Anaphylaxis

Question 1

What is anaphylaxis reaction?

Answer 1

• type 1 immune reaction, results from antibody-angtigen reaction on the surface of mast cells and basophils
• second time exposure, igE antibodies mae on cell surface of mast cells and basophils
• then antigen exposure results in cross linakge between antigen and antibody and degranulation of mast cell - then get histamine, bradykinin released ect.

Question 2

Most common types of reactions?

Answer 2

Suxamethonium > vecuronium > atricurium

latex allergy

Question 3

anaphylactoid reaction

Answer 3

• no cross linking of immunoglobulin with antigen
• same management
• e.g drugs binding directly to mast cells causing vasoctive mediators

Question 4

clinical features

Answer 4

tachycardia, hypotension, bronchosapsm, skin manifestations - flushin, erythema, utricaria, angio-edema
-laryngeal oedema, airway obstruction
bronchosapms, myocardial depression, dysarthymias, coagulation abnormlities

-pain, vomiting shivering

Question 5

Management of anaphylaxis

Answer 5

Primary
-stop agent
-CPR, 100% oxygen
IV fluid resuscitation
adrenaline - stops mast cell degranulation and vasoconstriction - dappens down immune rsponse
-IM - 0.5-1ml of 1:1 soluition repeat 5-10 minytes or IV - 0.5-1ml of 1;10 solution
-ecg moniroing

Secondary
-antihistamines - chlorpheniramine, ranitadine, hydrocorisone bronchodilators

adrenaline
noradrenaline - hypotension 
vasopressin - hypotension 
glucagon - hypotension 
salbutamol - bronchospasm 
magnesium - bronchospasm

Question 6

testing after

Answer 6

• serum tryptase - 10mls of blood should be taken at 1-4 hrs after exposure and sent for serum tryptase levels
• elevated means that mast cell degranulation has occured from a hypersensitivity response

can do skin testing later on

Question 7

latex allergy

Answer 7

-type 4 delayed hypersensitivty contact dermatitis, or type 1 igE medciated anaphylactic reaction

Question 8

people at risk of latex allergy

Answer 8

• patient with repeatefd exposure to latex
• medical workers
• hisotry of atopy
• hist of other allergies
• prev history to glove, catheter, balloon

–> can do skin prick test, or radioallergosorbent test

-patient should be scheduled at start of day, and everyone should be warned. monitored and eeverythign latex free