Anaphylaxis

Question 1

Anaphylaxis is Ig____-mediated reaction

Answer 1

IgE

Question 2

Which cells are responsible for Anaphylaxis?

Answer 2

Mast Cells and Basophils

Question 3

Children MC get anaphylaxis from what?

Answer 3

Foods -> nuts, fruit, milk, eggs, shellfish, fish

Question 4

Adults MC get anaphylaxis from what?

Answer 4

Bees and wasps

Question 5

MC causes of anaphylaxis overall?

Answer 5

• Foods -> nuts, fruit, milk ,eggs, shellfish, fish
• Bees and Wasps
• Meds -> ABX, NSAIDs, Aspirin
• Animal venoms, latex, proteins (teatnus antitoxin, blood transfusions)

Question 6

Which vaccines have a higher risk of anaphylaxis?

Answer 6

• flu
• MMR
• Yellow Fever
• Tetanus

Question 7

What are the immune-complex mediators?

Answer 7

• Whole blood
• Plasma
• Dialysis Membranes
• Immunoglobulins
• Gamma Globulin

Question 8

What are the non-immunologic activators that may cause anaphylaxis?

Answer 8

Opiates
Radiopaque contrast dye
ACE-I
ABX: Vancomycin, Aminoglycosides

Question 9

How does a Hx of Atopy affect anaphylaxis?

• incr risk of anaphylaxis?
• incr death when anaphylaxis occurs?

Answer 9

It does NOT increase risk of anaphylaxis, but it does increase risk of DEATH when anaphylaxis occurs

Question 10

Anaphylactoid Rxns vs Anaphylactic Rxns

Answer 10

Anaphylactoid Rxns are clinical indistinguishiable from anaphylaxis, but does not involve IgE and does not require prior sensitization.
They occur via direct stimulation of mast cells or via immune complexes that activate compliment system

Anaphylactoid Rxns
Direct mass cell stim
Immune complexes -> Compliment
Triggers: Iodine contrast, NSAIDs, Aspirin, Opiods, Monoclonal Antibodies, Exercise

Anaphylaxis
IgE
Req prior sensitization
Triggers: food, bees, wasps, meds

Question 11

Which Anaphylaxis triggers has the highest reported deaths per year?

Answer 11

B-lactam ABX

Question 12

Anaphylaxis affects which organ systems?

Answer 12

Skin, Resp, Cardio, GI

Question 13

Anaphylaxis increases vascular permeability and causes which SS?

Answer 13

• Urticaria
• Angioedena
• Larygneal Edema
• Nasal Congestion
• GI Cramping/Vomiting

Question 14

Initially, do CHILDREN present with trouble breathing or flushing/itchiness?

Answer 14

Trouble breathing

Resp -> then skin

Question 15

Initially, do ADULTS present with trouble breathing or flushing/itchiness?

Answer 15

Initially, adults get flushing/itchiness

Question 16

Rapid PE Assessment

Answer 16

• General Appearance and Vital Signs: distress?
• Lungs: BS absent or wheezing? Swollen airways? Hoarse/Loss of voice?
• Heart: tachy, hypotensive, signs of shock?
• Neuro: mentation change, combative?
• GI: V/D, abdominal distention

Question 17

Non-pharm trmnt

Answer 17

• Airways - intubate, ventilate
• High flow O2
• Cardiac monitor + pulse ox
• IV access (large bore)
• Fluid Bolus for HypoTN or Tachy
  Supine position

Question 18

Mild cases of anaphylaxis can be confirmed by measuring _____ or _____

Answer 18

• 24-hour urinary levels of N-methylhistamine
• Serum levels of Tryptase

Question 19

What to do if pt with anaphylaxis is hypotensive or tachy?

Answer 19

give IV Fluid bolus
peds: 20mg/kg
Adults: 1L

Question 20

should IV fluids be given bolus or drip if pt shows hypoTN or Tachy?

Answer 20

BOLUS

Question 21

IV Fluid Bolus dosage for peds and adults

Answer 21

peds: 20mg/kg
Adults: 1L

Question 22

trmnt for anaphylactic shock

Answer 22

Epi
Benadryl
Albuterol +/- Ipratropium bromide nebulizer
Methylprednisone

Question 23

Epi MOA

Answer 23

Alpha Agonist - further vasoconstricts smooth muscle and keeps everything from leaking out
B1 Agonist - further excites the heart
B2 Agonist - further bronchodilates the lungs

Question 24

when to give epi IM vs IV?

Answer 24

normally IM
IV for severe cardiac symp or SHOCK

Question 25

if you give epi racemic nebulizer for laryngeal swelling, should you still give IM injection?

Answer 25

yes

Question 26

Does using both a H1RB and H2RB lessen then their effectiveness?

Answer 26

NO, they actually work better when used together

Question 27

Which histamine receptor blocker do you use?

Answer 27

H1RB Benadryl H2RB famotidine

Question 28

Benadryl dosing

Answer 28

Adults: 50 mg IV or IM Peds: 1 mg/kg IV

Question 29

Famotidine dosing

Answer 29

Adults: 20mg IVP Peds: 0.25mg/kg, not to exceed adult dose

Question 30

Corticosteroid MOA

Answer 30

potent inhibitors of inflammatory processes and potent anti-allergic compounds reducing the number, maturation and activation of mast cells

Question 31

Pt is on BB and giving Epi doesnt seem to do shit. What now?

Answer 31

BB + Epi = PEMDAS give Glucagon IV bolus over 5 min +/- titrated infusion If epinephrine is ineffective in treating anaphylaxis in patients taking b-blockers, then glucagon administration might be necessary. Glucagon can reverse refractory bronchospasm and hypotension during anaphylaxis in patients on b-blockers by activating adenyl cyclase directly and bypassing the b-adrenergic receptor.

Question 32

Warn the nurse to push glucagon bolus SLOW or else what?

Answer 32

pt may vomit. if so, turn them on their side slightly

Question 33

What med is the last resort and why?

Answer 33

Magnesium (smooth muscle relaxer) is last resort bc it can counteract with epi and cause hypoTN

Question 34

Mild cases of anaphylaxis can be confirmed by measuring _____ or _____

Answer 34

* 24-hour **urinary** levels of **N-methylhistamine** * Serum levels of **Tryptase**