Emergency & Acute Care Medicine

Anaphylaxis is a life-threatening reaction with respiratory, cardiovascular, cutaneous or gastrointestinal manifestations resulting from exposure to an offending agent usually food, insect sting, medication or physical factors. Anaphylaxis treatment that we usually follow can be divided into 3 stage.

 

Initial Treatments;

Anaphylaxis symptoms onset varies widely, but usually occurs within seconds or minutes of exposure. In some case anaphylaxis, may be delayed for hours. Anaphylaxis can be protracted, lasting for more than 24 hours, or can reoccur after initial resolution. Initial treatment for anaphylaxis is epinephrine injection usually known as EpiPen auto injector.

 

Emergency room Management;

Administer epinephrine

Administer oxygen

Maintain airway with oropharyngeal device

Administer antihistamine

Treat hypotension with IV fluids or colloidal replacement

Treat bronchospasm preferably with beta 11 agonists given continuously or intermittently.

 

Follow Up Treatments; 

At discharge, some experts advocate a short course of antihistamines and oral corticosteroid.As anaphylaxis is a fatal condition the science is always behind to find the best treatment methods and medicines. In India, the Ayurveda medicine, one of the ancient system of medicine in the world, called PUNARNAVASAVAM is being used for similar conditions.

 

The Main Logic Behind the Use of This Medicine

This medicine is slightly alcoholic in nature and contains alcohol soluble chemical extracts of some plants. Alcohol can easily pass through the cell barriers the medicine is fast in action. The chemical nature of the drug will reduce the swelling of the airway and reduce the action of mast cells. More scientific explanation about the nature and action of the drug is unknown.

 

Main Advantages of this medicine;

Although the EpiPen is the immediate choice of medicine to save life of the patient we need supportive treatments like emergency room treatment and in many cases, follow up treatment also to make the patient to be normal. If those can be done with this single medicine it will be a great choice.

 

CLINICAL EXPERIENCE;

1. The case was for a child of 1 1/2 years old, had a history of food allergy to multiple items like, milk nuts, soy etc.

• The child drank some milk, after 5 minutes the symptoms appeared

• The skin Started having urticaria, itching over face, arms and some parts of chest

• The respiratory symptoms include difficulty in breathing, coughing, noise while breathing

Given Punarnavasam 1 ml, orally in 15 minutes’ interval for 4 times. After 2 dose, itself the child got ease in breathing. After one hour, the child became normal with normal respiration, all the skin manifestations are gone and started playing actively

2. The second was a girl child of age 2 years, had a history of severe allergy towards nuts

• She accidently took a very small piece of hazelnut along with her non-allergic sibling.

• She did not develop any symptoms until 4hours after the intake of nut.

• Then she started coughing vigorously, voice became so bad, eyes become protruded resulting in severe respiratory obstruction. She was trying to take breath through mouth, but it was difficult for her

• No skin manifestations were there.

Gave Punarnavasam 2 ml orally in 10 minutes’ interval for 6 times and then in 15 minutes’ interval for 4 times. After 30 minutes the symptoms got reduced and she started breathing through nose, cough reduced. After 2 hours, she became normal all symptoms got relieved.