1. Allergy & Anaphylaxis Flashcards
Adrenaline
Indications: Anaphylactic reactions, Severe croup
Precautions: NO absolute contraindications to adrenaline in anaphylactic reactions - used in life-saving situations
Dosage :
Anaphylaxis - IM route is preferred as it is safer than IV.
(IV administration may be necessary when response to repeated IM doses and volume expansion is inadequate).
IV needs continuous monitoring of ECG, pulse oximetry and BP. (IV infusion safer than slow bolus)
EpiPen® - Adult, child >20 kg, IM 0.3 mg. Repeat after 5 mins if required.
Child 10–20 kg, IM 0.15 mg. Repeat after 5 mins if required.
IM - Adult, child, 10 micrograms/kg up to 500 micrograms (0.5 mL). Repeat every 3–5 minutes if required.
IV infusion - Adult, child, initially 0.1 microgram/kg/minute, then titrate according to response.
Slow IV injection - Adult, 50 micrograms (0.5 mL). Repeat according to response. Give IV infusion if repeated doses required.
Child, initially 1 microgram/kg (0.01 mL/kg). Titrate dose according to response.
Nebuliser - For upper airway tract obstruction, eg laryngeal oedema.
Adult, child, up to 5 mL (5 mg).
Severe croup
>1 month, neb 5 mL of undiluted adrenaline 1:1000 as a single dose. Repeat after 30 minutes if required.
(Use with prednisolone or dexamethasone).
Counselling:
- Make sure anyone who may need to give you adrenaline is taught how to recognise when you need it and how to give it.
- Call an ambulance as soon as possible after using adrenaline because further doses may be required.
- Keep two adrenaline autoinjectors with you at all times.
- They need to be stored in the dark, between 15°C and 25°C, but not refrigerated; you may need an insulated pouch.
- Note the use by date for your adrenaline and arrange a new supply in advance.
Practice points:
- glucagon may be useful for adrenaline-resistant anaphylaxis in patients on beta-blockers
- EpiPen® training devices are available to assist with education of patients and carers; a written action plan should be provided
Cyclizine
Sedating antihistamine
Cyproheptadine
Sedating antihistamine
Dexchlorpheniramine
Sedating antihistamine
Diphenhydramine
Sedating antihistamine
Doxylamine
Sedating antihistamine
Pheniramine
Sedating antihistamine
Promethazine
Sedating antihistamine
Trimeprazine
Sedating antihistamine
Cetirizine
Non-Sedating antihistamine
Desloratidine
Non-Sedating antihistamine
Fexofenadine
Non-Sedating antihistamine
Levocitirizine
Non-Sedating antihistamine
Loratidine
Non-Sedating antihistamine