anaphylaxis

Question 1

basic definition of anaphylaxis

Answer 1

Anaphylaxis is a severe, systemic hypersensitivity reaction caused by massive release of histamine and other inflammatory mediators from mast cells and basophils, typically triggered by an allergen.

Question 2

first pharmacological management if patient is showing systemic signs of anaphylaxis

Answer 2

ADRENALINE
0.5 mg adrenaline undiluted

repeat the adrenaline IM every ten minutes if the patient is not improving, or every five minutes if the patient is deteriorating.

Administer adrenaline IV if the patient is deteriorating despite adrenaline IM:

Question 3

paediatric IM adrenaline dose

Answer 3

0.1 mg per 10 kg
e.g. 10 kg dose is 0.1 mg

Question 4

other considerations of management in anaphylaxis

Answer 4

fluids if the patient is hypovolemic

ICP for IV adrenaline infusion if not improving

Consider 5 mg of nebulised adrenaline if the patient has airway oedema or prominent bronchospasm.

Consider administration of loratadine PO if the patient has itch or rash, and systemic signs of anaphylaxis are improving

Question 5

resp sx of anaphylaxis

Answer 5

dyspnoea, chest or throat tightness, wheeze or stridor.

Question 6

cardiovascular sx of anaphylaxis

Answer 6

hypotension, poor perfusion, fainting, collapse or altered level of consciousness.

Question 7

GI sx of anaphylaxis

Answer 7

severe nausea, vomiting, abdominal pain or diarrhoea.

Question 8

Exposure to an allergen results in

Answer 8

the release of inflammatory mediators from mast cells and basophils which cause the signs and symptoms of anaphylaxis. While there are a number of mediators, histamine is the most widely recognised.

Question 9

outline the criteria for anaphylaxis

Answer 9

It is usually characterised by skin features of systemic inflammatory mediator release (urticaria, itch or flush, swollen lips and/or tongue) plus involvement of one or more
- cardiovascular
-GI
- resp

Question 10

outline thresholds for administering adrenaline in ? anaphylaxis

Answer 10

Have a low threshold for administering adrenaline if anaphylaxis is suspected, even if it is not immediately life-threatening.
Have a low threshold for repeat adrenaline if the patient is not improving.

Question 11

what is angiodema

Answer 11

is a condition that results in intermittent, unpredictable and isolated swelling of the mouth and/or face. It often occurs in patients taking aspirin or an angiotensin converting enzyme (ACE) inhibitor and may occur following fibrinolytic therapy.

Question 12

management of isolated angiodema

Answer 12

may respond to nebuliser adrenaline

IM and IV adrenaline should not be administered because angioedema rarely responds to systemic adrenaline and the adverse effects of systemic adrenaline usually outweigh any possible benefit.

Question 13

management of minor allergic reaction

Answer 13

Administer loratadine if itch is prominent

Administer prednisone or prednisolone in addition to loratadine, if the itch is associated with a rash

Question 14

criteria for minor allergy guideline

Answer 14

minor allergic reactions (including bites and stings) that are confined to skin involvement.