Anaphylaxis

Question 1

Recommended doses for adrenaline in anaphylaxis:

a) <6m
b) 6m - 6y
c) 6y - 12y
d) >12 y

Answer 1

a) 100-150 micrograms (0.1-0.15ml 1 in 1000)

b) 150 micrograms (0.15ml 1 in 1000)

c) 300 micrograms (0.3ml 1 in 1000)

d) 500 micrograms (0.5ml 1 in 1000)

Question 2

How often can doses of IM adrenaline be repeated in anaphylaxis?

Answer 2

Repeat every 5 mins

Question 3

Where is the best site for IM injection of adrenaline in anaphylaxis?

Answer 3

Anterolateral aspect of middle third of thigh

Question 4

Define refractory anaphylaxis

Answer 4

Respiratory and/or cardiovascular problems persist despite 2 doses of IM adrenaline.

Question 5

What should be considered in cases of refractory anaphylaxis

Answer 5

1) IV fluids for shock

2) IV adrenaline infusion (seek expert help)

Question 6

What test can be done to establish whether a patient has had a true episode of anaphylaxis?

Answer 6

Serum tryptase - levels remain elevated for up to 12h following acute episode

Question 7

Where should all patients with a NEW diagnosis of anaphylaxis be referred?

Answer 7

To a specialist allergy clinic

Question 8

What should all patients be prescribed before leaving hospital after anaphylaxis (unless the reaction was drug-induced)?

Answer 8

Patients should be prescribed 2 adrenaline auto-injectors & training should be provided on how to use it.

Question 9

Why is a risk-stratified approach to discharge taken in anaphylaxis?

Answer 9

As biphasic reactions can occur in up to 20% of patients

Question 10

Who can be considered for fast track discharge following anaphylaxis? (i.e. after 2 hours of symptom resolution)

Answer 10

• good response to a SINGLE dose of adrenaline
• complete resolution of symptoms
• has been given an adrenaline auto-injector and trained how to use it

Question 11

When would a patient need to wait a minimum of 6 hours before discharge following anaphylaxis?

Answer 11

1) 2 doses of IM adrenaline needed, or

2) previous biphasic reaction

Question 12

When would a patient need to wait a minimum of 12 hours before discharge following anaphylaxis?

Answer 12

1) severe reaction requiring > 2 doses of IM adrenaline

2) patient has severe asthma

3) patient presents late at night

Question 13

When can a patient be discharged following anaphylaxis if they had complete symptom resolution after 1 dose of adrenaline?

Answer 13

2 hours after symptom resolution

Question 14

When can a patient be discharged following anaphylaxis if they required 2 doses of adrenaline?

Answer 14

6 hours after symptom resolution

Question 15

When can a patient be discharged following anaphylaxis if they have previously had a biphasic reaction?

Answer 15

6 hours after symptom resolution

Question 16

When can a patient be discharged following anaphylaxis if they required >2 doses adrenaline?

Answer 16

12 hours after symptom resolution

Question 17

When can a patient be discharged following anaphylaxis if they have severe asthma?

Answer 17

12 hours after symptom resolution

Question 18

When can a patient be discharged following anaphylaxis if they present late at night?

Answer 18

12 hours after symptom resolution

Question 19

When can a patient be discharged following anaphylaxis if they present in areas where access to emergency access care may be difficult?

Answer 19

12 hours after symptom resolution