*Module 6: Anaphylaxis Flashcards
What is a potentially life-threatening acute allergic reaction that can occur within seconds to minutes of allergen exposure?
Anaphylaxis
What is the main mediator of anaphylaxis?
Mast cells
What is histamine’s role in anaphylaxis?
Histamine is a potent vasodilator, leading to a drop in blood pressure and an increase in heart rate/cardiac contraction.
How does histamine affect blood vessels?
Histamine makes blood vessels leaky, leading to edema.
What symptoms can histamine cause?
Itching and bronchospasm.
What is the most common trigger for anaphylaxis admission?
Food allergies, but not the most common cause of fatalities.
What history is often involved in fatal cases of anaphylaxis?
Asthma history.
What indicates a high likelihood of anaphylaxis?
Sudden onset of illness with skin or mucosal involvement and sudden respiratory symptoms or sudden reduced BP.
What are two or more symptoms indicating high likelihood of anaphylaxis after allergen exposure?
Sudden skin or mucosal symptoms, sudden respiratory symptoms, sudden reduced BP, or sudden gastrointestinal symptoms.
What are risk factors for anaphylaxis?
Cardiovascular disease, asthma, older age, and comorbid conditions.
What are biphasic reactions?
Reoccurrence of symptoms after the patient has been asymptomatic and has had no further exposure to the allergen.
What is the greatest risk of biphasic reactions associated with?
Patients with severe anaphylaxis, those who needed more than one dose of epinephrine, and delayed epinephrine administration.
What are mouth signs of an allergic reaction?
Itchy mouth or ear canal, nasal congestion, sneezing, slight dry cough, odd taste, trouble swallowing, and obstructive swelling.
What are skin signs of an allergic reaction?
Hives, flushing, redness, and turning blue.
What are abdominal signs of an allergic reaction?
Nausea, vomiting, diarrhea, and stomach pain.
What are cardiovascular signs of an allergic reaction?
Drop in blood pressure, loss of consciousness, chest pain, and a weak pulse.
What are emotional signs of an allergic reaction?
Sense of impending doom, change in alertness, and mood change.
How may children express allergic reactions?
“My tongue is too big,” “My mouth itches,” “There is something stuck in my throat,” etc.
What are severe anaphylactic symptoms?
Repetitive vomiting, sudden reduced BP, widespread hives, significant swelling, trouble breathing, anxiety, and confusion.
When should epinephrine be given?
If there are mild symptoms for more than one body system.
What are mild symptoms of an allergic reaction?
Itchy/runny nose, itchy mouth, a few hives, mild nausea.
What can cause anaphylaxis?
Food, medication, insect venom, exercise with food or medicine, and Alpha-Gal allergy.
What is exercise-induced anaphylaxis (EIA)?
Onset of allergic symptoms during or immediately after exercise.
What are cofactors for exercise-induced anaphylaxis?
Food and NSAIDs.
When does exercise-induced anaphylaxis most often occur after food?
Minutes to a few hours.
When does exercise-induced anaphylaxis most often occur after ingesting an NSAID?
Hours.
What is Alpha-gal not found in?
Fish, reptiles, birds, or people.
When do symptoms commonly appear after eating meat or dairy products?
2-6 hours.
What is the mechanism of action of epinephrine?
α/β-agonist stimulates α and β1 and β2 receptors, leading to smooth muscle relaxation.
What is the median interval between onset of symptoms and respiratory or cardiac arrest for food allergy?
30 minutes.
When does epinephrine have peak plasma levels?
10 minutes.
How does epinephrine increase vascular resistance?
Via vasoconstriction.
What does epinephrine increase in the heart?
Cardiac output.
What does epinephrine reverse?
Bronchoconstriction and mucosal edema.
What does epinephrine stabilize?
Mast cells and basophils.
What may mask the true nature of an allergic reaction?
Antihistamines.
What should be communicated when counseling on epinephrine devices?
Recognizing when to use, how to use, always carry 2, how to store, and what to do after injection.
What is Auvi-Q?
An auto-injector available in 0.1, 0.15, and 0.3 mg strengths.
What strengths are EpiPen & EpiPen Jr available in?
0.15 and 0.3 mg; they are auto-injectors.
What strengths is the authorized generic for Adrenaclick available in?
0.15 and 0.3 mg; it is an auto-injector.
What strengths is Symjepi pen available in?
0.15 and 0.3 mg; it is not an auto-injector but a pre-filled syringe.
What is Neffy®?
A nasal spray epinephrine by ARS Pharma.
What is the strength of Neffy®?
2mg/0.1 mL.
What dose does EID require for 16.5-33 lbs?
0.1 mg dose, provided by Auvi-Q only.
What dose does EID require for 33-66 lbs?
0.15 mg dose, provided by all EIDs.
What dose does EID require for 66+ lbs?
0.3 mg dose, provided by all EIDs and Neffy.
How should epinephrine be stored?
DRY & ROOM temp; protect from light, heat, and cold.
What color change indicates epinephrine exposure to light?
Mauve-brown.
What are the adverse effects of epinephrine?
Palpitations, pale sweating, nausea, dizziness, tremor, anxiety, and restlessness.
Where are EIDs injected?
Into the anterolateral thigh as an intramuscular injection.
Why is IM preferred over subcutaneous for EIDs?
It provides consistently more rapid plasma/tissue concentrations.
How often may epinephrine be repeated after inadequate response?
Every 5-15 minutes.
How long should you hold the EID for?
At least 2-3 seconds.
What position should a person having anaphylaxis lie in?
Flat with legs/feet up while waiting for an ambulance.
What can an individual do after receiving epinephrine?
They can sit if having trouble breathing but should not walk around or stand.
True or false: after epinephrine, an individual can have a drink.
False.
