- Anaphylaxis
Link:www.nationalauditprojects.org.uk/article.php?article=922
- Investigations
- MCT (>20ng/ml typically in anaphylaxis)
Immediate
1 hour
6-24 hours
Stored at 4 degrees if to be analysed in 48 hrs
Store at -20 if later - Refer to allergy centre with record
- Intradermal skin tests
- Specific IgE antibodies in serum (sux only)
- RAST test
- Yellow card
- Allergy bracelet
- Inform GP and patient
- Anaphylaxis
Link:www.aagbi.org/sites/default/files/ana_web_laminate_final.pdf
- T1 hypersensitivity reaction
- Exposure to antigen stimulates production of IgE antibodies
- Antibody levels decrease but IgE binds to basophils and mast cells
- Re-exposure causes antigen to bind with IgE antibodies & release mediators (leukotrienes, histamine, PGs). These cause hypotension, bronchospasm, airway oedema
- Commoner in females, 5% mortality
- Typically occurs at 30-60 mins
- Anaphylactoid reaction
- Clinically indistinguishable
- Not IgE mediated
- Release of vasoactive substances
- Involves complement activation
- Management
Link:www.aagbi.org/sites/default/files/ana_web_laminate_final.pdf
- Immediate
- Stop administration of agents
- 100% O₂
- Call for help
- Elevate feet
- Adrenaline 0.5 - 1 ml of 1:10,000
- IV fluid colloid/crystalloid (2-4L)
- Subsequent Mx
- Steroids 100-500mg
- Chlorphenamine (20mg)
- Bronchodilators
- 4ml/hr of 1:10,000 adrenaline
- ABGs - if acidosis consider 8.4% bicarbonate (1mmol/ml) 0.5-1mmol/kg
- Causes
- NMBDs 70%
- Commonest: sux > vec > atracurium
- Quaternary ammonium found in hair dyes, cosmetics & some foods
- Latex 13%
- Cross sensitivity with bananas/chestnut/avocado
- Colloids 5%
- Gelatins or hyperosmolar fluids
- Induction agents 3%
- ABx 3%
- Penicillins (8% cross-sensitivity with cephalosporins)
- Others 2%
- BDZ 2%
- Opioids <2%
- Clinical signs
- Hypotension 30%
Bronchospasm 25%
Flushing 20%
Cough 5%
Low SpO2 3%
Cyanosis 3%
- CEACCP
Link:ceaccp.oxfordjournals.org/content/4/4/111.full.pdf