From the Guidelines
Anaphylactic shock with low neutrophils and high lymphocytes requires immediate administration of epinephrine, typically given as 0.3-0.5mg intramuscularly in the mid-outer thigh for adults (0.15mg for small children), repeatable every 5-15 minutes if needed, as recommended by the most recent guidelines 1. This condition suggests a severe allergic reaction occurring alongside an unusual immune cell profile. The abnormal cell count pattern (neutropenia with lymphocytosis) warrants further investigation after stabilization, as it could indicate an underlying condition such as viral infection, certain autoimmune disorders, or medication effects that may have contributed to the anaphylactic reaction. Some key points to consider in the management of anaphylaxis include:
- The use of epinephrine as the first-line treatment, with a dose of 0.01 mg/kg of a 1:1000 solution to a maximum of 0.5 mg in adults and 0.3 mg in children, administered intramuscularly in the anterolateral thigh 1.
- The potential for biphasic anaphylaxis, which is a recurrent anaphylactic reaction that can occur 1-72 hours after the initial reaction, and the need for extended observation in patients at high risk for this complication 1.
- The importance of identifying and avoiding the trigger, as well as prescribing an epinephrine auto-injector for future emergencies, to prevent recurrent anaphylactic reactions 1.
- The role of H1 antihistamines, such as diphenhydramine, and H2 blockers, such as ranitidine, in the management of anaphylaxis, although their use is not supported by strong evidence 1.
- The use of corticosteroids, such as methylprednisolone, to help prevent biphasic reactions, although the evidence for this is limited 1. It is essential to prioritize the patient's safety and well-being, and to take a cautious approach in the management of anaphylaxis, given the potential for severe and life-threatening complications.
From the FDA Drug Label
17 PATIENT COUNSELING INFORMATION Advise patients or their caregivers about common adverse reactions associated with the use of epinephrine including an increase in heart rate, the sensation of a more forceful heartbeat, palpitations, sweating, nausea and vomiting, difficulty breathing, pallor, dizziness, weakness or shakiness, headache, apprehension, nervousness, or anxiety
The FDA drug label does not answer the question.
From the Research
Anaphylactic Shock
- Anaphylactic shock is a life-threatening systemic reaction that can cause airway, breathing, or circulatory compromise 2.
- It is a sudden-onset, immediate reaction that implies a risk of death, with fatalities possible from asphyxiation, collapse from hypotensive shock, cardiac arrest, or acute severe bronchoconstriction causing respiratory failure and arrest 3.
- Anaphylaxis can be classified into immunologic, nonimmunologic, or idiopathic based on the associated mechanism, with immunologic causes mediated by IgE antibodies and nonimmunologic causes involving mast cell mediator release 3.
Low Neutrophils and High Lymphocytes
- There is no direct information in the provided studies about the specific relationship between anaphylactic shock, low neutrophils, and high lymphocytes.
- However, it is mentioned that idiopathic anaphylaxis involves mast cell activation and activated lymphocytes 3, suggesting a potential link between lymphocyte activity and anaphylaxis.
Treatment and Management
- The treatment of anaphylaxis involves removal of the trigger, early administration of intramuscular epinephrine, and supportive care for the patient's airway, breathing, and circulation 4, 2.
- Adjunctive treatments include fluid therapy, H(1) and H(2) histamine receptor antagonists, corticosteroids, and bronchodilators, but these do not substitute for epinephrine 2, 5.
- Patients with a history of anaphylaxis should be educated about their condition, especially with respect to trigger avoidance and the correct use of epinephrine autoinjector kits 4, 5.