Anaphylaxsis

Question 1

Define anaphylaxsis

Answer 1

Severe, life-threatening, generalised or systemic hypersensitivity reaction

the sudden onset and rapid progression of symptoms
Airway and/or Breathing and/or Circulation problems

Question 2

What are common causes of anaphylaxsis

Answer 2

food (e.g. nuts) - the most common cause in children
drugs
venom (e.g. wasp sting)

Question 3

What airway problems may occur in anaphylaxsis?

Answer 3

Swelling of the throat and tongue →hoarse voice and stridor

Question 4

What breathing problems may occur in anaphylaxsis?

Answer 4

Respiratory wheeze

Dyspnoea

Question 5

What circulatory problems may occur in anaphylaxsis?

Answer 5

Hypotension

Tachycardia

Question 6

When skin/mucosal changes are commonly seen in anaphylaxis?

Answer 6

generalised pruritus

widespread erythematous or urticarial rash

Question 7

What is the treatment for anaphylaxsis?

Answer 7

IM adrenaline

500 micrograms for adults

Question 8

What is the management after stabilisation?

Answer 8

Non-sedating oral anti-histamines

If new should be referred to specialist allergy clinic

Question 9

What happens post allergy assessment?

Answer 9

Prescribed 2 adrenaline auto-injectors

Training on how to use it

Question 10

What is the risk-stratified approach to discharge post anaphylaxis?

Answer 10

2 hrs post symptom resolution if

• good response to adrenaline
• given epipen and training

6 hrs

• 2 IM doses needed
• previous biphasic recation

12hrs

• severe reaction > 2 IM doses
• severe asthma
• possibility of ongoing reaction
• patient presents late at night

Question 11

What are the two allergy tests?

Answer 11

Skin prick
Radioallergosorbent test (RAST)
Skin patch testing

Question 12

What are the main features of the skin prick test?

Answer 12

Drops of diluted antigen placed on skin
Skin pricked
Wheal develops if allergic
15 minutes

Question 13

What are the main features of the radioallergosorbent test?

Answer 13

Determine IgE amount that reacts with allergen
Results = grade 0-6
Used when prick test is unsuitable e.g. eczema or anti-histmamines

Question 14

What are the main features of the skin patch testing?

Answer 14

For contact dermatitis
30-40 allergens placed on back
Patches removed after 48 hours
Read by dermatologist

Question 15

What are the features of urticaria?

Answer 15

pale, pink raised skin. Variously described as ‘hives’, ‘wheals’, ‘nettle rash’
pruritic

Question 16

What is the management for urticaria?

Answer 16

non-sedating antihistamines are first-line

prednisolone is used for severe or resistent episodes