Dawa ya Salbutamol inayopeanwa kwa kutumia kifaa cha kusaidia kupumua (nebulizer) yaweza kuwa madhubuti wakati epinephrine haileti nafuu ya dalili za mkazo wa mishipa ya mkondo-ewa. Methylene blue imewahi kutumiwa kwa wale wasiopata nafuu kutokana na matibabu ya mwanzo kwa sababu hulainisha misuli-laini.
===Kujiandaa===
Watu walio kwenye hatari ya kupata anaphylaxis wanashauriwa na "mpango wa kukabiliana na mzio wa dharura". Wazazi wanafaa kufahamisha shule kuhusu muzio ya watoto wao la kufanya iwapo kutatokea dharura ya anaphylaxis. Mpango huu kwa kawaida unafaa ujumuishe kutumia sindano za moja kwa moja yaani epinephrine auto-injectors, pendekezo la kuvaa kikuku chenye king’ora cha matibabu, na mawaidha ya jinsi ya kujiepusha na visababishi.{{cite journal|last=Martelli|first=A|coauthors=Ghiglioni, D, Sarratud, T, Calcinai, E, Veehof, S, Terracciano, L, Fiocchi, A|title=Anaphylaxis in the emergency department: a paediatric perspective.|journal=Current opinion in allergy and clinical immunology|date=2008 Aug|volume=8|issue=4|pages=321–9|pmid=18596589}} Matibabu ya kufanya mwili usiwe mwepesi kuhisi kinachosababisha mmenyuo wa mwili kutokana na mzio (allergen immunotherapy) yapo kwa visababishi vingine. Aina hii ya matibabu yaweza kuzuia uwezekano wa kutokea kwa maradhi ya anaphylaxis ya siku zijazo. Dawa ya kutumika kwa miaka mingi ya kuzua mmenyuo wa nyama iliyoko chini ya ngozi imepatikana kuwa madhubuti, huku dawa ya kunywa au kumeza ikipatikana kuwa madhubuti vizio vingi vya vyakula.
==Matarajio==
Kuna uwezekano mkubwa wa kupona wakati kiini kinajulikana na mtu kupata matibabu ya haraka.{{cite book|last=Harris|first=edited by Jeffrey|title=Head and neck manifestations of systemic disease|year=2007|publisher=Informa Healthcare|location=London|isbn=9780849340505|pages=325|url=http://books.google.ca/books?id=31yUl-V90XoC&pg=PA325|coauthors=Weisman, Micheal S.}}
Hata kama kiini hakijulikana, kama tiba ya kuzuia mmenyuo ipo, mtu-husika kwa kawaida hupata nafuu ya haraka. Kama mtu atakufa, kwa kawaida huwa ni kutokana na tatizo la kupumua (haswa kufungika kwa mkondo-ewa) au mshtuko wa moyo. Anaphylaxis husababisha kifo kwa asilimia 0.7–20% ya visa.{{cite book |title=Rosen's emergency medicine: concepts and clinical practice 7th edition |last=Marx |first=John |authorlink= |coauthors=|year=2010 |publisher=Mosby/Elsevier |location=Philadelphia, PA |isbn=9780323054720|page=15111528 }}{{cite journal|last=Triggiani|first=M|coauthors=Patella, V, Staiano, RI, Granata, F, Marone, G|title=Allergy and the cardiovascular system.|journal=Clinical and experimental immunology|date=2008 Sep|volume=153 Suppl 1|pages=7–11|pmid=18721322|url=http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2515352/?tool=pubmed|pmc=2515352}} Baadhi ya vifo vimetokea baina ya dakika chache tu. Watu wanaougua anaphylaxis inayotokana na kufanya mazoezi mara nyingi huwa na matokeo mazuri, huku wakipata visa kidogo na visivyokuwa hatari kadri wanavyoendelea kuzeeka.{{cite book|last=editor|first=Mariana C. Castells,|title=Anaphylaxis and hypersensitivity reactions|year=2010|publisher=Humana Press|location=New York|isbn=9781603279505|pages=223|url=http://books.google.ca/books?id=bEvnfm7V-LIC&pg=PA223}}
==Uwezekano==
Uwezekano wa kutokea kwa kisa cha anaphylaxis ni 4–5 kwa watu 100,000 kwa mwaka, huku uwezekano wa walio kwenye hatari ukiwa asilimia 0.5%–2%.{{cite journal|last=Simons|first=FE|coauthors=World Allergy, Organization|title=World Allergy Organization survey on global availability of essentials for the assessment and management of anaphylaxis by allergy-immunology specialists in health care settings.|journal=Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology|date=2010 May|volume=104|issue=5|pages=405–12|pmid=20486330|url=http://www.csaci.ca/include/files/WAO_Anaphylaxis_Guidelines_2011.pdf}} Viwango hivi vinaonekana kuongezeka. Idadi ya watu waliokuwa na anaphylaxis miaka ya 1980 ilikuwa takriban 20 kwa 100,000 kwa mwaka, huku miaka ya 1990 ikiwa 50 kwa 100,000 kwa year.{{cite journal |author=Simons FE |title=Anaphylaxis: Recent advances in assessment and treatment |journal=J. Allergy Clin. Immunol.|volume=124 |issue=4 |pages=625–36; quiz 637–8 |year=2009 |month=October |pmid=19815109 |doi=10.1016/j.jaci.2009.08.025|url=https://secure.muhealth.org/~ed/students/articles/JAClinImmun_124_p0625.pdf}} Ongezeko hili la anaphylaxis, kimsingi, linaonekana kusababishwa na vyakula.{{cite journal|last=Koplin|first=JJ|coauthors=Martin, PE, Allen, KJ|title=An update on epidemiology of anaphylaxis in children and adults.|journal=Current opinion in allergy and clinical immunology|date=2011 Oct|volume=11|issue=5|pages=492–6|pmid=21760501}} Hatari kubwa zaidi inaonekana kuwa kwa vijana na watu wa jinsia ya kike.
