Anafilaksi her ya\u015ftan insan\u0131 etkileyebilen ya\u015fam\u0131 tehdit eden bir durumdur. En \u015fiddetli alerji bi\u00e7imidir. Ya\u015flanma, glomer\u00fcler kay\u0131p, azalm\u0131\u015f kreatinin klirensi, gecikmi\u015f gastrik bo\u015falma, azalm\u0131\u015f intrinsik fakt\u00f6r salg\u0131lanmas\u0131 gibi organ sistemlerinde fizyolojik fonksiyon kayb\u0131na neden olur [1]. Ya\u015fam beklentisi ve ya\u015fl\u0131 yeti\u015fkinlerin say\u0131s\u0131 artt\u0131k\u00e7a, alerjik hastal\u0131klar geriatrik pop\u00fclasyonda artan bir insidans g\u00f6stermektedir [2]. Ya\u015fam beklentisi artarken, ya\u015fl\u0131 hastalarda anafilaksi \u00f6zellikleri hakk\u0131nda \u00e7ok az \u015fey bilinmektedir [3]. Bununla birlikte ya\u015fl\u0131 hastalarda anafilaksi daha \u015fiddetli ve \u00f6l\u00fcmc\u00fcl olma riski daha y\u00fcksektir [4]. \u0130la\u00e7 alerjileri, t\u00fcm istenmeyen ila\u00e7 reaksiyonlar\u0131n\u0131n %6-10\u2019unu olu\u015fturur ve nihayetinde \u00f6l\u00fcmc\u00fcl reaksiyonlar\u0131n %10\u2019una kadar\u0131n\u0131 olu\u015fturur[5]. K\u0131l\u0131n\u00e7 ve ark. yapt\u0131\u011f\u0131 bir \u00e7al\u0131\u015fmada, ila\u00e7 alerjilerinin ya\u015fl\u0131 hastalarda hastaneye yat\u0131\u015f oran\u0131n\u0131n yeti\u015fkin hastalara g\u00f6re yakla\u015f\u0131k olarak 2 kat daha fazla oldu\u011funu g\u00f6r\u00fclmektedir [6]. \u00d6te yandan g\u0131da alerjileri giderek artmakla birlikte, \u00e7ocuklara g\u00f6re daha az belirgindir [7]. Yine ayn\u0131 \u00e7al\u0131\u015fmada ya\u015fl\u0131larda anaflaksinin sebebi genellikle g\u0131da ili\u015fkili olmad\u0131\u011f\u0131 g\u00f6r\u00fclm\u00fc\u015ft\u00fcr. Aurich ve ark. yapt\u0131\u011f\u0131 \u00e7al\u0131\u015fmada Avrupa\u2019da ya\u015fl\u0131larda anafilaksinin sebeplerinin s\u0131kl\u0131\u011fa g\u00f6re s\u0131ralamas\u0131 b\u00f6cek sokmas\u0131, ila\u00e7 alerjileri ve g\u0131da alerjisidir[8]. Arroyo ve ark. Amerika\u2019da anafilaksinin sebeplerinin s\u0131kl\u0131\u011f\u0131 g\u00f6re s\u0131ralamas\u0131 ila\u00e7 alerjisi, b\u00f6cek sokmalar\u0131 ve g\u0131da alerjisi olarak s\u0131ralanmaktad\u0131r [9]. T\u00fcrkiye\u2019de yap\u0131lan \u00e7al\u0131\u015fmada ise, ila\u00e7lar, b\u00f6cek sokmas\u0131 ve g\u0131da alerjisi olarak s\u0131ralanmaktad\u0131r[10].<\/p>\n\n\n\n
Klinik \u00d6zellikler ve Tan\u0131<\/strong><\/p>\n\n\n\n Anafilaksi tan\u0131s\u0131 klinik ile konulur ve anafilaksiye ait spesifik semptom, bulgu veya laboratuar belirteci yoktur [11]. Net bir klinik tablo olmamas\u0131 ve bir\u00e7ok g\u00f6r\u00fc\u015f\u00fcn olmas\u0131 sebebiyle anaflaksi zaman zaman atlanmaya sebep olmu\u015f olabilir. Bunun i\u00e7in bir\u00e7ok komite taraf\u0131ndan bir\u00e7ok g\u00f6r\u00fc\u015f ortaya at\u0131lm\u0131\u015ft\u0131r. En s\u0131k kullan\u0131lan The National Institute of Allergy and Infectious Diseases (NIAID) taraf\u0131ndan 2006\u2019da ve World Allergy Organization (WAO) 2020\u2019de yay\u0131nlad\u0131klar\u0131 kriterlerdir [11]. World