Anaphylaxis

Question 1

which type of bees can cause life threatening anaphylaxis?

Answer 1

hymenoptera

50% pts had no prior reaction or known allergy
60% will have anaphylaxis again with repeat sting.

Question 2

How to decrease risk for anaphylaxis by bee sting?

Answer 2

venom immunotherapy reduces risk of anaphylaxis to about <5%

Question 3

How does venom immunotherapy work?

Answer 3

venom specific immunoglobulin IgG changes T cell responses and decreases venom specific IgE.

Question 4

When to order venom specific immunotherapy

Answer 4

hx of systemic allergic reaction to an insect sting and evidence of venom specific IgE either by skin or in vitro test so after anaphylaxis episode needs to get referral for immunotherapy.

Question 5

How to treat anaphylaxis

Answer 5

IM epinephrine, H1 receptor antagonists, corticosteroids, and supportive therapy for shock. these don’t help prevent next episode

Question 6

What happens to serum IgE levels after anaphylaxis?

Answer 6

they rise acutely and they decrease after venom immunotherapy .

Levels don’t predict protection from future anaphylaxis rxn

Question 7

Tryptase levels in anaphylaxis

Answer 7

rise after anaphylaxis (released from mast cells and basophils. ALso seen in mast cell disorders and meylodysplastic syndromes. But not clinically relevant for immunotherapy

Question 8

triggers for anaphylaxis:

Answer 8

food: nuts shellfish
medications (beta lactam abx)
insect stings

Question 9

cardiovascular clinical manifestations of anaphylaxis:

Answer 9

cardiovascular: vasodilation causes hypotension and tissue edema
see tachcardia

Question 10

respiratory clinical manifestations of anaphylaxis:

Answer 10

upper airway edema causing stridor and hoarseness

bronchospasm causing wheezing

Question 11

cutaneous clinical manifestations of anaphylaxis:

Answer 11

urticarial rash, pruritis and flushing

Question 12

GI clinical manifestations of anaphylaxis

Answer 12

nausea, vomiting, abdominal pain

Question 13

Treatment of anaphylaxis:

Answer 13

IM epinephrine,
airway management and IVF (volume resuscitation)

adjunctive therapy: antihistamines and steroids

Question 14

are there absolute contraindications in epinephrine use in anaphylaxis

Answer 14

no. it is advised to give to pt who have mild symptoms

Question 15

pt has wheezing after being stung by bee and is comfortable in ED. what to do?

Answer 15

still give IM epinephrine even in mild cases.

Discharge with autoinjectable epinephrine. and referral to allergist.