Anaphylaxis

Question 1

• potentially life-threatening systemic allergic reaction
  involving one or more organ systems that typically occurs within seconds to minutes of exposure to the
  anaphylactic trigger
  + drug, food, or hymenoptera sting
  + radiocontrast administration or latex exposure

Answer 1

ANAPHYLAXIS

Question 2

80-90% of anaphylactic episodes are ____, 10—20% of cases are ____

Answer 2

• uniphasic
• biphasic

Question 3

may be experienced as a “lump” in the throat with hoarseness, or stridor

Answer 3

Laryngeal edema

Question 4

feeling of tightness in the chest and/or
audible wheezing is one of the manifestations also of anaphylaxis

Answer 4

Bronchial obstruction

Question 5

• most common presentations of anaphylaxis (>90% of cases)
• Symptoms include urticarial eruptions, flushing with diffuse erythema, and/or a feeling of generalized warmth

Answer 5

Cutaneous manifestations

Question 6

Gastrointestinal manifestations

Answer 6

represent another severe presentation of anaphylaxis, and include nausea, vomiting, crampy
abdominal pain, and/or fecal incontinence

Question 7

PREDISPOSING FACTORS AND ETIOLOGY

Answer 7

• Preexisting Asthma
• underlying cardiovascular disease
• Atopy
• Hymenoptera allergy
• environmental allergies
• Drugs
• amblyomma americanum ticks

Question 8

Triggers Anaphyalxis

Answer 8

• insects venom
• latex
• drugs
• contrast media

Question 9

• peaks 60—90 min after the onset of anaphylaxis
• An elevated may warrant further workup for mastocytosis, esp. if the presenting reaction occurred in the setting of
  hymenoptera sting

Answer 9

serum tryptase

Question 10

Tx for Anaphylaxis

• treatment of first choice intramuscular
  administration
• can further accelerate empty heart syndrome
  due to its chronotropic effects
  + patients should be in supine position before receiving

Answer 10

Epinephrine

Question 11

Results of Epinephrine that provides both alpha and beta-adrenergic effects

Answer 11

• vasoconstriction,
• bronchial
  smooth-muscle relaxation,
• attenuation of enhanced venular permeability

Question 12

may attenuate this response; therefore, an alternative anti-hypertensive may be considered in patients at high risk of needing emergency epinephrine

Answer 12

Beta blockers

Question 13

Mechanical Tx Anaphylaxis

Answer 13

• Oxygen alone via a nasal catheter or with nebulized albuterol
• endotracheal intubation or a tracheostomy is mandatory for
  oxygen delivery if progressive hypoxia develops

Question 14

are also useful therapeutics to treat
urticaria/angioedema and bronchospasm once the patient is
hemodynamically stable

Answer 14

Ancillary agents such as antihistamines, glucocorticoids, and
bronchodilators

Question 15

Prevention of Anaphylaxis

Answer 15

• Avoidance
• Specific Immunotherapy
• Tolerance Induction
• Desensitization

Question 16

• elicits a temporary state of tolerance to the drug in sensitized, clinically reactive
  patients
• works best for IgE-mediated reactions

Answer 16

Desensitization

Question 17

• 80% of children with peanut allergy remain sensitive for life
• early introduction of peanut protein to the diet of high risk infants (4-11 months of age with atopic dermatitis and/or egg allergy) can prevent the development of most (80% or more)
  peanut allergy compared with children who did not consume peanuts (avoidance group)- ”
  (LEAP) study

Answer 17

Tolerance Induction

Question 18

• “tolerizing” patients to allergen by means of serial subcutaneous administration of
  escalating doses of extract containing relevant allergen until a target maintenance dose is achieved
• In the case of hymenoptera allergy, patients receive venom immunotherapy VIT extracts containing actual hymenoptera venom with a maintenance dose equivalent to 2—5 stings.
• The recommended duration of treatment is 3—5 years

Answer 18

Immunotherapy