[Therapeutic measures for anaphylactic reactions in the course of allergen-specific immunotherapy]

Allergologic emergencies that are caused by an overwhelming immunologic systemic reaction during immunotherapy are guessed to occur in 1:1,000,000 to 1:100,000. These anaphylactic or anaphylactoid reactions are induced by the liberation of different mediators. The symptoms are determined by the kind, the quantity and the relation of these mediators and by the individual predisposition. In general, these symptoms can be detected on the skin, the lungs, the cardiovascular system and the gastrointestinal tract. The early treatment of circulatory and pulmonary disturbances is decisive for the prognosis of the patient. The severity of symptoms is graded from 1 to 4. An adequate therapy has to be given immediately according to the severity of the symptoms in a step-wise approach. Initially, an interruption of the allergen exposition is important, as is an oxygen supply and placement of intravenous accesses. In the specific drug-therapy a few substances have proved to be reliable. Catecholamines (adrenaline, dopamine, noradrenaline), histamine-antagonists, glucocorticosteroids, theophylline and volume substitutes belong to this group, but not the intravenous application of calcium.