Anaphylaxis

Question 1

When do most reactions occur?

Answer 1

Within 30 mins of exposure to trigger

Question 2

What are common causes of anaphylaxis in children?

Answer 2

• Food
• Bites / stings: bee, wasp, jumper ant
• Medications
• Other: exercise, idiopathic, latex, biological fluid transfusion

Question 3

What are the most common foods causing anaphylaxis in children?

Answer 3

• Peanut
• Tree nuts
• Cow milk
• Eggs
• Soy
• Shell fish
• Fish
• Wheat

Question 4

What are the high risk patient groups for anaphylaxis?

Answer 4

• Hx of anaphylaxis
• Multiple allergy to food and drugs
• Poorly controlled asthma
• Pre existing lung diseases

Question 5

What are the respiratory features of anaphylaxis?

Answer 5

• Tongue swelling
• Stridor
• Hoarse voice / change in character of cry
• Feeling of swelling / tightness of throat
• Persistent cough
• Wheeze
• Dysphagia

Question 6

What are the CV features of anaphylaxis?

Answer 6

• Pale and floppy infant
• Palpitations
• Tachycardia
• Bradycardia
• Hypotension
• Cardiac arrest
• Altered consciousness / confusion

Question 7

What are the GIT features of anaphylaxis?

Answer 7

• N / V / D

- Abdo / pelvic pain

Question 8

What are the mucocutaneous features of anaphylaxis?

Answer 8

• Generalised pruritus
• Urticaria / intense erythema
• Conjunctival erythema and tearing
• Flushing
• Angioedema
• Neuro fx
• HA
• Dizziness / confusion
• Collapse

Question 9

How quickly does mast cell tryptase measured in serum return to normal after reaction?

Answer 9

Within hours. Normal result does not exclude allergy / anaphylaxis

Question 10

Describe the acute management of anaphylaxis.

Answer 10

• Posture: supine. L lateral if vomiting.
• IM adrenaline 0.01mL/kg of 1/1000 into lateral thigh. Rpt after 5mins if not improving
• If no improvement: senior consult, consider IV adrenaline infusion
• Fluid: 20mL/kg 0.9% saline
• Neb adrenaline adjunct if upper airway obstruction; consider neb salbutamol if resp distress
• Observe min 4h

Question 11

What is the indication for antihistamines in anaphylaxis?

Answer 11

Symptomatic relief of pruritus. Second generation preferred.

Question 12

When should children be admited following anaphylaxis?

Answer 12

• Greater than 1 dose of adrenaline
• Fluid bolus required
• Inadequate response to treatment
• Child lives long distance from services

Question 13

What is required prior to discharge for patient considered at risk of anaphylaxis in the community?

Answer 13

• Anaphylaxis action plan (ASCIA)
• EpiPen (Jnr) and trained in use with EpiPen trainer.
• Consider Medicalert bracelet
• Refer paed allergy specialist
• Ensure asthma control dressed

Question 14

When should children be considered for transfer to tertiary centre?

Answer 14

• Inadequate adrenaline response
• Multiple adrenaline doses
• Adrenaline infusion
• Immediate life threatening situations
• Care beyond comfort of hospital