Anaphylaxis

Question 1

What type of hypersensitivity reaction is anaphylaxis?

Answer 1

IgE-mediated (type 1) hypersensitivity reaction

Question 2

What triggers the release of chemical mediators in anaphylaxis?

Answer 2

Degranulation of basophils and mast cells after re-exposure to a specific antigen

Question 3

What are the initial symptoms of anaphylaxis following oral exposure?

Answer 3

Respiratory symptoms occur before cutaneous flushing with pruritus and urticaria

Question 4

What are concerning symptoms of anaphylaxis that require aggressive treatment?

Answer 4

Fullness or a ‘lump in the throat’, persistent throat clearing, or difficulty breathing

Question 5

What is the first line treatment for anaphylaxis?

Answer 5

Intramuscular epinephrine

Question 6

How quickly can anaphylaxis evolve after exposure?

Answer 6

Usually within 1 hour of exposure

Question 7

What percentage of anaphylactic-related fatalities occur within the first hour?

Answer 7

Roughly half

Question 8

What is the relationship between the rapidity of symptom onset and disease severity in anaphylaxis?

Answer 8

The more rapid the onset and progression of symptoms, the more severe the disease process

Question 9

What can cause morbidity and mortality in anaphylaxis?

Answer 9

Loss of airway and distributive shock

Question 10

What is a biphasic response in anaphylaxis?

Answer 10

Recurrence of symptoms peaking 8 to 11 hours after the initial reaction

Question 11

What percentage of patients with diagnosed anaphylaxis experience a clinically significant biphasic response?

Answer 11

4 to 5%

Question 12

What are common gastrointestinal symptoms in anaphylaxis?

Answer 12

Abdominal pain, cramps, vomiting, hypotonia, syncope, or incontinence

Question 13

What are the clinical criteria for diagnosing anaphylaxis?

Answer 13

At least 1 of the following within minutes to hours:
* Respiratory symptoms
* Hypotension (systolic less than 90 mm Hg or a decrease of greater than 30% from baseline)

* Signs or symptoms of end-organ dysfunction

Question 14

What differentiates angioedema from anaphylaxis?

Answer 14

Urticaria; oral symptoms and need for airway control can mimic each other

Question 15

How can laboratory testing be useful for diagnosing anaphylaxis?

Answer 15

No, there is no accurate testing for diagnosis or confirmation

Question 16

What can confirm anaphylaxis?

Answer 16

Serum tryptase can be considered for confirmation of an anaphylactic episode but has low sensitivity

Question 17

What is the first step in managing anaphylaxis?

Answer 17

Airway securing due to risk of perioral oedema, stridor and angioedema

Question 18

What position should a patient be in if they are experiencing anaphylaxis?

Answer 18

Lie flat; if pregnant, lie on their side

Question 19

What to do after securing airway in anaphylaxis?

Answer 19

After airway is secured, decontaminate and provide epinephrine dose in the anterolateral aspect of the thigh.
Give high flow oxygen and apply monitoring for pulse oximetry, ECG and blood pressure.

Question 20

What is the recommended dose of IM adrenaline for patients over 12 years?

Answer 20

0.5 ml

Question 21

What is the recommended dose of IM adrenaline for children 6 months to 6 years?

Answer 21

0.15 ml

Question 22

What indicates that anaphylaxis is refractory?

Answer 22

No response to 2 appropriate doses of adrenaline

Question 23

What should be established for refractory anaphylaxis management?

Answer 23

Dedicated peripheral IV or interosseous access And give rapid fluid bolus of saline

Question 24

What fluid is recommended for rapid IV bolus in refractory anaphylaxis?

Answer 24

0.9% NaCl
* Avoid infusing on same side as BP cuff because this will interfere with infusion. Monitor GFR high BP as this indicates adrenaline overdose.

Question 25

What can be given for patients for bronchospasm?

Answer 25

Bronchodilators can be given to patients with bronchospasm and glucagon for patients that are resistant.

Question 26

What additional medications can be given in the acute phase of anaphylaxis?

Answer 26

Methylprednisolone or hydrocortisone, anti-histamines, bronchodilators, glucagon

Question 27

What type of hypersensitivity reaction is anaphylaxis?

Answer 27

IgE-mediated (type 1) hypersensitivity reaction

Question 28

What triggers the release of chemical mediators in anaphylaxis?

Answer 28

Degranulation of basophils and mast cells after re-exposure to a specific antigen

Question 29

What are the initial symptoms of anaphylaxis following oral exposure?

Answer 29

Respiratory symptoms occur before cutaneous flushing with pruritus and urticaria

Question 30

What are concerning symptoms of anaphylaxis that require aggressive treatment?

Answer 30

Fullness or a 'lump in the throat', persistent throat clearing, or difficulty breathing

Question 31

What is the first line treatment for anaphylaxis?

Answer 31

Intramuscular epinephrine

Question 32

How quickly can anaphylaxis evolve after exposure?

Answer 32

Usually within 1 hour of exposure

Question 33

What percentage of anaphylactic-related fatalities occur within the first hour?

Answer 33

Roughly half

Question 34

What is the relationship between the rapidity of symptom onset and disease severity in anaphylaxis?

Answer 34

The more rapid the onset and progression of symptoms, the more severe the disease process

Question 35

What can cause morbidity and mortality in anaphylaxis?

Answer 35

Loss of airway and distributive shock

Question 36

What is a biphasic response in anaphylaxis?

Answer 36

Recurrence of symptoms peaking 8 to 11 hours after the initial reaction

Question 37

What percentage of patients with diagnosed anaphylaxis experience a clinically significant biphasic response?

Answer 37

4 to 5%

Question 38

What are common gastrointestinal symptoms in anaphylaxis?

Answer 38

Abdominal pain, cramps, vomiting, hypotonia, syncope, or incontinence

Question 39

What are the clinical criteria for diagnosing anaphylaxis?

Answer 39

At least 1 of the following within minutes to hours: * Respiratory symptoms * Hypotension * Signs or symptoms of end-organ dysfunction

Question 40

What differentiates angioedema from anaphylaxis?

Answer 40

Urticaria; oral symptoms and need for airway control can mimic each other

Question 41

Is laboratory testing useful for diagnosing anaphylaxis?

Answer 41

No, there is no accurate testing for diagnosis or confirmation

Question 42

What is the role of serum tryptase in anaphylaxis?

Answer 42

It can be considered for confirmation of an anaphylactic episode but has low sensitivity

Question 43

What is the first step in managing anaphylaxis?

Answer 43

Airway securing

Question 44

What position should a patient be in if they are experiencing anaphylaxis?

Answer 44

Lie flat; if pregnant, lie on their side

Question 45

What is the recommended dose of IM adrenaline for patients over 12 years?

Answer 45

0.5 ml

Question 46

What is the recommended dose of IM adrenaline for children 6 months to 6 years?

Answer 46

0.15 ml

Question 47

What indicates that anaphylaxis is refractory?

Answer 47

No response to 2 appropriate doses of adrenaline

Question 48

What should be established for refractory anaphylaxis management?

Answer 48

Dedicated peripheral IV or interosseous access

Question 49

What fluid is recommended for rapid IV bolus in refractory anaphylaxis?

Answer 49

0.9% NaCl

Question 50

What additional medications can be given in the acute phase of anaphylaxis?

Answer 50

Methylprednisolone or hydrocortisone, anti-histamines, bronchodilators, glucagon

Question 51

What is the long term management of anaphylaxis?

Answer 51

creating a personalized emergency action plan, carrying and knowing how to use an epinephrine auto-injector, and avoiding known allergens to reduce risk