Anaphylaxis

Question 1

What is adrenaline dose in adults and children?

Answer 1

Adult: 0.5mg IM Children: 0.01ml/kg

IM Lateral thigh

Up to every 5 minutes, if not responding, consider infusion

Question 2

What the triggers of anaphylaxis?

Answer 2

Food: Peanuts, tree nuts, seafood, eggs, cow’s milk

Bites/stings: Bees, wasps, jumping ants Medications:

Betablockers, ab infusions, vaccines

Others: exercise, idiopathic, latex, hydatid

Question 3

What are clinical features of anaphylaxis? What is required for diagnosis?

Answer 3

Resp: Tongue swelling, angioedema, stridor, wheeze, cough, tightness/swelling in throat

Cardio: Cyanosis, Tachycardia, bradycardia, hypotension, cardiac arrest

Skin: Urticaria, angioedema, pruritis

Gastro: Vomiting, diarrhoea, nausea, abdo pain

At least one resp/cardio symptoms and at least one skin/gastro symptom

Except for non-food allergens where GIT involvement is considered anaphylaxis

Question 4

How do you manage anaphylaxis?

Answer 4

Lie patient supine (or on side if vomiting)

Administer IM adrenaline

Repeat dose if required

Call ambulance if in GP setting

Consider anti-histamines, corticosteroids

Observe for 4 hours

Consider IV access

Question 5

When do you admit a child after anaphylaxis?

Answer 5

Greater than one dose of adrenaline required

Fluid bolus given

Inadequate response to therapy

Long distance from medical services

Question 6

What are the long term treatment goals for a child whose had an anaphylaxis?

Answer 6

Action plan: Epipen (20 epipen 300ug)

Alert bracelet

Referral to allergy specialist

Ensure tight control of asthma