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Immunology > 2.1.4 Anaphylaxis > Flashcards

2.1.4 Anaphylaxis Flashcards

1
Q

What is anaphylaxis?

A

Severe life threatening hypersensitivity reaction

Rapid onset

Potentially life-threatening airway, breathing or circulatory problems

Usually associated with skin and mucosal changes

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2
Q

How rare is anaphylaxis mortality?

A

Extremely rare

More likely to die from fire or murder

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3
Q

How can anaphylaxis occur?

A

Immunologic IgE or non-IgE
Non-immunologic

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4
Q

How is the body affected by anaphylaxis?

A

Multiple organ dysfunction

use ABC approach

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5
Q

What makes anaphylaxis difficult to recognise?

A

Different reaction patterns

Skin manifestations are subtle and not present in 20%

In infants mimics other conditions

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6
Q

What is the clinical criteria for diagnosing anaphylaxis?

VERY LONG CARD :/

A

Anaphylaxis highly likely when one of the 3 criteria are met

Acute onset of illness - minutes to hours, with involvement of skin, mucosal tissue or both AND 1:
- Respiratory compromise
- Reduced BP or associated symptoms of end organ dysfunction eg syncope

Two or more of the following that occur rapidly after exopsure to likely allergen:
- Involvement of skin/mucosa
- Respiratory compromise
- Reduced BP or associated symptoms
- Persistent GI symptoms

Reduced BP after exposure to known allergen for that patient
- Infants low systolic for age or >30% decrease,
- Adults <90mmHg or >30% decrease from persons baseline

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7
Q

What are the mast cell mediators involved in anaphylaxis?

A

Histamine
Tryptase
Platelet activating factor

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8
Q

How are reactions different in children vs adults?

A

Upper respiratory much more common in kids vs adults

Lower respiratory more common in kids vs adults

Cutaneous, GI and CVS slightly more common in kids vs adults

Neurological slightly more common in adults than kids

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9
Q

What is the most likely cause of anaphylaxis in kids?

A

Foods e.g. peanuts or milk

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10
Q

What are the likely causes of anaphylaxis in adults?

A

Drugs e.g. Abx, NSAIDS

Insect stings e.g. wasps

Food e.g. fish, nuts

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11
Q

What is the differential diagnosis of anaphylaxis?

A

Common entities
- Syncope
- Asthma
- Panic attack

Post-prandial events
- Pollen-food syndrome
- Scromboidosis

Shock
- Hypovolaemic or cardiogenic
- Distributive
- Septic

Non-organic disease
- Vocal cord dysfunction
- Factitious induced illness

Others
- Phaeochromocytoma
- Thyrotoxicosis

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12
Q

How is anaphylaxis managed acutely?

A
  • Assessment A-E
  • Treatment IM adrenaline, oxygen, IV fluids, supine
  • Treatment if needed IM adrenaline, beta-agonists, antihistamines, steroids, volume
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13
Q

How is anaphylaxis managed long-term?

A
  • Emergency preparedness
  • Assess/treat co-morbidites
  • Allergen avoidance
  • Immuno-modulation
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14
Q

Compare the use of adrenaline and antihistamines in treating anaphylaxis?

A

Adrenaline is used for higher severity anaphylaxis, e.g. when CVS or multiple systems are involved

Antihistamines are used for more mild anaphylaxis, e.g. skin reaction only

Adrenaline is effective for all symptoms

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15
Q

How can you identify the allergen responsible for anaphylaxis?

A

History of event
Examination
Allergy tests

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16
Q

What are the factors of long term ananphylaxis management?

A

Age
- Infants
- Adolescents
- Elderly

Concomitant disease and medication
- Asthma and other respiratory diseases
- Cardiovascular disease
- Psychiatric illness

Cofactors
- Stress
- Infection
- Exercise

Allergens

17
Q

What are the factors determining risk of developing anaphylaxis?

A

Allergen
- Molecular weight and stability (heat stable or labile)

Sensitisation
- Immunoglobulin classes, their proportion and affinity, strength of sensitisation

Route of allergen contact
- Affects absorption

Prescence of co-factors
- Modulate absorption, activation and release of mediators

18
Q

How do we decide who needs an adrenaline auto-injector?

A

Given when a patient has a high risk of developing anaphylaxis to a common allergy

19
Q

Give 4 examples of intrinsic co-factors which affect the risk of anaphylaxis

A

Atopic disease e.g. asthma, eczema
CV disease
Skin disease
Other allergies

20
Q

What is an extrinsic co-factor affecting the risk of anaphylaxis?

A

Drugs

21
Q

Give 4 examples of direct modulating co-factors affecting risk of anaphylaxis

A

Exercise
Alcohol consumption (increased consumption lowers threshold for anaphylaxis)
Infectious disease
NSAIDs

22
Q

When should adrenaline autoinjectors be used?

A

Think 3 ā€˜Dā€™

  • Is it a definite reaction?
  • Is it a dangerous reaction
  • Do it if in doubt
23
Q

What systems are involved for antihistamine use?

A

GI
Skin

24
Q

What systems are involved for adrenaline use?

A

Respiratory
CVS
CNS

25
Q

What are the criteria for the ideal adrenaline auto-injector?

A
  • Delivers correct dose
  • Delivers in correct timeframe
  • Delivers adrenaline to correct compartment
  • Must be robust and reliable to withstand real-life use
  • Must be easy, convenient and safe for patients or carers to use, includes preventing needle-stick injuries
26
Q

What are the two types of epipen?

A

EpiPen Jr- 0.15mg
EpiPen- 0.30mg

27
Q

How do you use an epipen?

A
  1. Take off blue safety cap
  2. Hold with orange side to the thigh and blue to the sky
  3. Hold away from the lateral leg and push firmly into lateral leg for 3 seconds

Can give a second dose if there is no improvement after 5 minutes

28
Q

Give two examples of other type of adrenaline pens

A

Jext 150- 0.15mg
Jext 300- 0.30mg

Emerade 150- 0.15mg
Emerade 300- 0.30mg
Emerade 500- 0.5mg (used for much larger patients)

29
Q

What are the actions of adrenaline?

A

Vasoconstriction- reverses airway oedema and hypotension

Inotropy and chronotropy

Bronchodilator

Stabilisation

30
Q

Why does adrenaline have to be injected IM rather than SC?

A

IM, rapid absorption to blood to enable systemic effects

SC- local vasoconstriction, will have no systemic effects

31
Q

What is the use of second-line drugs for anaphylaxis?

A

Antihistamines
-Relieve itch, flushing and urticaria

Corticosteroids

Bronchodilators
-Relieve bronchospasm

NOT LIFE SAVING

32
Q

Why are expired epipens still used?

A

EpiPens 24 months past expiry still contained 90% of labeled dose, therefore still very effective

Due to shortage

Can use as long as viewing window is clear

33
Q

What is involved in an allergy action plan?

A

Parent/carer education/training
- Confirmation of diagnosis
- Identification of trigger
- Symptom recognition

Optimal management of concomitant allergies e.g. asthma

Adrenaline auto-injector prescription with full training

Carry 2 epipens incase second dose needed

Immunology (14 decks)

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