Anaphylaxis

Question 1

What are some signs of anaphylaxis?

Answer 1

Uritcarial rash / skin reaction
Angioedema of the eyes or lips 
Conjunctival injection
Laryngoedema causing stridor, breathing difficulties 
Bronchospasm causing cough 
Tachycardia 
Hypotension 
Shock

Question 2

What are some common precipitants for anaphylaxis?

Answer 2

The most common allergens include:

• Peanuts or other nuts
• Seafood
• Insect bites (especially wasps and bee stings)
• Drugs and IV injections e.g. antibiotics, NSAIDs, iron, heparin)

Question 3

How do we manage a case of anaphylaxis?

Answer 3

A-E approach
SAFBOP
S - Steroids - Hydrocortisone 200mg IM or slow IV

A - ADRENALINE - 1:1000 500micrograms IM (0.5ml) repeat after 5 min if no better
ANTIHISTAMINES - Chlorphenamine 10mg IM or slow IV
AIRWAY - consider intubation / ventilation if necessary or emergency cricothyrotomy with 14G needle. 100% O2

F - Fluids (500mL NaCl)

B - Bronchodilators
For persistent bronchospasm despite epinephrine, salbutamol 2.5-5mg nebulised

O - Oxygen
Every patient, who is critically ill, requires supportive oxygen treatment.

P - Positioning
LIE THE PATIENT DOWN if hypotensive (preserve blood flow to brain)

Question 4

What dose of adrenaline should be given. How and when?

Answer 4

Always give IM unless experienced with IV
1 in 1000 adrenaline 500mcg to adult or child above 12

A repeat dose can be given in 5 minutes if there is no response