Recognising And Diagnosing Anaphylaxis

Question 1

Definition of Anaphylaxis

Answer 1

Sudden, severe, potentially fatal, systemic allergic reaction with symptoms occurring in the skin, respiratory system, GIT and CVS within minutes to 2 hours after exposure to the allergy causing substance

Question 2

What are the 6 Skin Reactions?

Answer 2

Urticaria 
Angioedema
Itching
Flushing
Rednesss
Immediate worsening of eczema

Question 3

What are the 4 upper GIT reactions

Answer 3

Swelling of the:
- tongue
- lips 
- palate
Oral itching

Question 4

What are the 4 lower GIT reactions?

Answer 4

Nausea
Colicky abdominal pain
Vomiting
Diarrhoea

Question 5

What are the 4 major/serious upper respiratory reactions

Answer 5

Hoarseness
Stridor
Dry staccato cough
Swelling of the larynx

Question 6

What are the 4 minor lower respiratory reactions

Answer 6

Nose that is:

• blocked
• runny
• itchy
• sneezy

Question 7

What are the 2 CVS reactions

Answer 7

Tachycardia

Hypotension

Question 8

What are the 6 neurological sign of the end-organ dysfunction of CVS

Answer 8

Change of activity level
Anxiety
A feeling of impending doom
Dizziness
Fainting 
Loss of consciousness

Question 9

How is anaphylaxis diagnosed

Answer 9

Clinically

Question 10

What tests can you perform at the time of anaphylaxis

Answer 10

Tryptase level

Question 11

What does tryptase level confirm

Answer 11

The degranulation of mast cell and basophils

Question 12

Why is tryptase level useful

Answer 12

It peaks at about 60 to 90 minutes after degranulation and stable in blood to be present in the serum for a few hours.
Helps when uncertainty exists.

Question 13

How do you perform the tryptase level test?

Answer 13

Perform 3 sequential tests

• immediately
• about 1 hour after
• 12- 24 hrs after

Question 14

What is clinical criterion 1 for anaphylaxis?

Answer 14

All people with no special risk factors

Sudden onset of an illness (min to several/2 hours) WITH AT LEAST ONE OF THE FOLLOWING
A) Sudden respiratory symptoms and signs
Or
B) Sudden reduced BP or symptoms of end-organ dysfunction

Question 15

What is clinical criterion 2 for anaphylaxis?

Answer 15

People at higher risk as they are known to be allergic to something and have been exposed to a likely allergen and not necessarily the allergen to which they are known to be allergic to.

2 or more of the following that occur suddenly after exposure to a likely allergen or other trigger for that patient (min to hrs)
Sudden:
- skin or mucosal symptoms and signs
- respiratory symptoms and signs
- reduced BP or symptoms of end-organ dysfunction
- GI symptoms

Question 16

What is clinical criterion 3 for anaphylaxis?

Answer 16

Only applies to person known to be exposed to their particular allergic trigger

Reduced BP after exposure to a known allergen
—> infants and children
Reduced sBP age-specific or greater than 30% decrease in sBP