Anaphylaxis

Question 1

Triggers:

Drugs - 2

Venom - 2

Foods?

Answer 1

Antibiotics**, muscle relaxants
Aspirin/NSAIDs

Wasp and bee stings

Peanuts & tree nuts, shellfish, eggs, cow’s milk

Other causes:

Idiopathic
Latex - hospital
Contrast media - CT

Question 2

Triad?

Answer 2

• Sudden onset and rapid progression of symptoms
• Life-threatening Airway and/or Breathing and/or Circulation problems
• Skin and/or mucosal changes (urticaria, angioedema)

Question 3

Differentials:

Panic attacks - may co-exist

Answer 3

Differentials:

Panic attacks - may co-exist

Question 4

What guidelines can be followed?

Answer 4

BSACI

British Society of Allergy & Clinical Immunology

Question 5

Airway problems?

Answer 5

Airways swelling – tongue and throat
Difficulty breathing and swallowing
Sensation the throat is ‘closing’
Hoarse voice
Stridor

Question 6

Breathing problems?

Answer 6

SOB

Increased RR

Wheeze

Confusion – may be a sign of hypoxia

Cyanosis (appears blue) – a late sign

Respiratory arrest

Question 7

Circulatory problems?

What should you make sure the patient doesn’t do?

Answer 7

Signs of shock- pale, clammy
Increased pulse rate(tachycardia)
Low blood pressure (hypotension)
Decreased conscious level
Myocardial ischaemia / angina
Cardiac arrest

DO NOT STAND PATIENT UP

Question 8

Disability problems?

Answer 8

Sense of impending doom

Anxiety, panic

Decreased conscious level caused by airway, breathing or circulation problem

Question 9

Exposure problems?

Answer 9

Present in >80% of anaphylactic reactions

Skin, mucosal or changes of both - urticaria and angioedema

Question 10

MAIN Treatment and go through doses?

What drug can reduce the effect of Rx?

Additional Rx - 3

Answer 10

Adrenaline IM

500 MG >12 yrs

300 MG 6-12

150 MG 6 months - 6 yrs

BETA BLOCKERS - may need more adrenaline

Establish airway
High flow oxygen
Iv fluid challenge

Then consider iv chlorphenamine & hydrocortisone – do not delay adrenaline administration to given these.

Question 11

Investigations:

Tryptase - what is it?

When should they be measured?

After how many hrs is measuring tryptase useless?

Answer 11

Released from activated mast cells

Peak at 1-2 hrs

After 4 hrs

Question 12

Discharge:

How long should they be kept in?

What 2 prescriptions need to be done?

Where should they be referred to?

Answer 12

12 hrs

ADRENALINE AUTOINJECTOR (X2) - they are trained

3 day course of antihistamines (Cetirizine)

Allergy clinic if new diagnosis