Allergies and anaphylaxis

By Ben Green

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AnaphylaxisBasic science

Anaphylaxis

Type 1 hypersensitivity reaction

Sudden onset immunological reaction

Following sensitisation to an allergen Often following the 3rd exposure

Mediated by IgE

Immunoglobulin E (IgE)Following sensitisation, exposure to an allergen can cause IgE binding via Fc receptors and subsequent degranulation of mast cells. This releases inflammatory mediators such as histamine and leukotrienes.

Histamine potentiates anaphylaxis, causing vasodilatation and tissue fluid leakage. This causes a range of symptoms including laryngeal oedema and circulatory shock, whilst leukotrienes are responsible for bronchoconstriction and wheeze/stridor.

Recognising anaphylaxis

Picture Quiza

The following slides list common symptoms of anaphylaxis!

Select the tab that matches the picture in order to advance!

Stridor/wheeze

Nausea/vomiting

AngioedemaShortness of breath

Cyanosis

ShockUrticaria

Common allergens

Stridor/wheeze

Nausea/vomiting

Shortness of breath

Cyanosis

ShockUrticaria

Common allergensAngioedema

Nausea/vomiting

Shortness of breath

Cyanosis

ShockUrticaria

Common allergensAngioedema

Stridor/wheeze

Stridor/wheeze

Nausea/vomiting

AngioedemaShortness of breath

Common allergens

ShockUrticaria

Cyanosis

Stridor/wheeze

Nausea/vomiting

AngioedemaShortness of breath

Common allergens

Shock

Cyanosis

Urticaria

Insects and stings

Anaphylaxis management

Insect and stings

Autoinjectors

Scenarios

Insects and stings

Wasp stings The wasp sting is easy to

insert, and easy to come out

Delivers 2-15mcg venomAlkaline

Treatment Remove sting Elevation Ice

Insects and stings

Bee stings The bee sting is barbed

and is harder to remove

Delivers 50mcg venomFormic/methanoic acid

Treatment Remove sting Elevation Ice

Match the insect to the ‘cure’

Match the insect to the ‘cure’

Bicarbonate for Bees

Match the insect to the ‘cure’

Vinegar for Vasps

Management of anaphylaxis

Your patient is unconscious following an anaphylactic reaction!

Select the correct order of treatment!

A wrong move returns you to the start!

Well done!

Having successfully treated your patient you decide to review the anaphylaxis guidelines to

make sure your treatment was correct!

UK Resuscitation Council Guidelines

UK Resuscitation Council Guidelines

Autoinjectors

Anapens

Deliver injection into outer thigh

3 different pens (dose varies with colour)

Delivers adrenaline

Hold in place for 10s

Massage for 10s

Epipens

Deliver injection into outer thigh

Delivers 0.3mg adrenaline

Hold in place for 10s

Massage for 10s

See video

Adrenaline and autoinjectors

True or false

Correctly answer a question to advance!

Adrenaline and autoinjectors

Adrenaline targets both alpha and beta adrenergic receptors!

FalseTrue

Adrenaline and autoinjectors

You must remove clothing and expose the skin before using the autoinjector!

True False

Adrenaline and autoinjectors

Adrenaline treats shock by causing peripheral vasoconstriction!

FalseTrue

Scenarios

Split into pairs

1 member wait outside the room…

Scenario 1 Scenario 2

Scenario 1

Information for patient...

You are complaining of nausea and light headedness (pass out after a minute or so)

A – NKDA M – salbutamol inhaler P – asthma L – scallops for starter E – at a restaurant

Scenario 1

Information for first aiders...

The casualty is looking pale and clammy

Upon examination has a weak rapid pulse

Scenario 2Information for patient...

Act slightly confused and complain of chest tightness (remain conscious throughout)

A – peanuts M – you have an epipen in your pocket P – none L – just eaten curry (unsure what was in it) E – at a friends house for dinner

Scenario 2

Information for first aiders...

You notice swelling around the patients face and lips

You notice the patient looks very flushed