Anaphylaxis Flashcards
List groups of people who are more likely to suffer from severe/fatal anaphylaxis(6)
Comorbidities: Chronic lung and cardiovascular diseases
On medications: beta blockers and ACE inhibitors
Exercise with co-triggers such as food allergies or NSAIDS allergy
Severe atopic diseases
Premenstrual status in women and girls
How do you diagnose anaphylaxis in a patient with skin manifestations without any exposure to a known or likely allergen?
There should also be at least one of these
1. Low BP
2. Respiratory compromise
3. Symptoms of another organ usually GIT
How do you diagnose anaphylaxis in a patient exposed to a likely allergen?
At least two of these:
1. Skin manifestations
2. Low BP
3. Respiratory compromise
4. GI symptoms such as abdominal pain or nausea/vomiting
How do you diagnose anaphylaxis in someone exposed to a known allergen?
Low SBP<90 OR a blood pressure drop by >30%
Pediatrics
a blood pressure drop of >30% or SBP< 70 mmHg(<1 years old) or SBP<70+(2x age) between 1-10 years)
List 5 common cofactors that amplify anaphylaxis
Exercise
Changes in routine such as travelling
Emotional stress
Premenstrual status in females
Acute infections(viral URTI)
What is a retrospective test used to confirm anaphylaxis?
Mast cell beta tryptase
Elevates 4-6 hours after onset but peaks 1-2 hours after onset
Where should the EpiPen be injected?
Mid upper lateral thigh
What is the preferred treatment of anaphylaxis in patients using beta blockers or ACE inhibitors?
Adrenaline first the if unresponsive to it add Glucagon
Name two adverse effects of glucagon.
Hyperglycaemia and vomiting
When do you add Salbutamol as an adjunctive therapy in anaphylaxis management?
If there is severe bronchospasm and adrenaline is ineffective
Useful especially in patients on beta blockers
When is Ringers lactate added in management of anaphylaxis?
If adrenaline is ineffective
What is the preferred dose of adrenaline for anaphylaxis?
1mg/ml(1:1000) as 0.01 mg/kg IM with a maximum dose being 0.5 ml
Repeat every 5-15 minutes if no improvements.
When is EpiPen prescribed? (9)
Allergen difficult to avoid
Teenagers and young adults
High risk food allergen and other risks
Raised baseline tryptase
Limited access to emergency medical care
Social factors
History of cofactors like exercise
Anaphylaxis and risk of ongoing exposure
Mild reaction to trace amount of allergen
Is anaphylaxis rarely fatal?
Yes but life threatening
Is epinephrine dangerous in patients with anaphylaxis?
Nope, give it correctly
Can antihistamines be used to treat anaphylaxis initially?
Nope
Name four causes of immunological non-IgE mediated anaphylaxis.
NSAIDS
Radio contrast media
Dextrans such as High molecular Weight iron
Biological agents such as monoclonal antibodies
Name two common causes of IDIOPATHIC anaphylaxis.
Exposure to an unknown agent
Mastocytosis/clonal mast cell disorders
List three common causes of non immunological anaphylaxis
Physical factors such as cold, heat, sunlight and exercise
Ethanol
Medications such as opioids.
List 8 common causes of immunological IgE mediated anaphylaxis.
Foods
Radio contrast media
Venom
Natural rubber latex
Occupational allergens
Seminal fluids
Aeroallergens
Medications such as NSAIDs, biological agents and beta lactams
When should you discharge a patient who had anaphylaxis?
After 4-6 hours if clinically stable( longer if suspecting Biphasic anaphylaxis)
What are the risk reduction strategies for anaphylaxis that should be implemented?(3)
Provide an emergency anaphylaxis plan including how to administer adrenaline
Refer to an allergologist to investigate the cause
Provide education and medical alert bracelet to the patient
Who should be referred for admission after anaphylaxis?
Uncontrolled asthma
Severe anaphylactic reaction(severe/life threatening presentation, needed fluid boluses and repeat adrenaline dose were required)
Outline the whole anaphylaxis management in sequence starting from administration of IMM
adrenaline.
Initial
IM adrenalin
If SBP<90: IV fluids either Ringers lactate or normal saline
Repeat adrenaline every 5-15 minutes if no improvements
Further persisting upper airway obstruction w/T improvement: Nebulized adrenaline 1mg in 3 ml of normal saline
No improvements: Endotracheal tube insertion or surgical Airway
Further persisting bronchospasm: Nebulized Salbutamol
Further persisting hypotension: Ranitidine, adrenal infusion, colloids or glucagon if suspecting beta blockers overdose
State objectives measures that shows that ABCs were stabilised
Airway: Attained, maintained and protected by the patient or you
Breathing: SATS>94%, ETCO2 35-45 mmHg, pO2 :80-100 mmHg, reduction in distress and improvement of symptoms
Circulation: blood pressure>90 mmHg, MAP>65, urine output 0.5-1 ml/kg/hour, improvement of lactate and symptoms and signs of Hypotension
What is Biphasic anaphylaxis?
An initial reaction followed by a delayed/ second phase reaction 6-72 hrs after the initial reaction without re-exposure to the allergen
