Anaphylaxis Flashcards

1
Q

What’s anaphylaxis?

A
  • acute allergic reaction to an antigen to which a body is hypersensitive
  • it has a rapid onset and may cause death
  • Characteristics: severe, life-threatening, generalised or systemic, hypersensitivity reaction
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2
Q

Mechanism of anaphylaxis (immunologic)

A
  • IgE binds to antigen -> activation of receptors on mast cells and basophils -> release of inflammatory mediators (e.g. histamine)
  • Mediators lead to: increase the contraction of bronchial smooth muscles, vasodilation, increase leakage of fluid from blood vessels, heart muscle depression
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3
Q

What are non-immunologic reactions?

A
  • substances that directly cause degranulation (and release of chemicals/cytokines) of mast cells and basophils
  • contrast medium, opioids, temperature (hot/cold) vibration
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4
Q

Allergy vs anaphylaxis

A
  • Allergy - is a disorder of immune system; exaggerated response by the immune system to a foreign substance; usually predictable
  • Anaphylaxis - is an acute systemic (multi-systemic) and severe type I hypersensitivity allergic reactions; it is a life-threatening emergency; it is an unusual/not predictable response
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5
Q

Possible signs and symptoms of anaphylaxis

A
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6
Q

What’s angiooedema?

A

Angioedema - swelling in deep dermis and subcutaneous tissues

  • acute mast cell- mediated reaction caused by

exposure to an allergen

  • happens due to increased vascular permeability

and eruption of intravascular fluid

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7
Q

Grades of anaphylaxis

A
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8
Q

Differentials fir anaphylaxis

A
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9
Q

What blood test is used in anaphylaxis?

Meaning of it

A

Mast cell tryptase

  • a marker for mast cell activation
  • normal serum level is 11.5 ng/mL (elevated result in anaphylaxis) -> less likely to be elevated in food allergy (as opposed to other causes
  • not used in paediatric food related allergy
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10
Q

Timing of mast cell tryptase blood test

A
  • blood taken on arrival (time the blood sample)
  • after emergency treatment (ideally within 1-2

hours, no later than 4 hours of symptoms onset)

  • peak at 1-2 hours
  • repeat 1-2 hours later

*blood sample may be required later, at follow up specialist allergy service -> to measure

baseline mast cell tryptase level (so inform the patient about it)

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11
Q

MoA of adrenaline in Rx of anaphylaxis

  • respiratory system
  • cardio-vascular system
A

- respiratory system: adrenaline -> relaxing of respiratory system as it acts on

sympathetic system (including smooth muscle walls of the airways) -> so air can get in

  • cardio-vascular: adrenaline stimulates alpha-adrenoceptors -> peripheral vascular resistance

increased -> improved blood pressure and coronary perfusion (reverses peripheral vasodilation)

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12
Q

Site of IM injection of adrenaline

A

epinephrine/adrenaline is given intramuscularly into the mid-antero-lateral thigh

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13
Q

Anti-Histamine MoA

A

Antihistamine counteracts the effect of histamine

(histamine is involved in inflammatory response and it is a mediator of itching; it is produced by basophils and mast cells; increases permeability of capillaries to white cells, vasodilations, increasing heart rate, cardiac contraction and glandular secretions)

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14
Q

Treatment algorithm for anaphylaxis

A
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15
Q

Observation time (in the hospital) for a person with anaphylaxis

A
  • depends on response to treatment
  • observe an adult person (16+) for 6 - 12 hours after the onset of symptoms -> depends

on treatment response

  • shorter periods of observation time may be considered if patient responses for treatment quickly, but before discharge post-reaction care should be provided
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16
Q

Do we need to refer a patient with anaphylaxis?

A
  • person need to be referred to a specialist allergy service (age appropriate)
  • trusts should have separate referral pathways for suspected anaphylaxis in peads and adults
17
Q

Two choices of EpiPens

A
18
Q

What to do before the discharge of a patient with anaphylaxis?

A

Before discharge offer information on the following:

  • anaphylaxis and its signs and symptoms
  • risk of biphasic reaction (recurrence of anaphylaxis after appropriate treatment)
  • what to do if anaphylactic episode occurs (use of epinephrine injector and call emergency services)
  • demonstrate the correct use of adrenaline injector
  • need for referral and referral process

information + support groups

19
Q

Biphasic anaphylaxis - what is this?

A

Therefore important to monitor a patient in ED for 4-6 hours after an attack

20
Q

Symptoms of laryngeal angioedema

A

A. First symptoms*: dysphagia, sensation of lump

in the throat, feeling of tightness, voice changes

(hoarse, rough voice)

B. Fully developed laryngeal attack: dyspnoea,

fear of asphyxiation (suffocation), aphonia

*patients recognition of first symptoms is crucial ->

need to to educate patient about them

21
Q

What further questions to ask/answer when we diagnose laryngeal angioedema in a physical exam?

A
22
Q

Treatment of angioedema

  • allergic
  • idiopathic
A
  • Allergic: anti-allergic agents- > antihistamines, glucocorticoids, adrenaline (inhalation)
  • Idiopathic: antihistamines *

*antihistamines may work in non-allergic idiopathic laryngeal angioedema but not in bradykinin-mediated angioedema

23
Q

What is HAE?

A

HAE - recurrent attacks of severe swelling (arms, legs, face, intestines and airway) with no itchiness -> possible obstruction, vomiting and abdo pain (intestines are affected)

24
Q

Pathophysiology of Type II HAE

A
  • mutation (autosomal dominant) in SERPING1 gene (which makes C1 inhibitor protein - inhibition of complement pathway) -> increased amount of bradykinin -> swelling
25
Q

Treatment of HAE type II

A
  • C1 inhibitor concentrate from donor blood
  • If the above not available -> use fresh frozen plasma (FFP) as it contains C1 inhibitor
26
Q

What meds are contraindicated in HAE?

A

DO NOT USE ACE INHIBITORS -> as they lead to bradykinin accumulation -> leads to further

swelling episodes

27
Q

Types (3) of HAE

A
28
Q

DIagnostic features suggesting HAE

A