Paediatric Anaphylaxis Flashcards
Definition of Anaphylaxis as per AV CPG
Severe, potentially life-threatening systemic hypersensitivity reaction
Common Allergens
Exposure to an allergen may be known or unknown.
Insect stings: Bees, wasps, jumping jack ants
Food: Peanuts/treenuts, egg, fish/shellfish, dairy products, soy, sesame seeds, wheat
Medications: Antibiotics, anaesthetic drugs, contrast media
Exercise-induced: Typically affecting young adults (rare)
Idiopathic anaphylaxis: No external trigger (rare)
RASH Criteria
Respiratory
Abdominal
Skin
Hypotension
Isolated Hypotension with known exposure OR
Isolated Severe Resp Distress with known exposure
Respiratory S+S
Respiratory distress, shortness of breath, wheeze, cough, stridor
Due to inflammatory bronchoconstriction or upper airway oedema
Abdominal S+S
Pain / cramping
Nausea / vomiting / diarrhoea
- Particularly to insect bites and systemically administered allergens (e.g. IV medications)
Skin S+S
Hives, welts, itching, flushing, angioedema (e.g. lips, tongue)
Due to vasodilation and vascular hyperpermeability
Cardiovascular (Hypotension) S+S
Hypotension
Due to vasodilation and vascular hyperpermeability
Anaphylaxis and Asthma considerations
Asthma, food allergy and high risk of anaphylaxis frequently occur together, often in adolescence.
Bronchospasm is a common presenting symptom in this group, raising the likelihood of mistaking anaphylaxis for asthma. A history of asthma increases the risk of fatal anaphylaxis.
Maintain a high index of suspicion for anaphylaxis in patients with a history of asthma or food allergy
Other causes of angiodema
Several types of non-allergic angioedema exist including hereditary angioedema (HAE) and its more broad categorisation: bradykinin-mediated angioedema.
These may present with similar symptoms to anaphylaxis including abdominal signs and symptoms
and laryngeal swelling however will not respond to anaphylaxis management.
Where HAE or bradykinin-mediated angioedema is identified AND the patient has their own
medication to manage this, follow the patient’s treatment plan and use the patient’s own medication.
Otherwise strongly consider standard anaphylaxis management if indicated.
Food Protein Induced Enterocolitis (FPIES)
FPIES is a non-immunoglobulin E mediated paediatric allergy that usually presents with nausea and
vomiting, and in severe cases may present with collapse, confusion or altered consciousness. These patients should not be treated with adrenaline under this guideline. If the patient has a positive diagnosis of FPIES and a care plan, treat symptomatically (e.g. ondansetron, IV fluid) and transport to hospital. Consider consultation with paediatric receiving hospital regarding steroid administration.
Risk factors for refractory anaphylaxis or deterioration
Expected clinical course (e.g. history of refractory anaphylaxis / ICU admission / multiple adrenaline
doses)
Hypotensive
Medication as precipitating cause (e.g. antibiotics, IV contrast medium)
Respiratory symptoms / respiratory distress
History of asthma or multiple co-morbidities/medications
OR
No response to initial dose of IM Adrenaline
Adrenaline in Anaphylaxis (CPG)
Adrenaline is the primary treatment agent for anaphylaxis.
Administration site: anterolateral mid-thigh.
Deaths from anaphylaxis are far more likely to be associated with delay in management rather than
inadvertent administration of Adrenaline.
Patients with known anaphylaxis may carry their own Adrenaline autoinjector. If the patient responds
well to their own autoinjector dose, further Adrenaline may not be required. Closely monitor for
deterioration and transport to hospital.
Patients should carry their Adrenaline auto-injector with them to hospital.
Adrenaline toxicity:
Where the patient develops nausea, vomiting, shaking, tachycardia or arrhythmias but has some improvement in symptoms and a normal or elevated BP, consider the
possibility of adrenaline toxicity rather than worsening anaphylaxis. Consider whether further doses of adrenaline are appropriate.
Bronchospasm in Anaphylaxis
Where bronchospasm persist despite the administration of adrenaline, administer salbutamol, ipratropium bromide and dexamethasone. These medications should never be the first line treatment for bronchospasm associated with anaphylaxis.
Hypotension in Anaphylaxis
Where hypotension persists despite initial Adrenaline therapy, large volumes of fluid may be extravasating. IV fluid therapy is indicated to support vasopressor administration.