Health Organization (WHO) anafilaksi kriterleri;<\/p>\n\n\n\n Kriter 1;<\/strong> Hastal\u0131\u011f\u0131n akut ba\u015flang\u0131c\u0131 (dakikalar ile birka\u00e7 saat aras\u0131nda) ve ayn\u0131 anda cilt, mukoza dokusu veya her ikisinin de tutulumu (\u00f6rn. yayg\u0131n kurde\u015fen, ka\u015f\u0131nt\u0131 veya k\u0131zar\u0131kl\u0131k, \u015fi\u015fmi\u015f dudaklar-dil-k\u00fc\u00e7\u00fck dil) ve a\u015fa\u011f\u0131dakilerden en az biri:<\/p>\n\n\n\n Kriter 2; <\/strong>Tipik cilt tutulumu olmasa bile, bilinen veya \u00e7ok olas\u0131 bir alerjene maruziyetten sonra (dakikalar ile birka\u00e7 saat aras\u0131nda) akut ba\u015flang\u0131\u00e7l\u0131 hipotansiyon, bronkospazm veya laringeal tutulumdan birinin olmas\u0131d\u0131r.<\/p>\n\n\n\n Hipotansiyonun tan\u0131m\u0131 ise; Yeti\u015fkinler ve 10 ya\u015f \u00fcst\u00fc \u00e7ocuklar<\/strong>da sistolik kan bas\u0131nc\u0131nda o ki\u015finin ba\u015flang\u0131\u00e7 \u200b\u200bde\u011ferine g\u00f6re %30\u2019dan fazla azalma veya<\/strong> sistolik kan bas\u0131nc\u0131n\u0131n <90 mmHg\u2019n\u0131n alt\u0131nda olmas\u0131d\u0131r [12]. Ya\u015fl\u0131 hastalarda farkl\u0131 olarak kardiyovask\u00fcler semptom bilin\u00e7 kayb\u0131 olabilir. Cilt semptomlar\u0131 yeti\u015fkin hastalara g\u00f6re daha az g\u00f6r\u00fclmektedir [13]. \u015eiddetli anafilaksi olan hastalarda hipotansiyon ve hipoksemi olas\u0131l\u0131\u011f\u0131 daha y\u00fcksektir. \u015eiddetli anafilaksi ileri ya\u015f, \u00f6nceden var olan kardiyopulmoner hastal\u0131k ve ila\u00e7 etiyolojisi ile ili\u015fkilidir [14].<\/p>\n\n\n\n Tedavi<\/strong><\/p>\n\n\n\n Anafilaksi varl\u0131\u011f\u0131nda hastalarda \u00f6nce sa\u011flanmas\u0131 gereken \u00f6nlem hava yolu a\u00e7\u0131kl\u0131\u011f\u0131n\u0131n sa\u011flanmas\u0131d\u0131r [15]. Hastada stridor veya solunum s\u0131k\u0131nt\u0131s\u0131 varsa acil ent\u00fcbasyon yap\u0131lmas\u0131 gerekebilir. Bu s\u00fcre\u00e7te \u00fcst solunum yolu \u00f6demi olaca\u011f\u0131ndan hastada acil krikotiroidotomi gerekebilir. Epinefrin ilk yap\u0131lmas\u0131 gereken ajand\u0131r, uyluk anterolateral k\u0131sm\u0131ndan intramuskuler olarak 0.01 mg\/kg (yeti\u015fkinlerde maximum doz 0.5 mg) olarak yap\u0131l\u0131r [11]. \u0130lk doz etkisiz olursa en az 5 dakika sonra doz tekrarlanmal\u0131d\u0131r. Epinefrin genellikle g\u00fcvenlidir ve anafilaksi i\u00e7in kullan\u0131m\u0131na dair herhangi bir mutlak kontrendikasyon yoktur. \u0130ntramuskuler yap\u0131lan adrenalinin yan etkileri genellikle hafif ve ge\u00e7icidir, en yayg\u0131n yan etkisi titreme, \u00e7arp\u0131nt\u0131 ve anksiyetedir [16]. Nadir durumlarda, alerjik reaksiyonlar i\u00e7in epinefrin kullan\u0131m\u0131 aritmilere ve miyokard enfarkt\u00fcs\u00fc gibi kardiyak istenmeyen olaylara neden olabilir [17]. Yap\u0131lan \u00e7al\u0131\u015fmalarda 50 ya\u015f\u0131n \u00fczerindeki hastalarda anafilaksi nedeniyle kullan\u0131lan intramuskuler adrenaline ba\u011fl\u0131 kardiyak istenmeyen olaylar\u0131n daha fazla g\u00f6r\u00fcld\u00fc\u011f\u00fc ortaya konulmu\u015ftur [18,19]. Ancak ayn\u0131 pop\u00fclasyonlarda \u015fiddetli anafilaksi ve \u00f6l\u00fcmc\u00fcl anafilaksi riski de artm\u0131\u015ft\u0131r [17,20,21]. Derleme, vaka raporu ve \u00e7al\u0131\u015fma yazarlar\u0131, hastalarda ileri ya\u015f olsa bile anafilaksi varl\u0131\u011f\u0131nda derhal epinefrin yap\u0131lmas\u0131 gerekti\u011fini \u00f6nermektedirler [11,13,18,22,23].