4. DEFNITION
Serious allergic reaction that is rapid in onset and may cause
death.
Multi organ involvement
Precipitated with in minutes of exposure to a particular allergen
In a sensitized patient
5. Clinical criteria for Anaphylaxis
1.Acute onset of illness with involvement of skin and/or
mucosal tissue along with
Resp.compromise / hypotension / associated symptoms
of organ dysfunction
2.Rapid onset of 2 0r more of the following after exposure to
likely allergen:
Involvement of skin and/or mucosal tissue
Resp.compromise
Hypotension
G I symptoms
3. Known allergen with hypotension
21. EPINEPHRINE
IV
Severe upper airway obstruction
Acute respiratory failure
Shock
Caution but not contra indicated..
22. EPINEPHRINE
Dose 100 microgram (0.1 mg) bolus over 5 to 10 mins
0.1 ml of 1:1000 diluted in 10 ml NS
Start infusion if there is no response (1-4 mic/min)
0.1 mic/kg/min in children
Stop if chest pain or arrhythmia occurs
23. EPINEPHRINE
IM
LESS SEVERE SYMPTOMS
Dose: 0.3 -0.5 ml of 1:1000
May be repeated every 5 to 10 mins
Antero lateral thigh is preferred over deltoid
27. SECOND LINE THERAPY
ANTI HISTAMINES
H1 blocker- Diphenhydramine/CPM 25 – 50 mg IV
H2 blocker - Ranitidine 50 mg IV
Avoid cimetidine
28. SECOND LINE THERAPY
AEROSOLISED BETA AGONISTS
Salbutamol
Levosalbutamol
Ipratropium bromide
Severe persistent cases magnesium may be used
29. SECOND LINE AGENTS
GLUCAGON
Reserved for patients on beta blockers and refractory to initial
measures
1 mg IV every 5 minutes until hypotension resolves followed by
5 – 15 mics / min infusion.
Side effects: Hypokalemia , hyperglycemia , nausea , vomiting.
30. PREVENTION
Allergy history
Label all loaded syringes
Give drugs in distal extremity whenever possible
Ensure all patients wait in ED for atleast 30 mins after any drug
administration
32. TAKE HOME
Always ABC first
Epinephrine is the drug of choice
Anaphylaxis is very near to severe allergic reactions
Change beta blockers
Put on long term steroids if it is idiopathic anaphylaxis
Educate every patient about prevention
National institute of allergy and infectious diseasesassociated symptoms of organ dysfunction – hypotonia , syncope , incontinence
Food commonest,1/3,peanuts and crustaceans commonest,wasp and bee stings ,antibiotics first,pencillin,next goes to rcm,1/3 unidentified.
Mild to fatal
Alpha 1 and beta 2 agonistic action,alpha action increases pvr and reverse peripheral vasodialation,vascularpermeability,and systemic hypotension.b agonist effect produces bronchodialation,cause positive ionotropic and chromotropic cardiac activity,and result in increased production of camp.epinephrine therefore reverses bronchospasm,stimulates increased cardiac output,and inhibits further mediator releaseExcessive alpha agonist activity can result in hypertensive crisis excessive b agonist activity can result in increse myocardial oxygen consumption,through increased wall tension,contractility and chronotropism and can produce hemodynamically significant supraventricular and ventricular dysrhytmias.
1 ml of in 1;1000 in 500 ml of d5w oor ns and running at a rate of 1-4 mic/min(0.5 -2ml/min)
Usually single dose will be sufficient
As early as possible,no gastric lavage
Distributive shock
To prevenr biphasic reaction and recurrences,prednisolone for 7-10 days,onset of action 4-6 hrs
Diphenhydramine 25-50 mg,cpm 10 -20 mg,blocks action of circulating histamine on target tissue,h2 blockers effectson effect of histamine on myocardial and peripheral vascular tissue.
Mgso4 1-2 gnm iv over 30 mins
Causes positive ionotropism by augmenting camp synthesis through a noradrenergic pathway
