Paediatric Anaphylaxis

Question 1

What are the 3 care objectives of paediatric Anaphylaxis

Answer 1

• Adrenaline (IM) with minimal delay
• Airway and perfusion support
• Hospital-based observation (Usually 4hours) at a minimum

Question 2

Definition of Anaphylaxis

Answer 2

Severe, potentially life-threatening systemic hypersensitivty reaction

Question 3

In Anaphylaxis what are respiratory signs

Answer 3

-SoB
- wheeze
- Cough
- Stridor

Question 4

In Anaphylaxis what are the Abdominal signs

Answer 4

• Pain/Cramping
• Nausea/vomiting/Diarrhoea

Question 5

In Anaphylaxis what are the Skin Signs

Answer 5

• Hives/Welts/Itching/Flushing/angiodema

Question 6

In Anaphylaxis what are the cardiovascular signs

Answer 6

• Hypotension

Question 7

What are 5 common allergens

Answer 7

• Insect Stings
• Food
• medications
• Exercise-induced
• Idiopathic

Question 8

What are some risk factors for refractory Anaphylaxis or deterioration

Answer 8

• Hx of refractory anaphylaxis/ICU admin/ Multiple adrenaline doses
• Hypotension
• Medication
• Respiratory - symptoms/Respiratory Distress
• Hx of asthma or multiple Co-morbidities
• No response to initial dose IM adrenaline

Question 9

What is the initial management to Anaphylaxis

Answer 9

• 10mcg/kg Repeat @ 5/60 as required (100mcg for <10kg)
• High Flow Oxygen

Question 10

What is the management for Airway oedema/stridor in Anaphylaxis

Answer 10

• Adrenaline 5mg nebulised
• Consult for repeat doses
• Notify receiving hospital

Question 11

What is the management for Paediatric Bronchospasm in Anaphylaxis (Age, Dise, pMDI)

Answer 11

12 - 15, 5mg, 4-12 (Salbutamol)
6 - 11, 2.5-5mg, 4-12 (Salbutamol)
2 - 5, 2.5mg, 2-6 (Salbutamol)

12 - 15 500mcg, 8 (atrovent)
6 - 11, 250mcg, 8 (Atrovent)
2 - 5, 250mcg, 4 (atrovent)

Question 12

What is the dexamethasone dose in Paediatric Anaphylaxis

Answer 12

600mcg/kg, (max 12mg)

Question 13

Pathophysiology of Anaphylaxis

Answer 13

1. Re-exposure of known Allergen enters the body
2. Allergen is picked up by roaming IgE Antibodies
3. IgE with allergen binds to Basophils and Mast cells
4. Mast cells and Basophils degranulate realeasing Histamine
5. Histamine causes Vasodilation and vascular endothelium to become “leaky”
6. Systemic vasodilation leads to angiodema, hives, swelling, Bronchospasm, abdominal issues
7. Prostoglandins are also released leading to further bronchoconstriction
8. Without management pt can enter Anaphylactic shock which is a type of distributive shock
9. Tissue hypo perfusion
10. MODS
11. Coma
12. Death

Question 14

How does Adrenaline work in Anaphylaxis

Answer 14

• Settles Mast cell degranulation, reducing Histmaine release
• Alpha effects: Vasoconstriction
• Beta 1: Chronotrophic and Ionotrophic effects
• Beta 2: Bronchodilation