Derm - anaphylaxis

Question 1

define anaphylaxis

Answer 1

a severe, life-threatening, generalised or systemic hypersensitivity reaction involving the airway, breathing, and circulation

Question 2

pathophysiology of anaphylaxis

Answer 2

type1 hypersensitivity
IgE antibodies
widespread vasodilation, bronchoconstriction and increased permeability of vascular endothelium.

Question 3

causes of anaphylaxis in children

Answer 3

• food triggers MC
• drugs
• injections
• venom
• idiopathic

Question 4

RF for anaphylaxis

Answer 4

• existing comorbidites

Question 5

what are cofactors

Answer 5

increase the risk of allergic reactions happening or their severity.

eg exercise, fever, acute infection, premenstrual status and emotional stress

Question 6

how to prevent recurrence of anaphylaxis

Answer 6

allergy testing through referral to an allergy specialist

Question 7

what is a key diagnostic feature of anaphylaxis.

Answer 7

A history of an acute onset of symptoms

Question 8

airway signs of anaphylaxis

Answer 8

lip, tongue, pharynx and epiglottis swelling
possibly causing cough
swallowing difficulty
hoarse voice
stridor

Question 9

breathing signs of anaphylaxis

Answer 9

tachypnoea, wheezing, cough, chest tightness, dyspnoea, hypoxia, hypercapnia, acute airway obstruction with laryngeal oedema and bronchospasm

Question 10

circulation signs of anaphylaxis

Answer 10

dizziness, pallor, tachycardia, clammy skin, drowsiness, collapse, hypotension, prolonged CRT and shock

Arrhythmias and ECG changes may be present.

Question 11

neuro signs of anaphylaxis

Answer 11

confusion, anxiety, collapse, loss of consciousness

Question 12

GI signs of anaphylaxis

Answer 12

abdominal cramping, D&V

Question 13

skin changes with anaphylaxis

Answer 13

urticaria, angioedema, pruritus and erythema

Question 14

life threatening ddx of anaphylaxis

Answer 14

Life-threatening asthma
Septic shock
Hereditary angioedema

Question 15

non life threatening ddx of anaphylaxis

Answer 15

Vasovagal episode
panic attack

Question 16

management of anaphylaxis ladder

Answer 16

1. A-E assessment
2. call for help
3. remove trigger
4. lie patient flat
5. IM adrenaline
6. establish airway, give high flow oxygen, monitor pulse oximtry, ecg, blood pressure
7. if no response, repeat IM adrenaline after 5 mins, fluid bolus
8. if no response, follow refractory anaphylaxis algorthim

Question 17

where to give IM adrenaline in anaphylaxis

Answer 17

inject at anterolateral aspect - middle third of the thigh

Question 18

adrenaline dose for child under 6m with anaphylaxis

Answer 18

100-150 micrograms

Question 19

adrenaline dose for child under 6m to 6y with anaphylaxis

Answer 19

150 micrograms

Question 20

adrenaline dose for child under 6y to 12y with anaphylaxis

Answer 20

300 micrograms

Question 21

adrenaline dose for for adults and child over 12y

Answer 21

500 micrograms

Question 22

a-adrenergic effetc of adrenaline

Answer 22

increases blood pressure

Question 23

b- agonist-adrenergic effect of adrenaline

Answer 23

increases cardiac contractility and heart rate, dilation of bronchioles15

Question 24

what is Refractory Anaphylaxis Algorithm

Answer 24

1. give IM adrenaline every 5 minutes until adrenaline infusion started
2. Airway; Upper airway obstruction/stridor- nebulised adrenaline, senior airway support
3. Breathing; Respiratory support via bag/mask or ventilation. Bronchospasm- nebulised salbutamol/ipratropium, IV salbutamol/aminophylline if required
4. Circulation; Further fluid boluses if needed and monitor response; if refractory to adrenaline infusion, consider the second vasopressor, glucagon and consider ECMO

Question 25

what is Biphasic anaphylaxis

Answer 25

after complete recovery of anaphylaxis, a recurrence of symptoms within 72 hours with no further exposure to the allergen. Manage in the same way as anaphylaxis

Question 26

what enzyme can be measured to support doagnosis of anaphylaxis

Answer 26

Mast cell tryptase

Question 27

advice post anaphylaxis

Answer 27

- Offer referral to a specialist allergy service - Offer an appropriate adrenaline injector (EpiPen)

Question 28

complications of anaphylaxis

Answer 28

anaphylactic shock casues cardio and resp problems