Anaphylaxis

Question 1

Anaphylaxis is likely when all of the following criteria are met…

Answer 1

Sudden onset and rapid progression of symptoms.
Life-threatening Airway and/or Breathing and/or Circulation problems.
Skin and/or mucosal changes (flushing, urticaria, angioedema).

Question 2

Signs and symptoms of allergic reactions / anaphylaxis - airway problems

Answer 2

Throat and tongue swelling (laryngeal/pharyngeal oedema)
Difficulty in breathing and swallowing
Hoarse voice
Stridor (high-pitched inspiratory noise caused by upper airway obstruction).

Question 3

Signs and symptoms of allergic reactions / anaphylaxis - breathing problems

Answer 3

Bronchospasm
Tachypnoea/dyspnoea
Wheeze/stridor
Fatigue
Confusion caused by hypoxia
Cyanosis (usually a late feature)
SpO2 <92%
Respiratory arrest.

Question 4

Signs and symptoms of allergic reactions / anaphylaxis - circulatory problems

Answer 4

Hypotension
Tachycardia
Pale and clammy skin
Dizziness
Decreased conscious level
Myocardial ischaemia
Bradycardia (usually a late feature)
Cardiac arrest.

Question 5

Signs and symptoms of allergic reactions / anaphylaxis - misc problems

Answer 5

Skin/mucosal changes (urticarial/hives)
Diarrhoea and/or vomiting
Abdominal pain
Anxiety.

Question 6

Management of anaphylaxis

Answer 6

remove trigger

<C>ABCDE
500mcg 1:1000 IM adrenaline anterolateral thigh
high flow oxygen
monitoring - sats, ECG, BP, HR

IM adrenaline every 5 minutes until improvement
IV fluid bolus 500-1000ml
5mg salbutamol for bronchospasm

ATMIST

discuss consideration of chlorphenamine once stable to help ease discomfort
</C>

Question 7

Symptomatic allergic reactions falling short of anaphylaxis but causing patient distress… discuss treatment

Answer 7

Discuss chlorphenamine (antihistamine) and hydrocortisone (steroid)