Anaphylaxis and Allergy (Adult)

Question 1

What is the patho of Anaphylaxis?

Answer 1

IgE mediated systemic degranulation of mast cells

Question 2

What are the symptoms of Anaphylaxis?

Answer 2

Respiratory (bronchospasm)
Cardiovascular (hypotension)
Severe GI
Skin (urticarial, erythema, angioedema) 90%

Question 3

What is the preferred route of Adrenaline administration in Anaphylaxis?

Answer 3

IM

Question 4

When should we consider switching to an Adrenaline infusion in Anaphylaxis and why?

Answer 4

If patient has failed to respond to 2-3 doses of IM Adrenaline
Boluses could cause extreme hypertension or ventricular arrhythmias

Question 5

How much fluid can shift from intravascular to extravascular during Anaphylaxis?

Answer 5

35%

Question 6

Protocol for a mild to moderate allergy?

Answer 6

180mg oral fexofenadine

Question 7

Protocol for Anaphylaxis?

Answer 7

IM adrenaline 10mcg/kg up to 500mcg every 5 mins
IF
IM not working after 2-3 doses
Syringe driver 5mcg/min
-increase rate by 5mcg/min prn
OR
Manual infusion 0.1mcg/kg/min
-1drop/sec = 6mcg/min
-consult >50mcg/min
OR
Bolus 25mcg prn

Question 8

Protocol for upper airway angioedeme in Anaphylaxis?

Answer 8

Nebulised adrenaline 5mg/ 5mL
-Prepare for potential surgical cricothyroidotomy

Question 9

Protocol for hypotension in Anaphylaxis?

Answer 9

Saline 250mL aliquots up to 30mL/kg
-aim for SBP > 100mmHg

Question 10

Protocol for persistent wheeze in Anaphylaxis?

Answer 10

IV/IO/IM Hydrocortisone 250mg
OR
Oral Prednisolone 50mg