Anaphylaxis

Question 0

Angioedema?

Answer 0

Swelling lips, periorbital region, face, hands, feet

Question 1

Patient with anaphylaxis – next step?

Answer 1

1. IM epinephrine

2. Corticosteroids and H1/H2 blockers

Question 2

Anaphylactoid reactions?

Answer 2

Like anaphylaxis but not caused by immunologic mechanisms

Question 3

Anaphylaxis results from?

Answer 3

Immunologic IgE-mediated mechanism

Question 4

Most common cause of drug related anaphylaxis? Most common cause of food related anaphylaxis?

Answer 4

Penicillins; Peanuts

Question 5

Anaphylaxis reactions usually occur within?

Answer 5

5-60 minutes

Question 6

Clinical Manifestations of anaphylaxis?

Answer 6

Flushing, urticaria, angioedema, diaphoresis

Nasal – sneezing, rhinorrhea, congestion
Throat – hoarseness, strider, laryngeal edema
Breathing – dyspnea, tachypnea, wheezing, Cyanosis
Cardiac – tachycardia, bradycardia, hypotension, arrhythmia
G.I. – nausea/vomiting, diarrhea,
Neuro – dizziness, weakness, syncope, seizures

Question 7

Erythema multiforme minor?

Answer 7

Target lesions that occurs after HSV or other infection or drugs.

Question 8

Erythema multiforme major? Findings? Causes?

Answer 8

SJS, involves two or more mucosal surfaces. Petechia, vesicles, bullae, Desquamation of skin

Usually caused by sulfa drugs or NSAIDs

Question 9

Toxic epidermal necrolysis?

Answer 9

Similar to SJS but greater than 30% epidermal detachment.

Symptoms include: fevers, 
Nero – seizures, coma, headache
Joints – arthralgias
Eyes – corneal ulcerations
Cardiac – arrhythmias, pericarditis,

Question 10

Serum sickness: Time of onset? Symptoms?

Answer 10

Allergic reaction 7-10 days after primary administration (Or 2-4 days after secondary administration) of a drug

Fever, polyarthralgia, urticaria, Lymphadenopathy, glomerulonephritis

Question 11

Sermon sickness: pathophysiology? Treatment?

Answer 11

Caused by formation of immune new complexes of IgG

Antihistamines, aspirin, NSAIDs

Question 12

Iodine allergy? Mechanism? Pretreatment? Not related to?

Answer 12

Radiologic contrast allergy.

Caused by hyperosmolar dye causing granulations of mast cells and basophils (not a true allergic reaction)

treat with preemptive diphenhydramine, H2-blockers, and corticosteroids 12 hours before procedure

No evidence that seafood allergy is related to adverse events

Question 13

Dilantin (phenytoin) hypersensitivity: Manifests as? Associated with? Mechanism? Treatment?

Answer 13

Skin rash up to TEN. Associated with drug fever that resembles infectious mononucleosis

Not IgE mediated (unclear mechanism)

Treatment is withdrawal of offending agent