Anaphylaxis and allergy

Question 1

What is anaphylaxis?

Answer 1

Severe, life-threatening, generalised or systemic hypersensitivity reaction

Sudden onset, progresses rapidly with life-threatening airway and/or breathing and/or circulation problems

Question 2

In addition to ariway/breathing/circulation problems in anaphylaxis, what other features may be seen?

Answer 2

Skin and/or mucosal signs of urticaria or angioedema are usually but not always present

Question 3

How many cases of anaphylaxis are fatal?

Answer 3

1 in 1000

Question 4

What proportion of anaphylaxis is caused by food allergy in children?

Answer 4

85%

Question 5

What kind of reactions cause most cases of anaphylaxis?

Answer 5

IgE-mediated reactions with significant respiratory or cardiovascular compromise

Question 6

In addition to food, what are 6 other causes of anaphylaxis?

Answer 6

1. Insect stings
2. Drugs
3. Latex
4. Exercise
5. Inhalant allergens
6. Idiopathic

Question 7

In what age group does most paediatric anaphylaxis occur?

Answer 7

<5 years

Question 8

When does the majority of fatal anaphylaxis occur?

Answer 8

Adolescents with allergy to nuts

Question 9

In addition to allergy what is an additional risk factor for anaphylaxis?

Answer 9

Asthma

Question 10

What is the long-term management of anaphylaxis?

Answer 10

detailed strategies and training for allergen avoidance, written management plan with instructions for treatment of allergic reactions, and provision of adrenaline auto-injectors

Question 11

What is an additional long-term treatment for some cases of allergy causing anaphylaxis, e.g. insect sting anaphylaxis?

Answer 11

Allergen immunotherapy (desensitisation- exposing to larger and larger amounts of allergen) to prevent future episodes

Question 12

What are 3 risk factors for fatal outcome of anaphylaxis?

Answer 12

1. Adolescence
2. Coexistent asthma
3. Nut allergy

Question 13

What are 3 airway signs of anaphylaxis?

Answer 13

1. Swelling
2. Hoarseness
3. Stridor

Question 14

What are 4 breathing features of anaphylaxis?

Answer 14

1. Tachypnoea
2. Wheeze
3. Cyanosis
4. SpO₂<92%

Question 15

What are 5 circulation features of anaphylaxis?

Answer 15

1. Pale
2. Clammy
3. Hypotension
4. Drowsy
5. Coma

Question 16

What are 2 possible skin features of anaphylaxis?

Answer 16

Urticaria

Aniogdoema

Question 17

What is the first thing you should do if you identify anaphylaxis in a patient?

Answer 17

Call for help

Question 18

What 3 positions might you put a patient with anaphylaxis in, based on their clinical features?

Answer 18

1. Breathing difficult - sit up
2. Hypotensive - supine and elevate legs
3. Unconscious - recovery position

Question 19

What is the immediate treatment for anaphylaxis?

Answer 19

Adrenaline 1:1000 dose (IM unless experienced with IV)

Question 20

Following adrenaline 1 in 1000, what are 6 additional treatments that may be given in anaphylaxis?

Answer 20

1. Establish airway
2. High flow oxygen
3. IV fluid (20ml/kg crystalloids)
4. Chlorphenamine (IM or slow IV)
5. Hydrocortisone (IM or slow IV)
6. Salbutamol if wheeze

Question 21

How much fluid should you give in anaphylaxis?

Answer 21

20ml/kg (crystalloids)

Question 22

How can you deliver chlorphenamine and hydrocortisone in anaphylaxis? 2 ways

Answer 22

IM or slow IV (for both)

Question 23

What are 3 important things to monitor in anaphylaxis?

Answer 23

1. Pulse oximeter
2. ECG
3. Blood pressure