Anaphylaxis
Severe multi-system allergic reaction includes allergic skin rashes and severe respiratory and/ or circulatory and/ or gastrointestinal manifestations.
Acute reaction occurs usually within 30 minutes (but sometimes up to 4 hours) of exposure to allergen.
Risk factors for poor outcome:
– Known allergies (nuts, stings, drugs)
– Poorly controlled Asthma
– Adolescent age
– Underlying cardiac/ respiratory illness
– Delay in administering Adrenaline
Key history questions:
– Timing of onset for allergic reactions
– Timing of potential allergen exposure
– Type: ingestion, contact, drug, sting
– Environment: indoor / outdoor
– Underlying atopy, asthma, allergies
– Previous allergic reactions?
– Carrying Epipen?
Examination:
Immediate identification & IM Adrenaline*
Life threatening A-B-C-D manifestations:
Airway: Stridor, hoarseness, swollen tongue
Breathing: Tachypnoea, Wheeze, Cyanosis, SaO2 <92%
Circulation: Tachycardia, Hypotension
Disability: Confusion, Drowsiness, Coma
Exposure: Pallor, Urticaria, etc
Management:
– Call senior help
– Give high flow O2
– Get IV access, fluid bolus
– IM Adrenaline
– IV Chlorpheniramine
– IV Hydrocortisone
– Monitor SaO2, ECG, BP
Soar J, Pumphrey R, Cant A, et al. Emergency treatment of anaphylactic reactions—guidelines for healthcare providers. Resuscitation 2008;77:157–69
Muraro A, Roberts G, Worm M, et al. Anaphylaxis: guidelines from the European Academy of Allergy and Clinical Immunology. Allergy 2014;69:1026–45