Immuno - Anaphylaxis

Question 1

Classify Hypersensitivity Reactions

Answer 1

Type 1 - Immediate hypersensitivtyType 2- Antibody mediated Type 3 - Immune complex mediatedType 4 - DelayedType 5 - Idioapathic

Question 2

Describe type 1 reactions

Answer 2

ImmediateIgE mediatedAnaphylaxisAsthmaAllergic Rhinitis

Question 3

Type 2 Reactions

Answer 3

Antibody mediatedIgG/M and complementRheumatic heartGoodpasturesAutoimmunoe haemolytic anaemia

Question 4

Type 3

Answer 4

Immune complex mediatedIgG and complementRALupus nephritis

Question 5

Type 4

Answer 5

DelayedT cells, macrophagesContact dermatitisChronic transplant rejectionCoeliac

Question 6

Define anaphylaxis

Answer 6

Severe, life threatening, generalisedSystemic HypersensitivityDivided into ALLERGIC and NON-ALLERGICAllergic - implies immunological reaction (IgE) Histamine —> pro inflam cytoikines, prostaglandins, cytokines Vasodilation and hypotension/tachyNon Allergic - Direct drug action causing mast cell and basophil degranulation

Question 7

Signs and symptoms of anaphylaxis

Answer 7

HypotensionRashBronchospasmSVR drops by 80% due to histamineAirway - oedema of tongue/lips/oropharynxBreathing - Pulmonary oedemaCVS - arrhythmias, syncopesGI - abdo pain, D,V,N

Question 8

Common triggers

Answer 8

NMBD - Roc, Sux, AtraAntibiotics - penicillins (beta lactams) - 8% cross react with cephsThioLatex (cross react strawberry and kiwi)Plasma expanders (Dextrans, starches, gelatins)Chlorhex/betadine/Iodine contract

Question 9

Old management

Answer 9

STOP OFFENDING AGENTCALL FOR HELPABCDESecure airwayGive 100%Elevate legs, and supine

Adrenaline 50mcg Iv0.5mls of 1:10,000) or 0.5 to 1mg (0.5 to 1 ml of 1:1000)Saline/fluid bolus 500mlsTHENChlorphenaramine 10mgHydrocortisone 200mgCan consider salbutamol,ipratropium if wheeze

Question 10

Blood managements

Answer 10

Take three samples for mast cell tryptasesImmediate1 hours after6 to 24 hours after

Question 11

Further actions post event

Answer 11

Refer to Regional Allergy CentreReport on Yellow CardDocument in notes,, discharge letter and GPGiven patient written record —> need for Medic Alert bracelet

Question 12

Further testing

Answer 12

Skin prick test 4-6 weeks afterRAST - antigen specific IgE antibodiesImmunuCAP - flurescent enzyme immunoassay More sensitive than RAST Detects specific IgE

Question 13

New ALS guidance

Answer 13

Chlorphenarmine and steroids OUTGive IM adrenalineRepeat after 5 minutesIf no response move to REFRACTORY algorhythmLow dose adrenaline infusion (1mg in 100mls saline)Start at 0.5 to 1 ml/kg/hoursConsider arterial line