<\/p>\n\n\n\n Di\u011fer tedaviler; ya\u015fl\u0131 hastalarda birden fazla ilac\u0131n d\u00fczenli al\u0131m\u0131 s\u0131k g\u00f6r\u00fcl\u00fcr (polifarmasi). E\u015f zamanl\u0131 ila\u00e7 kullan\u0131m\u0131 anafilaksinin y\u00f6netimini de\u011fi\u015ftirebilir. Adrenalinin etkisi kullan\u0131lan beta-blok\u00f6rler taraf\u0131ndan azalt\u0131labilir. Bu durumda adrenalin etkili de\u011filse, glukagon intraven\u00f6z kullan\u0131labilir [24,25].<\/p>\n\n\n\n Sonu\u00e7 olarak alerji gen\u00e7 bireylere \u00f6zg\u00fc olarak d\u00fc\u015f\u00fcn\u00fclebilir fakat ileri ya\u015flarda da alerji devam etmesi yayg\u0131nd\u0131r. \u00d6l\u00fcmc\u00fcl ve \u015fiddetli anafilaksi riskini art\u0131ran fakt\u00f6rlerden biri 65 ya\u015f \u00fcst\u00fcnde olmakt\u0131r. Geriatrik pop\u00fclasyonda s\u0131kl\u0131kla hastane yat\u0131\u015f\u0131 gerekir. Hala anafilaksiyi etkileyen fakt\u00f6rler net olarak ayd\u0131nlat\u0131lamam\u0131\u015ft\u0131r.<\/p>\n\n\n\n Kaynaklar<\/strong><\/p>\n\n\n\n [1] Mangoni AA, Jackson SHD. Age-related changes in pharmacokinetics and pharmacodynamics: basic principles and practical applications. Br J Clin Pharmacol 2004;57:6\u201314. https:\/\/doi.org\/10.1046\/j.1365-2125.2003.02007.x.<\/p>\n\n\n\n [2] Milgrom H, Huang H. Allergic disorders at a venerable age: A mini-review. Gerontology 2014;60. https:\/\/doi.org\/10.1159\/000355307.<\/p>\n\n\n\n [3] Cardona V, Guilarte M, Luengo O, Labrador-Horrillo M, Sala-Cunill A, Garriga T. Allergic diseases in the elderly. Clin Transl Allergy 2011;1:11. https:\/\/doi.org\/10.1186\/2045-7022-1-11.<\/p>\n\n\n\n [4] Francuzik W, D\u00f6lle S, Worm M. Risk factors and treatment of refractory anaphylaxis – a review of case reports. Expert Rev Clin Immunol 2018;14:307\u201314. https:\/\/doi.org\/10.1080\/1744666X.2018.1450140.<\/p>\n\n\n\n [5] Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. JAMA 1998;279:1200\u20135. https:\/\/doi.org\/10.1001\/jama.279.15.1200.<\/p>\n\n\n\n [6] K\u0131l\u0131n\u00e7 M, \u00c7\u00f6lkesen F, Sadi Aykan F, Evcen R, Y\u0131ld\u0131z E, \u00d6nalan T, et al. Drug Allergies in Older Adults: A Major Problem in a Specific Population. Int Arch Allergy Immunol 2025;186:59\u201366. https:\/\/doi.org\/10.1159\/000540374.<\/p>\n\n\n\n [7] Baseggio Conrado A, Ierodiakonou D, Gowland MH, Boyle RJ, Turner PJ. Food anaphylaxis in the United Kingdom: analysis of national data, 1998-2018. BMJ 2021;372:n251. https:\/\/doi.org\/10.1136\/bmj.n251.