Anaphylaxis

Anaphylaxis

  • A life-threatening medical emergency
  • Type 1 hypersensitivity reaction (IgE mediated)
  • Rapid onset of symptoms
  • Airway, breathing and/or circulation compromise

 

Presentation

  • History of exposure to allergen (although can be idiopathic)
  • Urticaria
  • Itching
  • Swelling around lips, tongue, eyes (angioedema)
  • Wheeze
  • Stridor (laryngeal involvement)
  • Shortness of breath
  • Tachycardia
  • Lightheadedness
  • Abdominal pain
  • Collapse

 

Principles of Management

  • Requires immediate and appropriate medical attention following ILS / ALS protocols
  • ABCDE approach to assess and manage the acutely unwell patient in a systematic way (as per ALS)
  • Secure airway (may require intubation)
  • Supplementary oxygen
  • Establish a diagnosis of anaphylaxis
  • Immediate IM adrenalin (>12 years 500mcg, 6-12 years 300mcg, <6 years 150mcg), repeated at 5 minutes if required
  • IV fluid bolus (volume expansion)
  • Lie the patient flat (maintain cerebral perfusion)
  • Antihistamine (oral chlorphenamine)
  • Steriod (IV hydrocortisone)

 

After the event

  • Assessment and close monitoring after the acute event is essential as biphasic reactions can occur
  • Elevated serum mast cell tryptase (measured within 6 hours of the event) can confirm the diagnosis of anaphylaxis
  • Referral to an immunologist is appropriate for diagnosis, education and supply of an Epipen
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