Anaphylaxis

Question 1

What is a hypersensitivity reaction?

Answer 1

Inappropriate response to harmless molecule

Question 2

Type 1 hypersensitivity

• interval between reaction:
• effector cells:
• target\antigen:
• examples:

Answer 2

• <30 min to 2\12hours
• IgE
• pollen\food\venom\ drugs
• anaphylaxis, uticaria, rhinitis, asthma

Question 3

Type 2 hypersensitivity

• interval between reaction:
• effector cells:
• target\antigen:
• examples:

Answer 3

• variable
• IgG, IgM, IgA
• RBC & platelet
• Rh incompatiability, thrombocytopnia, goodpasture syndrome

Question 4

Type 3 hypersensitivity

• interval between reaction:
• effector cells:
• target\antigen:
• examples:

Answer 4

• 1 to 3 weeks after exposure
• complement
• vessels, spleen, kidney, lung
• serum sickness, hypersensitivity pneumonitis

Question 5

Type 4 hypersensitivity

• interval between reaction:
• effector cells:
• target\antigen:
• examples:

Answer 5

• 2 to 7 days after exposure
• t-cell lymphocyte
• MTB - chemicalls
• contact dermaitits, tb skin reaction, graft vs host disease

Question 6

allergic rhinitis and allergic asthma have a combination of

Answer 6

Type 1 and type 4 hypersensitivity reactions

Question 7

Autoimmunity is associated with which type of hypersensitivity reaction

Answer 7

Type 2

Question 8

What is goodpasture syndrome?

Answer 8

IgG and IgA response against proteins in the BM of kidney + lung

Question 9

Wnich of the hypersensitivity reactions is more sever and associated with systemic disease

Answer 9

Type 3

Question 10

Name a drug that causes

• type 2:
• type 3:
• type 4:

Answer 10

• quinidine
• cefaclor
• neomycin

Question 11

What is the prototype of

• type 1
• type 4

Answer 11

• anaphylaxis

- ivy posioning

Question 12

Differentiate bteween type 2 and type3

Answer 12

• antigens on specific structure

- antigens and antibodies all over the body

Question 13

Mysthenia gravis is which type of antibody?

Answer 13

Type 2

Question 14

What is the MOA in type 3

Answer 14

Complexes swim in the circulation and go to ceratain organs (joint synovium, kidney glomeruli, lung aleveoli)

Question 15

How to treat type 4 hypersensitivity

Answer 15

Avoid trigger - steroidal topical treatment

Question 16

MOA of type 4 hypersensitivty

Answer 16

Allergen on the skin > APC Tcells identify > inflammatory cascade > itching and erythemia

Question 17

What is anaphylaxis

Answer 17

Multiorgan system reaction from chemical mediators of (mast cells) + (basophils)

Question 18

What is the cause, effector, the mediator in type 1 hypersensitivity?

Answer 18

• allergen
• IgE on mast cell
• histamine

Question 19

What are the effects of histamine in anaphylaxis shock?

Answer 19

• respiratory: bronchospasm & increased mucus secretion > SOB, tightness, wheeze, stridor, hoarseness, cough
• GI: abdo pain, diarrhea
• CNS: lightheadidness, loss of concisousness, headache, anxiety
• vasodilation: Edema
• ithciness\rash

Question 20

When to consider patient having anaphylaxis “symptoms wise”

Answer 20

Two systems are affected

• SOB
• diarrhea

Question 21

What are the most common in patient and outpatient causes of anaphylaxis?

Answer 21

• food: outpatient

- drug: inpatient

Question 22

Name non-immunological causes of anaphylaxis?

Answer 22

Exercise

Direct mast cell degranulation

Question 23

What is the best treatment of anaphylaxis?

Answer 23

Prevention

• avoid trigger
• patient education
• self administration of epinephrine

Question 24

What are the medications used in mild to moderate anaphylaxis?

Answer 24

Antihistamine (diphenhydramine)

Question 25

What medications to use in severe symptoms “trouble breathing or swallowing

Answer 25

Epinephrine “CVS\respiratory”

Question 26

ABCD in anaphylaxis should be along with:

Answer 26

Epinephrine

Question 27

In a patient with cardiac arrest who you’ve aldready adminsterd IV epinephrine and required another dose, what will you give

Answer 27

IM epinephrine

Question 28

What is the role of epinephrine

Answer 28

Vasoconstrictor (Alpha 1 agonist) - increase BP - decrease edema

Question 29

What is the second line for anaphylaxis?

Answer 29

Antihistamine (diphenhydramine)

Question 30

In a patient with cardiac arrest who you’ve aldready adminsterd IV epinephrine and required another dose, what will you give

Answer 30

IM epinephrine

Question 31

What is the second line for anaphylaxis?

Answer 31

Antihistamine (diphenhydramine)

Question 32

Why is rantidine usually raken? (H2 antagonist)

Answer 32

To enhance effect oH1 antagonist

Question 33

What to do for patient with respiratory distress in anaphylaxis?

Answer 33

Give b2 adrenergic agonist | “Salbutamol and slameterol”

Question 34

How to administer salbutamol in anaphylaxis?

Answer 34

5-10 puffs every 20 minutes until symptoms of wheezing or respiratory distress

Question 35

How to prevent the recurrance of anaphylactic symptoms after an initial remission?

Answer 35

Give corticosteroid

Question 36

What is biphasic anaphylaxis

Answer 36

Initial remission > 8 to 72 hours anaphylactic symptoms

Question 37

What is protracted anaphylaxis

Answer 37

Presistance of symptoms for hours\days despite treatment

Question 38

Who should get an epipen?

Answer 38

1- at risk of anaphylaxis 2- not responding to treatment 3- altered conciousness during allergic reaction 4- living in remote area

Question 39

When to give epipen 0.3 mg

Answer 39

When then weigth is >25 kg

Question 40

When to give epipen 0.15

Answer 40

When the weight is 15-25 kg

Question 41

Where to give the dose of epipen?

Answer 41

Mid outer part of thigh