<\/p>\n\n\n\n [8] Aurich S, D\u00f6lle-Bierke S, Francuzik W, Bilo MB, Christoff G, Fernandez-Rivas M, et al. Anaphylaxis in Elderly Patients-Data From the European Anaphylaxis Registry. Front Immunol 2019;10. https:\/\/doi.org\/10.3389\/fimmu.2019.00750.<\/p>\n\n\n\n [9] Arroyo AC, Robinson LB, Cash RE, Faridi MK, Hasegawa K, Camargo CA. Trends in Emergency Department Visits and Hospitalizations for Acute Allergic Reactions and Anaphylaxis Among US Older Adults: 2006-2014. Journal of Allergy and Clinical Immunology: In Practice 2021;9. https:\/\/doi.org\/10.1016\/j.jaip.2021.03.032.<\/p>\n\n\n\n [10] Y\u0131ld\u0131z E, Arslan \u015e, \u00c7\u00f6lkesen F, Evcen R, Sadi Aykan F, K\u0131l\u0131n\u00e7 M. Anaphylaxis in older adult patients: a 10-year retrospective experience. World Allergy Organization Journal 2022;15. https:\/\/doi.org\/10.1016\/j.waojou.2022.100665.<\/p>\n\n\n\n [11] Golden DBK, Wang J, Waserman S, Akin C, Campbell RL, Ellis AK, et al. Anaphylaxis: A 2023 practice parameter update. Ann Allergy Asthma Immunol 2024;132:124\u201376. https:\/\/doi.org\/10.1016\/j.anai.2023.09.015.<\/p>\n\n\n\n [12] Cardona V, Ansotegui IJ, Ebisawa M, El-Gamal Y, Fernandez Rivas M, Fineman S, et al. World allergy organization anaphylaxis guidance 2020. World Allergy Organization Journal 2020;13. https:\/\/doi.org\/10.1016\/j.waojou.2020.100472.<\/p>\n\n\n\n [13] Ventura MT, Boni E, Taborda-Barata L, Blain H, Bousquet J. Anaphylaxis in elderly people. Curr Opin Allergy Clin Immunol 2022;22:435\u201340. https:\/\/doi.org\/10.1097\/ACI.0000000000000855.<\/p>\n\n\n\n [14] Brown SGA, Stone SF, Fatovich DM, Burrows SA, Holdgate A, Celenza A, et al. Anaphylaxis: clinical patterns, mediator release, and severity. J Allergy Clin Immunol 2013;132:1141-1149.e5. https:\/\/doi.org\/10.1016\/j.jaci.2013.06.015.<\/p>\n\n\n\n [15] A\u011fa\u00e7k\u0131ran \u0130. Management of Anaphylaxis in the Emergency Department. In: Bo\u011fan M, editor. Last Call For Emergency Medicine-2. First Edition, Ankara: BIDGE Publications; 2024, p. 52\u20139.<\/p>\n\n\n\n [16] Cardona V, Ferr\u00e9-Ybarz L, Guilarte M, Moreno-P\u00e9rez N, G\u00f3mez-Gal\u00e1n C, Alcoceba-Borr\u00e0s E, et al. Safety of Adrenaline Use in Anaphylaxis: A Multicentre Register. Int Arch Allergy Immunol 2017;173:171\u20137. https:\/\/doi.org\/10.1159\/000477566.<\/p>\n\n\n\n [17] Lieberman P, Simons FER. Anaphylaxis and cardiovascular disease: therapeutic dilemmas. Clin Exp Allergy 2015;45:1288\u201395. https:\/\/doi.org\/10.1111\/cea.12520.<\/p>\n\n\n\n [18] Kawano T, Scheuermeyer FX, Stenstrom R, Rowe BH, Grafstein E, Grunau B. Epinephrine use in older patients with anaphylaxis: Clinical outcomes and cardiovascular complications. Resuscitation 2017;112:53\u20138. https:\/\/doi.org\/10.1016\/j.resuscitation.2016.12.020.<\/p>\n\n\n\n [19] O\u2019Brien ME, Koehl JL, Raja AS, Erickson TB, Hayes BD. Age-related cardiovascular outcomes in older adults receiving epinephrine for anaphylaxis in the emergency department. J Allergy Clin Immunol Pract 2019;7:2888\u201390. https:\/\/doi.org\/10.1016\/j.jaip.2019.04.040.