Anaphylaxis

Question 1

Anaphylaxis Management

Answer 1

• Oxygen high flow
• Consider MICA
• Adrenaline IM 10mcg/Kg repeat 5/60
• Salbutamol (20/60)
  2-5 yrs = 2.5mg
  6-11 yrs = 2.5 - 5mg
• Atrovent = 250mcg
• Dex 600mcg/kg (max 12mg)

Question 2

Define Anaphylaxis

Answer 2

Anaphylaxis is an acute, severe, systemic, hypersensitivity reaction. A patient receives an initial exposure to an antigen. On the subsequent exposure, they suffer a systemic response. The antigen binds to IgE antibodies on mast cells causing degranulation (and release of inflammatory mediators - histamines). This results in vasodilation, increased vascular permeability, and relative fluid loss. This can cause signs of allergy (itch, rash etc) as well as circulatory collapse and respiratory compromise leading to altered consciousness.

Question 3

R.A.S.H Criteria

Answer 3

Two or more of R.A.S.H:

R = Respiratory distress (SOB, wheeze, cough, stridor)
A = Abdominal symptoms (N, V, D, abdo pain/cramps)
S = Skin/mucosal symptoms (hives, welts, itch, flushing. Angioedema, swollen lips/tongue)
H = Hypotension (or ACS)
OR
Isolated hypotension (relative to age)/respiratory distress with an exposure to known antigen