Anaphylaxis

Question 1

What are 9 symptoms of anaphylaxis?

Answer 1

1. Difficult or noisy breathing
2. Swelling of tongue
3. Swelling or tightness in throat
4. Difficulty talking and/or hoarse voice
5. Wheeze or sudden, persistent cough
6. Loss of consciousness, or collapse
7. Persistent diAdrenaline AutoInjector (EpiPen)iness
8. Pallor and floppiness (in young children)
9. Vomiting and abdominal pain following an insect sting, tick bite or injected substance

Question 2

Does anaphylaxis require a counselling room?

Answer 2

No

Question 3

What are 5 red flags for referral with requests for an epipen?

Answer 3

1. Clinical need not confirmed by a medical or nurse practitioner (refer without supply)
2. Child <7.5 kg where clinical need not confirmed by a clinical immunology or allergy specialist (refer without supply)
3. No personal ASCIA Action Plan for Anaphylaxis (supply and refer)
4. Poorly controlled asthma (supply and refer)
5. Taking a beta-blocker (supply and refer)

Question 4

Does anaphylaxis have a PSA self-care card?

Answer 4

No

Question 5

What is the preferred treatment option for anaphylaxis?

Answer 5

Adrenaline AutoInjector (EpiPen)

Question 6

Which patients should use EpiPen (Adrenaline 300 microg)?

Answer 6

Adults and children over 20 kg

Question 7

Which patients should use EpiPen Jnr (Adrenaline 150 microg)?

Answer 7

Children 7.5 kg to 20 kg

Question 8

What are the directions for Adrenaline AutoInjector (EpiPen) in anaphylaxis?

Answer 8

1. Remove the allergen (if still present).
2. Lie the patient flat. If breathing is difficult, they can sit with their legs outstretched (not in a chair). They must not stand or walk, even if they appear to have recovered. If they are unconscious, vomiting or pregnant, place them in the recovery position. If they are pregnant, place them on their left side.
3. Administer adrenaline as an intramuscular injection into the outer mid-thigh, using an adrenaline auto-injector. Hold in for 3 seconds.
4. Phone for an ambulance (000). Stay with the patient. Notify the patient’s family or emergency contact.
5. Repeat dose of adrenaline (with a separate device) if no response after 5 minutes.
6. Transfer the patient by ambulance to a hospital for at least 4 hours of observation.
7. Commence CPR at any time if the person is unresponsive and not breathing normally.
8. If a patient with known asthma and allergy to food, insect bites/stings or medicine has sudden breathing difficulty (including wheeze, persistent cough or hoarse voice), adrenaline should always be administered first, followed by their asthma reliever inhaler

Question 9

Is Adrenaline AutoInjector (EpiPen) safe in pregnancy?

Answer 9

Yes

Question 10

Is Adrenaline AutoInjector (EpiPen) safe in breastfeeding?

Answer 10

Yes

Question 11

What is the age range for Adrenaline AutoInjector (EpiPen)?

Answer 11

Safe in children over 7.5 kg (unless advised by a clinical immunology or allergy specialist)

Question 12

What are 8 pieces of non-pharmacological advice for anaphylaxis?

Answer 12

1. Be vigilant about avoiding known trigger(s)
2. Note the expiry date of their adrenaline auto-injector and arrange a new supply in advance
3. Store their adrenaline auto-injector at 15 to 25 °C (not refrigerated) and protected from light, and in an insulated wallet if outdoors for an extended period (e.g. hiking, at the beach)
4. Always have their adrenaline auto-injector and their ASCIA Action Plan for Anaphylaxis with them and readily available
5. Keep their adrenaline auto-injector and asthma reliever inhaler together, if their ASCIA Action Plan for Anaphylaxis includes both
6. Have their ASCIA Action Plan for Anaphylaxis or other allergy management plan reviewed annually
7. Educate carers, educators and work colleagues about their ASCIA Action Plan for Anaphylaxis, including how to recognise anaphylaxis and how to administer the adrenaline auto-injector
8. Document episodes of anaphylaxis and allergic reactions using the ASCIA event record form