*Module 6: Anaphylaxis

Question 1

What is a potentially life-threatening acute allergic reaction that can occur within seconds to minutes of allergen exposure?

Answer 1

Anaphylaxis

Question 2

What is the main mediator of anaphylaxis?

Answer 2

Mast cells

Question 3

What is histamine’s role in anaphylaxis?

Answer 3

Histamine is a potent vasodilator, leading to a drop in blood pressure and an increase in heart rate/cardiac contraction.

Question 4

How does histamine affect blood vessels?

Answer 4

Histamine makes blood vessels leaky, leading to edema.

Question 5

What symptoms can histamine cause?

Answer 5

Itching and bronchospasm.

Question 6

What is the most common trigger for anaphylaxis admission?

Answer 6

Food allergies, but not the most common cause of fatalities.

Question 7

What history is often involved in fatal cases of anaphylaxis?

Answer 7

Asthma history.

Question 8

What indicates a high likelihood of anaphylaxis?

Answer 8

Sudden onset of illness with skin or mucosal involvement and sudden respiratory symptoms or sudden reduced BP.

Question 9

What are two or more symptoms indicating high likelihood of anaphylaxis after allergen exposure?

Answer 9

Sudden skin or mucosal symptoms, sudden respiratory symptoms, sudden reduced BP, or sudden gastrointestinal symptoms.

Question 10

What are risk factors for anaphylaxis?

Answer 10

Cardiovascular disease, asthma, older age, and comorbid conditions.

Question 11

What are biphasic reactions?

Answer 11

Reoccurrence of symptoms after the patient has been asymptomatic and has had no further exposure to the allergen.

Question 12

What is the greatest risk of biphasic reactions associated with?

Answer 12

Patients with severe anaphylaxis, those who needed more than one dose of epinephrine, and delayed epinephrine administration.

Question 13

What are mouth signs of an allergic reaction?

Answer 13

Itchy mouth or ear canal, nasal congestion, sneezing, slight dry cough, odd taste, trouble swallowing, and obstructive swelling.

Question 14

What are skin signs of an allergic reaction?

Answer 14

Hives, flushing, redness, and turning blue.

Question 15

What are abdominal signs of an allergic reaction?

Answer 15

Nausea, vomiting, diarrhea, and stomach pain.

Question 16

What are cardiovascular signs of an allergic reaction?

Answer 16

Drop in blood pressure, loss of consciousness, chest pain, and a weak pulse.

Question 17

What are emotional signs of an allergic reaction?

Answer 17

Sense of impending doom, change in alertness, and mood change.

Question 18

How may children express allergic reactions?

Answer 18

“My tongue is too big,” “My mouth itches,” “There is something stuck in my throat,” etc.

Question 19

What are severe anaphylactic symptoms?

Answer 19

Repetitive vomiting, sudden reduced BP, widespread hives, significant swelling, trouble breathing, anxiety, and confusion.

Question 20

When should epinephrine be given?

Answer 20

If there are mild symptoms for more than one body system.

Question 21

What are mild symptoms of an allergic reaction?

Answer 21

Itchy/runny nose, itchy mouth, a few hives, mild nausea.

Question 22

What can cause anaphylaxis?

Answer 22

Food, medication, insect venom, exercise with food or medicine, and Alpha-Gal allergy.

Question 23

What is exercise-induced anaphylaxis (EIA)?

Answer 23

Onset of allergic symptoms during or immediately after exercise.

Question 24

What are cofactors for exercise-induced anaphylaxis?

Answer 24

Food and NSAIDs.

Question 25

When does exercise-induced anaphylaxis most often occur after food?

Answer 25

Minutes to a few hours.

Question 26

When does exercise-induced anaphylaxis most often occur after ingesting an NSAID?

Answer 26

Hours.

Question 27

What is Alpha-gal not found in?

Answer 27

Fish, reptiles, birds, or people.

Question 28

When do symptoms commonly appear after eating meat or dairy products?

Answer 28

2-6 hours.

Question 29

What is the mechanism of action of epinephrine?

Answer 29

α/β-agonist stimulates α and β1 and β2 receptors, leading to smooth muscle relaxation.

Question 30

What is the median interval between onset of symptoms and respiratory or cardiac arrest for food allergy?

Answer 30

30 minutes.

Question 31

When does epinephrine have peak plasma levels?

Answer 31

10 minutes.

Question 32

How does epinephrine increase vascular resistance?

Answer 32

Via vasoconstriction.

Question 33

What does epinephrine increase in the heart?

Answer 33

Cardiac output.

Question 34

What does epinephrine reverse?

Answer 34

Bronchoconstriction and mucosal edema.

Question 35

What does epinephrine stabilize?

Answer 35

Mast cells and basophils.

Question 36

What may mask the true nature of an allergic reaction?

Answer 36

Antihistamines.

Question 37

What should be communicated when counseling on epinephrine devices?

Answer 37

Recognizing when to use, how to use, always carry 2, how to store, and what to do after injection.

Question 38

What is Auvi-Q?

Answer 38

An auto-injector available in 0.1, 0.15, and 0.3 mg strengths.

Question 39

What strengths are EpiPen & EpiPen Jr available in?

Answer 39

0.15 and 0.3 mg; they are auto-injectors.

Question 40

What strengths is the authorized generic for Adrenaclick available in?

Answer 40

0.15 and 0.3 mg; it is an auto-injector.

Question 41

What strengths is Symjepi pen available in?

Answer 41

0.15 and 0.3 mg; it is not an auto-injector but a pre-filled syringe.

Question 42

What is Neffy®?

Answer 42

A nasal spray epinephrine by ARS Pharma.

Question 43

What is the strength of Neffy®?

Answer 43

2mg/0.1 mL.

Question 44

What dose does EID require for 16.5-33 lbs?

Answer 44

0.1 mg dose, provided by Auvi-Q only.

Question 45

What dose does EID require for 33-66 lbs?

Answer 45

0.15 mg dose, provided by all EIDs.

Question 46

What dose does EID require for 66+ lbs?

Answer 46

0.3 mg dose, provided by all EIDs and Neffy.

Question 47

How should epinephrine be stored?

Answer 47

DRY & ROOM temp; protect from light, heat, and cold.

Question 48

What color change indicates epinephrine exposure to light?

Answer 48

Mauve-brown.

Question 49

What are the adverse effects of epinephrine?

Answer 49

Palpitations, pale sweating, nausea, dizziness, tremor, anxiety, and restlessness.

Question 50

Where are EIDs injected?

Answer 50

Into the anterolateral thigh as an intramuscular injection.

Question 51

Why is IM preferred over subcutaneous for EIDs?

Answer 51

It provides consistently more rapid plasma/tissue concentrations.

Question 52

How often may epinephrine be repeated after inadequate response?

Answer 52

Every 5-15 minutes.

Question 53

How long should you hold the EID for?

Answer 53

At least 2-3 seconds.

Question 54

What position should a person having anaphylaxis lie in?

Answer 54

Flat with legs/feet up while waiting for an ambulance.

Question 55

What can an individual do after receiving epinephrine?

Answer 55

They can sit if having trouble breathing but should not walk around or stand.

Question 56

True or false: after epinephrine, an individual can have a drink.

Answer 56

False.