Kwa sasa, anaphylaxis inaongoza kwa vifo kati ya 500–1,000 kwa mwaka (2.4 kwa milioni) nchini Marekani, vifo 20 kwa mwaka nchini Uingereza (0.33 kwa milioni), na vifo 15 kwa mwaka nchini Australia (0.64 kwa milioni). Viwango vya vifo vimeshuka baina ya miaka ya 1970 na 2000.{{cite journal|last=Demain|first=JG|coauthors=Minaei, AA, Tracy, JM|title=Anaphylaxis and insect allergy.|journal=Current opinion in allergy and clinical immunology|date=2010 Aug|volume=10|issue=4|pages=318–22|pmid=20543675}} Nchini Australia, vifo vya anaphylaxis kutokana na chakula huwapata wanawake huku vinavyotokana na kuumwa na wadudu vikiwapata wanaume. Vifo kutokana na anaphylaxis haswa husababishwa na matibabu.
==Historia==
Neno "aphylaxis" liliunganishwa na Charles Richet mwaka wa 1902 na baadaye kubadilika na kuwa "anaphylaxis" kwa sababu lilionekana kutamkika vyema.{{cite journal|last=Boden|first=SR|coauthors=Wesley Burks, A|title=Anaphylaxis: a history with emphasis on food allergy.|journal=Immunological reviews|date=2011 Jul|volume=242|issue=1|pages=247–57|pmid=21682750}} Baadaye alitunukiwa Tuzo ya Nobel ya Udaktari na Uchunguzi wa Kimatibabu kwa kazi yake murua kuhusu anaphylaxis mwaka 1913. Hata hivyo mmenyuo wenyewe umekuwa ukiripotiwa tangu jadi.{{cite journal|last=Ring|first=J|coauthors=Behrendt, H, de Weck, A|title=History and classification of anaphylaxis.|journal=Chemical immunology and allergy|year=2010|volume=95|pages=1–11|pmid=20519878|url=http://media.wiley.com/product_data/excerpt/42/04708611/0470861142.pdf}} Neno hili limetokana na lugha ya Kigiriki|Maneno ya Kigiriki ἀνά ana, ''dhidi'', na φύλαξις phylaxis, ''kinga''.{{cite web|url=http://www.merriam-webster.com/dictionary/anaphylaxis|title=anaphylaxis |accessdate=2009-11-21|publisher=merriam-webster.com }}
==Utafiti==
Kuna juhudi zinazoendelezwa ili kuunda epinephrine ambayo inaweza kuwekwa chini ya ulimi (sublingual epinephrine) ili kutibu anaphylaxis. Sindano ya kuingiza chembe-chembe za kuzuia yaani ‘anti-IgE antibody’ omalizumab inaendelewa kutafitiwa kama njia ya kuzuia marudio ya maradhi haya kwa zaidi ya mara moja, ingawa bado haijapendekezwa.{{cite journal|last=Vichyanond|first=P|title=Omalizumab in allergic diseases, a recent review.|journal=Asian Pacific journal of allergy and immunology / launched by the Allergy and Immunology Society of Thailand|date=2011 Sep|volume=29|issue=3|pages=209–19|pmid=22053590}}
==Marejeleo==
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Années d'expérience en traduction : 21. Inscrit à ProZ.com : Feb 2012.
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I’m a native Swahili speaker and a trained translator, English & Kiswahili teacher, and journalist. I have a great cultural and political knowledge of East and Central African people (Swahili-speaking countries) and I’m familiar with all Swahili dialects – from Eastern D.R. Congo, Rwanda, Burundi, Uganda, Tanzania, and Kenya. I have worked with/for film industry companies like HBO-VICE, research firms, the government, many organizations,s and courts. I’m a reliable freelance translator, interpreter, transcriber, subtitling specialist, and editor for reputable language companies in the US, Canada, and Europe. I have excellent computer skills and I’m conversant with tools such as SDL Trados, Subtitle Edit, and VideoPad.
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Master of Public Administration | August 2014 to December 2015 | Bowling Green State University (BGSU): Bowling Green, OH
Specialization: International Development
Related coursework: Public Policy & Public Administration, Personnel Management, Research Methods, Public, Administration Theories, Public Budgeting & Fiscal Policy, Program Monitoring & Evaluation, International Political Economy, Perspectives of International Media, Race Relations and Multi-Culturalism, Local Economic and Community Development and Conflict Resolution
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