Se hable de anafilaxia alérgica o reacción anafiláctica en dos tipos de situaciones. La primera situación es cuando aparecen al mismo tiempo, de manera brusca, por contacto con algún alergeno, síntomas alérgicos en dos o más zonas del cuerpo: bronquios, laringe, nariz y ojos, piel, aparato digestivo, aparato circulatorio. Esos síntomas pueden ser de intensidad leve a grave. La segunda situación es cuando por contacto con un alergeno aparecen síntomas bruscos, de carácter grave, que hacen que caiga la tensión arterial, es decir que aparezca un “shock” anafiláctico. Actualmente se tiende a usar el término anafilaxia para la primera situación, aunque algunos médicos lo prefieren reservar para el caso de que haya “shock”.
Alrededor del 30% de los casos de anafilaxia se producen por alergia a algún alimento. Los casos más habituales son por alergia a los frutos secos, frutas o el marisco. En el caso de los niños, el desencadenante más frecuente es el huevo o la leche.
¿Qué síntomas produce la anafilaxia?
Los síntomas, tanto de la anafilaxia, son la suma de los síntomas de cada zona afectada.
En los bronquios, asma: tos, sibilantes o “pitos” en el pecho, dificultad respiratoria y opresión o dolor en el pecho.
En la laringe: tos seca perruna, afonía, dificultad para hablar o tragar, estridor, que es un ruido ronco al tomar aire, dificultad respiratoria.
En nariz y ojos, rinitis y conjuntivitis: estornudos, goteo nasal, picor, taponamiento nasal, lagrimeo, picor y enrojecimiento de ojos.
En la piel y mucosas, urticaria y edema o inflamación: enrojecimiento, habones o ronchas grandes con picor por cualquier sitio, inflamación de ojos, labios, lengua, campanilla, o cualquier zona del cuerpo, picor en la cabeza. Un síntoma muy típico, y que anuncia una reacción grave, es el picor y enrojecimiento de palmas de manos y plantas de pies.
En el aparato digestivo: vómitos, dolor abdominal, retortijones, diarrea.
En el aparato circulatorio: bajada de la tensión arterial, hasta llegar a “shock”, que es cuando la tensión arterial está bajo mínimos. Al bajar la tensión no llega bien la sangre a los órganos del cuerpo, sobre todo al cerebro. Se producen malestar, mareos, visión borrosa, sensación de angustia, de muerte inminente, llegando a la pérdida de conciencia, o incluso a las convulsiones. Cuando la reacción es grave y mantenida pueden quedar daños cerebrales permanentes, o incluso provocar la muerte.
¿Cuál es el tratamiento de los síntomas agudos de anafilaxia?
El tratamiento de la anafilaxia, si es leve, es el que corresponde al síntoma presente: antihistamínicos para los picores, urticaria, edema, rinitis o conjuntivitis, broncodilatadores para el asma leve y los sibilantes, líquidos rehidratantes para los síntomas abdominales, y se debe vigilar al paciente por si empiezan a aparecer síntomas más intensos.
Si los síntomas son intensos de entrada, o son leves pero van empeorando, o si se tiene dudas de la intensidad de la reacción, el tratamiento que se ha de usar sin tardanza es la adrenalina o epinefrina, inyectada vía intramuscular, que se repetirá tantas veces como haga falta.
La adrenalina es el medicamento capaz de salvar la vida en caso de anafilaxia. Otros medicamentos como los corticoides inyectados (tipo Urbasón®, Actocortina®, o similares) y los antihistamínicos no tienen ni la eficacia ni la rapidez de acción necesaria en la anafilaxia. Los corticoides son útiles para evitar recaídas de la segunda fase de la anafilaxia, que ocurre al cabo de varias horas, pero no sirven como sustitutos de la adrenalina.
Una vez administrada la adrenalina se debe solicitar atención médica urgente, pues los efectos de la adrenalina pueden ser pasajeros y los síntomas pueden reaparecer. Por eso se puede repetir la adrenalina hasta que el paciente se quede estable.
Más información sobre la Anafilaxia en los siguientes enlaces:
SEICAP: http://pacientes.seicap.es/es/anafilaxia_23857
AEPNAA: http://www.aepnaa.org/alergia/anafilaxia-63
BLOG: https://blog.allergychef.es/alergico-con-riesgo-de-anafilaxia/
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