Anaphylaxis

Question 1

What are the main cells involved in anaphylaxis?

Answer 1

Mast cells and basophils

Question 2

Derm symptoms of anaphylaxis?

Answer 2

Urticaria (may be absent in up to 10%)

Question 3

Respiratory symtoms of anaphylaxis?

Answer 3

1. Angioedema (may involve larynx)
2. Bronchospasm/wheezing
3. Rhinorrhea/cough

Question 4

Cardiovascular symptoms of anaphylaxis?

Answer 4

1. Cardiovascular collapse

Question 5

GI symptoms of angioedema?

Answer 5

Abdominal pain, N/V/D

Question 6

What is an anaphactoid reaction?

Answer 6

1. It is the direct release of histamine (as opposed to IgE mediated)
2. No prior exposure necessary
3. Examples radiographic contrast

Question 7

What patients with anaphylaxis need epinephrine?

Answer 7

Those with life threatening symptoms. Not all patients need.

Those with airway symptoms need an IM dose immediately

Question 8

Dose of epinephrine for severe cases?

Answer 8

0.1 mg IV over 5-10 min 1:100,000 dilution

Question 9

Dose of epinephrine for less severe cases?

Answer 9

0.3-0.5 mg IM of 1:1,000 every 5-10 min anterior thigh

Question 10

Besides epinephrine, what other drugs are indicated for anaphylaxis?

Answer 10

1. H1 and H2 blockers
2. Crystalloids for hypotension
3. Albuterol/Ipratroprium (for bronchospasm)
4. Steroids (not supported by literature but still given often)

Question 11

What is the dispo plan in an anaphylactic patient that you have controlled their symptoms?

Answer 11

Watch them for 4 hours and send them how with an epi-pen

Question 12

What is the only difference between an anaphylactic (IgE) reaction and anaphylactoid (direct-release) reaction?

Answer 12

No prior sensitization required for anaphylactoid

Question 13

What are symptoms of early anaphylaxis?

Answer 13

Increased secretions

1. Watery eyes
2. Rhinorrhea
3. Bronchial secretions
4. Bronchial constriction (wheezing)

Question 14

What are late stages of anaphylaxis?

Answer 14

Increased capillary permeability

1. CV compromise
2. Hypotension
3. Urticaria
4. Angioedema

Question 15

What are the most common medications to cause anaphylaxis?

Answer 15

1. PCN
2. Sulfa drugs
3. IV contrast

Question 16

Nearly all deaths caused by anaphylaxis are caused by what?

Answer 16

Airway compromise (so get control early)

Question 17

In general, all ampules of IV epi have how much drug?

Answer 17

1 mg

Question 18

How long should steroids be given after anaphylaxis?

Answer 18

For days

Question 19

What might you need to give an anaphylactic patient that’s on β-blockers?

Answer 19

Glucagon so epi can work

Question 20

In an anaphylactic that’s wheezing, what should you try?

Answer 20

Inhaled β agonist and racemic epi