Allergy

Question 1

17yo male presents to your rural emergency department with throat tightness, stridor, dizziness and feeling faint after consuming Chinese food. What are you most worried about?

Answer 1

Anaphylatic allergic reaction

Highest incidence in 0-19yo, food most common cause
Middle aged or older - medication or insect venom most common cause

Question 2

General clinical symptoms of allergy

Answer 2

Headache
Anxiety
Tremor
(HAT)

Question 3

What are possible skin symptoms of an allergic reaction?

Answer 3

Pruritis
Erythema
Edema
Urticaria

PEE-U

Question 4

What are possible respiratory symptoms of an allergic reaction?

Answer 4

Stridor, Wheeze
Cough, Sneeze
Throat tightness, chest tightness
Dyspnea, dysphagia
Hoarse voice

Question 5

What are possible cardiovascular symptoms of an allergic reaction?

Answer 5

Hypotension
Dizziness-lightheadedness
Faint/Weakness/Syncope
Tachycardia, arrhythmia
Myocardial infarction

Question 6

What are possible ophthalmic symptoms of an allergic reaction?

Answer 6

Itchy eyes

Tearing

Question 7

What are possible gastrointestinal symptoms of an allergic reaction?

Answer 7

Nausea, Vomiting, Diarrhea

Abdominal pain

Question 8

List FIVE red flag symptoms of allergy

Answer 8

Throat tightness
Stridor
Lightheadedness/dizziness
Faint/weak/syncope
Hypotension

Question 9

Other than medications what else should a patient with a prior history of anaphylaxis have?

Answer 9

Medical alert bracelet informing anaphylactic reaction

Question 10

You see your patient after an episode of anaphylaxis, how would you counsel this patient?

Answer 10

• Discuss an anaphylaxis emergency plan, i.e. signs/symptoms anaphylaxis, medications to use and what to do
• Ensure patient has appropriate medications (antihistamines, bronchodilator, steroids, epinephren auto-injector x 3 (home, car, school)
• Ensure medical alert bracelet
• Educate use of medications
• Advise F/U if use of EpiPen

Question 11

In patients with allergies you should ALWAYS:

Answer 11

document and re-evaluate their allergies peroidically

Question 12

You are working in the emergency department when EMS brings in a patient in anaphylaxis. What medication would you order?

Answer 12

Epinepherine 0.5ml of 1:1000 IM lateral thigh q3-5min in adults

Epinepherine 0.01ml/kg (0.4ml max) of 1:1000 IM lateral thigh q3-5min in children

Question 13

You are working in the emergency department when EMS brings in a 60yo male patient with anaphylaxis. You order your first line medication but that does not seem to help. Why may this be the case? What else would you prescribe?

Answer 13

Patient has underlying cardiac disease.

Glucagon 1mg IM if on B-blockers

Question 14

The patient with anaphylaxis is stabilized. What are you now most worried about? How would you manage this worry?

Answer 14

Delayed hypersensitivity reaction.
Mx: observe in ER for 6-8hr, supervision 48hrs after discharge
Antihistamine - Benadryl 50mg IM/IV q4-6h
Corticosteroid - Methylprednisolone 50-100mg IV x 1 or Prednisone 50mg po x 1
Bronchodilator - Salbutamol MDI 4puff inhale q4-6h or neb if bronchspasm

Question 15

The patient with anaphylaxis is ready for discharge, what is your management plan?

Answer 15

F/U with GP 24-48hrs to update allergic rxn
Allergy avoidance
Allergist referral
Rx: H1 antagonist - Benadryl 50mg po daily x 3d or Cetirizine 10mg po daily x 3d
H2 antagonist - ranitidine 150mg po daily x 3d
Corticosteroid - prednisone 50m po daily x 5d
Epinepherine - EpiPen 0.3mg IM (adults)
EpiPen JR 0.15mg IM children

Question 16

What medications do you use to treat patients with angioedema or urticaria?

Answer 16

Epinepherine
Antihistamines
Corticosteroids
Airway management

Question 17

Define anaphylaxis

Answer 17

i) Exposure to trigger followed by 2 affected organ systems
ii) Exposure to trigger + hypotension + other organ system
iii) Skin change + Mucosal membrane change + other organ system