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

Lungs

GI tract

© 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

Fluids

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