Anaphylaxis

Question 1

Anaphylaxis Causes

Answer 1

• Foods
• Venom
• Drugs
• Idiopathic

Question 2

Anaphylaxis Early Presentation

Answer 2

• Hx of previous sensitivity or recent exposure to a new drug
• Skin symptoms, generalised itching, urticaria, erythema, conjunctivitis, angio-oedema

Question 3

Anaphylaxis Later Presentation

Answer 3

• Signs of airway becoming involved (itching palate or eternal auditory meatus, stridor, wheezing)
• Palpitations, tachycardia, nausea, vomiting, abdo pain
• Airway swelling, stridor, breathing difficulty, wheeze, cyanosis, hypotension, tachycardia, reduced cap refill suggest impending severe reaction

Question 4

Anaphylaxis Differentials

Answer 4

• Life threatening asthma
• Low blood pressure and petechial rash can be septic shock
• Vasovagal episode, panic attack, breath holding spell, idiopathic urticaria

Question 5

Anaphylaxis Immediate Management

Answer 5

• Secure airway and give 100% oxygen
• Lay flat, raise legs
• Adrenalin 0.5mg IM, repeat every 5mins as needed
• After initial resuscitation; Chlorphenamine 10mg IV, Hydrocortisone 200mg IV
• IV fluid challenge 500mls if normotensive, 1L if hypotensive
• If wheeze treat for asthma
• If still hypotensive, admit to ICU, IVI adrenalin and aminophylline and nebuliser salbutamol (get expert help)

Question 6

Anaphylaxis Further Management

Answer 6

• Measure serum tryptase 1-6h afterwards (demonstrates mast cell degranulation)
• Admit, monitor ECG
• Observe for 6-12 hours from onset
• If itching continues; chlorphenamine
• Educate on self management
• Allergy testing