Allergic Reaction

Question 1

Definition of Anaphylaxis:

Answer 1

Severe, life threatening, generalised or systemic hypersensitivity reaction. Characterised by: rapid onset of A/B/C problems associated with skin/mucosal changes.

Question 2

What is a relapse after an apparent recovery called?

Answer 2

A biphasic response.

Question 3

Risk factors for anaphylactic reactions:

Answer 3

Pre diagnosis of another allergic condition i.e. asthma or atopic eczema. These people have an increased risk of death particularly if it is poorly controlled.

Question 4

Name 4 categories of triggers:

Answer 4

Food, Venom, Drugs, Other.

Question 5

Anaphylaxis is likely when these 3 criteria are met:

Answer 5

1) Sudden onset & rapid progression 2) Life threatening ABC 3) Skin/mucosal changes

Question 6

Describe skin/mucosal changes:

Answer 6

Erythmea/Flushing, urticaria (raised, itchy), weals, welts, angioedema, local skin temperature changes (particularly in darker skin where flushing is less obvious)

Question 7

Airway problems:

Answer 7

Tongue swelling, throat swelling, difficulty swallowig, hoarse voice. stridor.

Question 8

Breathing problems:

Answer 8

Difficulty breathing, bronchospasm, tachypnoea, dyspnoea, wheeze, stridor, fatigue, confusion caused by hypoxia, cyanosis, reduced saturations, respiratory arrest.

Question 9

Cardiac problems:

Answer 9

Tachycardia, hypotension, pallor, clamminess, dizziness, reduced LOC, MI, bradycardia (late sign), cardiac arrest.

Question 10

Other symptoms:

Answer 10

Skin/mucosal changes, D&V, nausea, abdo pain, anxiety.

Question 11

Management of Anaphylaxis:

Answer 11

DRCABCDE, sudden onset/rapidly progressing symptoms, skin changes?
REMOVE TRIGGER
Lay or sit patient.
IM ADRENALINE
OXYGEN if hypoxic (Consider salbutamol/IB)
Apply monitoring in the 5 minutes following IM Adrenaline
Repeat adrenaline after 5 minutes if no improvement
IV FLUID BOLUS (Histamine causes vascular permeability)
If no improvement after two doses, follow refractory anaphylaxis algorithm

Question 12

Management of Refractory Anaphylaxis:

Answer 12

Nil improvement after two doses of IM adrenaline.
IV/IO access.
IV Fluids.
IM Adrenaline every 5 minutes.
High flow O2.
Salbutamol/IB if required.
Monitor to ED.

Question 13

Mild/Moderate Allergic Reaction:

Answer 13

Onset progressed over minutes to hours.
Skin/mucosal changes without life threatening ABC symptoms.
Oral antihistamine is treatment of choice.