Allergy And Anaphylaxis

Question 1

Anaphylaxis treatment: 1st line

Answer 1

ABC, VS, SPO2, Monitor
- secure airway early
- O2 sat >90
Epinephrine
- IM:0.3-0.5 q 5-10 min
- IV: 100mcg (0.1mg) IV over 5-10 min
Fluids (distributive shock)
- 1-2L crystalloid (w/epi)

Question 2

Anaphylaxis treatment: 2nd line

Answer 2

Corticosteroids (prevent biphasic reaction)
- methylepred 80-125mg IV
- hydrocort: 250-500mg IV
Antihistamies
- H1: benadryl 25-50 IV
- H2: ranitidine, cimetidine
Inhailed bronchodilators
- b2 agonist
Vasopressors
- if refractory shock
Glucagon??

Question 3

Anaphylaxis treatment: home meds

Answer 3

Current reaction:
- Benadryl
- corticosteroids (prednisone 3-5 days)

Future reactions
- epi pen x 2

Question 4

1st priority in severe anaphylaxis?

Answer 4

Securing the airway

Question 5

Treatment of choice for anaphylaxis

Answer 5

Epinephrine is the TOC. Often underused and sub-optimally dosed

Question 6

B-blocker and anaphylaxis

Answer 6

They have several HOTN 2/2 unopposed a-adrenergic stimulation

Question 7

What to give pts with b blocker use and anaphylaxis

Answer 7

Fluids + Epi then give Glucagon IV q 5 min until HOTN resolves, then do an infusion

Question 8

Presentation of allergic drug reactions?

Answer 8

SX:
- generalized malaise,
- arthralgia,
- arthritis,
- pruritis,
- urticarial eruptions,
- fever,
- adenopahthy,
- hepatosplenomegaly
Drug fever
Lupus like reaction

Question 9

Skin reactions with drug reactions

Answer 9

Erythemia
Pruritis
Urticaria
Angioedema
Erythema multiforme
Photosensitivity

Question 10

Angioedema clinical presentation

Answer 10

Similar to urticaria but w/ deeper involvement
- forms in dermis
- face, neck, extremeties
Potential for airway compromise

Question 11

What is hereditary angioedema?

Answer 11

Rare autosomal dominant D/O often onset by minor trauma
- allergic meds dont work

Question 12

Management of angioedema?

Answer 12

C1 esterase inhibitors
- berinert
- ruconest
Bradykinin 2 receptor agonist
- icatibant
Kallikrein inhibitor
- ecallantide

Question 13

What wont help with ACEI angioedema?

Answer 13

Epi, antihistamies, corticosteroids
- its not IgE mediated
Ecallantide and kallikrein inhibitor dont work either

Question 14

What to do with minor angioedema patients?

Answer 14

Switch ACEI to other HTN med
If no airway compromise
- observe for 12-24rs and discharge