Anaphylaxis

Question 1

Defined as a serious allergic reaction that is rapid in onset and may cause death

Answer 1

Anaphylaxis

Question 2

MCC of anaphylaxis in children

Answer 2

1) Medications and latex in hospital setting 2) Food allergy outside the hospital

Question 3

Principal pathologic features in fatal anapylaxis

Answer 3

1) Acute pulmonary hyperinflation 2) Pulmonary edema 3) Intra-alveolar hemorrhaging 4) Visceral congestion 5) Laryngeal edema 6) Urticaria and angioedema

Question 4

Most cases of anaphylaxis are the result of activation of what cells

Answer 4

Mast cells and basophils via cell-bound allergen-specific IgE molecules

Question 5

Clinical anaphylaxis caused by other mechanisms other than IgE-mediated reactions

Answer 5

Anaphylactoid reactions

Question 6

Plasma histamine vs Plasma beta tryptase: Elevated for a brief period but unstable and difficult to measure

Answer 6

Histamine

Question 7

Plasma histamine vs Plasma beta tryptase: More stable and remains elevated for several hours but often is not elevated, especially in food-induced anaphylaxis

Answer 7

Beta tryptase

Question 8

Anaphylaxis is highly likely especially when any one of what 3 criteria is fulfilled

Answer 8

1) Acute onset of an illness (minutes to hours) with involvement of skin and/or mucosal tissue and at least 1 of the ff: a) Respi compromise b) Reduced BP or symptoms of end-organ dysfunction 2) 2 or more of the ff that occur rapidly after exposure to a likely allergen a) skin/mucosal tissue involvement b) Respi compromise c) Reduced BP or assoc symptoms d) Persistent GI symptoms 3) Reduced BP following exposure to likely allergen (mins to hours)

Question 9

Criteria of BP drop to qualify anaphylaxis

Answer 9

1) Infants and children: Low SBP or >30% drop in SBP 2) Adults: SBP less than 90mmHg or 30% drop from baseline

Question 10

Most important medication for anaphylaxis

Answer 10

Epinephrine

Question 11

Epinephrine for anaphylaxis should be given via what route

Answer 11

IM

Question 12

Dose of epinephrine for anaphylaxis

Answer 12

0.01 mg/kg

Question 13

More than 90% of biphasic responses of anaphylaxis occur within ___, hence patients should be observed within this time period prior to discharge

Answer 13

4 hours

Question 14

Anaphylactic symptoms that recur after apparent resolution are termed

Answer 14

Biphasic responses