<\/p>\n\n\n\n [20] Tejedor-Alonso MA, Farias-Aquino E, P\u00e9rez-Fern\u00e1ndez E, Grifol-Clar E, Moro-Moro M, Rosado-Ingelmo A. Relationship Between Anaphylaxis and Use of Beta-Blockers and Angiotensin-Converting Enzyme Inhibitors: A Systematic Review and Meta-Analysis of Observational Studies. J Allergy Clin Immunol Pract 2019;7:879-897.e5. https:\/\/doi.org\/10.1016\/j.jaip.2018.10.042.<\/p>\n\n\n\n [21] Sturm GJ, Herzog SA, Aberer W, Alfaya Arias T, Antol\u00edn\u2010Am\u00e9rigo D, Bonadonna P, et al. \u03b2\u2010blockers and ACE inhibitors are not a risk factor for severe systemic sting reactions and adverse events during venom immunotherapy. Allergy 2021;76:2166\u201376. https:\/\/doi.org\/10.1111\/all.14785.<\/p>\n\n\n\n [22] Nazir S, Lohani S, Tachamo N, Ghimire S, Poudel DR, Donato A. Takotsubo cardiomyopathy associated with epinephrine use: A systematic review and meta-analysis. Int J Cardiol 2017;229:67\u201370. https:\/\/doi.org\/10.1016\/j.ijcard.2016.11.266.<\/p>\n\n\n\n [23] Shrestha B, Kafle P, Thapa S, Dahal S, Gayam V, Dufresne A. Intramuscular Epinephrine-Induced Transient ST-Elevation Myocardial Infarction. J Investig Med High Impact Case Rep 2018;6:2324709618785651. https:\/\/doi.org\/10.1177\/2324709618785651.<\/p>\n\n\n\n [24] McLure M, Eastwood K, Parr M, Bray J. A rapid review of advanced life support guidelines for cardiac arrest associated with anaphylaxis. Resuscitation 2021;159:137\u201349. https:\/\/doi.org\/10.1016\/j.resuscitation.2020.10.001.<\/p>\n\n\n\n [25] Rukma P. Glucagon for Refractory Anaphylaxis. Am J Ther 2019;26:e755\u20136. https:\/\/doi.org\/10.1097\/MJT.0000000000000910.<\/p>\n","protected":false},"excerpt":{"rendered":" Anafilaksi her ya\u015ftan insan\u0131 etkileyebilen ya\u015fam\u0131 tehdit eden bir durumdur. En \u015fiddetli alerji bi\u00e7imidir. Ya\u015flanma, glomer\u00fcler kay\u0131p, azalm\u0131\u015f kreatinin klirensi, gecikmi\u015f gastrik…<\/p>\n","protected":false},"author":1185,"featured_media":668,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"inline_featured_image":false,"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[1,10014],"tags":[10020,10051,10018],"class_list":["post-667","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-genel","category-akademik-blog-yazisi","tag-acil-tip","tag-anaflaksi","tag-geriatri"],"acf":[],"_links":{"self":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/posts\/667","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/users\/1185"}],"replies":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/comments?post=667"}],"version-history":[{"count":0,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/posts\/667\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/media\/668"}],"wp:attachment":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/media?parent=667"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/categories?post=667"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/tags?post=667"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}\n