AnaphylaxisDr. Stella YiuEmergency Physician, TOH
LMCC Objectives
History and Physical of allergic reaction pts
Determine urticaria with systemic diseases
Investigations to identify allergens
Manage urticaria and anaphylaxis in ED
1. History and Physical
CDMQ: What can cause allergic reactions? (5 categories)
Urticaria: triggers
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DrugsFood allergensInsectsPhysical stressors (cold, exercise)Respiratory allergy (Pollen)
What systems are involved?
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Blood vessels
© anaphylaxisweb
Soft tissues
50% has angioedema (lips/face/upper airway)
If airway/tongue -> potential airway obstruction
Investigations for allergic reaction/anaphylaxis
No Labs
Maybe skin testing later
2. Acute/chronic + systemic illness
Urticaria
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Systemic illness -> urticariaSerum sickness
Transfusion reactions
Viral/bacterial infections
Vasculitis
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Systemic illness: serum sickness
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Systemic illness: serum sickness
Fever, rash, arthralgia
Systemic illness: transfusion reactions
Systemic illness: transfusion reactions
Systemic illness: transfusion reactions
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Systemic urticaria: Viral/Bacterial infection
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Systemic urticaria: Vasculitis
Associated with
SLE, Sjogren, LeukemiaDrugs
Systemic unwell: Arthralgia, fever, abdo pain, lymphadenopathy
Definition of anaphylaxis
MCQ 5: Who does not have anaphylaxis?
A. Ate peanut butter. Swollen lips and wheezing. VS normal.
B. Shrimp fest at Red Lobsters. Vomiting and tight throat.
C. Stung by bee. Low BP.D. Flu shot. Hives. VS normal. E. Hay fever, swollen throat, low BP.
Anaphylaxis Definition
> 2 systems: CVS (BP), airway, GI, skin
Skin + airway/BP
BP
3. Manage anaphylaxis
CDMQ: Management steps of patient with anaphylaxis (8)
Airway (2):
Epinephrine imIntubate if needed (what indications)
Breathing (1):
OxygenB2 agonist (Ventolin)
Bronchodilators
Epinephrine
Circulation (2)
Iv fluids if hypotensiveIv epinephrine if no better
Drugs (3)
Antihistamines (H1- Benadryl, H2- Ranitidine)
Steroids
Antihistamines
H1: Benadryl (Diphenhydramine)H2: Ranitidine
Fluids, Symptomati
c
Discharge instructions
Allergy testing outpatient
Carry Epi-Pen at all times
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Discharge meds
Steroid- 2nd phase reaction (6-72 hours)- Prednisone po or solumedrol iv
Continue Antihistamines
LMCC Objectives
History and Physical of allergic reaction pts
Determine urticaria with systemic diseases
Investigations to identify allergens
Manage urticaria and anaphylaxis in ED