Anaphylaxis, Acute
Allergic Reactions, and
Angioedema
ANAPHYLAXIS AND
ALLERGIC REACTIONS
Clinical Features
Majority: signs and symptoms begin suddenly,
often within 60 minutes of exposure
biphasic phenomenon
...
Diagnosis
Serum tryptase levels
Treatment
Treatment
Treatment
Disposition and Follow-Up
Admission/Discharge
Admission to hospital is rare
All unstable patients with anaphylaxis refra...
Disposition and Follow-Up
Admission/Discharge
If patients remain symptom free after
appropriate treatment following 4 hou...
Disposition and Follow-Up
URTICARIA AND
ANGIOEDEMA
Urticaria
Treatment of urticarial reactions is generally
supportive and symptomatic, with attempts to
identify and remove...
Angioedema
Angioedema of the tongue, lips, and face has
the potential for airway obstruction.
Management is supportive, ...
Angioedema
Patients with mild swelling and no evidence of
airway obstruction can be observed in the ED
and discharged if ...
Take home message
ANY QUESTION?
Anaphylaxis, acute allergic reactions, and angioedema
Anaphylaxis, acute allergic reactions, and angioedema
Anaphylaxis, acute allergic reactions, and angioedema
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Anaphylaxis, acute allergic reactions, and angioedema

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Anaphylaxis, acute allergic reactions, and angioedema

  1. 1. Anaphylaxis, Acute Allergic Reactions, and Angioedema
  2. 2. ANAPHYLAXIS AND ALLERGIC REACTIONS
  3. 3. Clinical Features Majority: signs and symptoms begin suddenly, often within 60 minutes of exposure biphasic phenomenon  3-20% of patients  caused by a second phase of mediator release, peaking 4-8 hours after the initial exposure and exhibiting itself clinically 3-4 hours after the initial clinical manifestations have cleared late-phase allergic reaction  primarily mediated by the release of newly generated cysteinyl leukotrienes, the former slow-reacting substance of anaphylaxis
  4. 4. Diagnosis Serum tryptase levels
  5. 5. Treatment
  6. 6. Treatment
  7. 7. Treatment
  8. 8. Disposition and Follow-Up Admission/Discharge Admission to hospital is rare All unstable patients with anaphylaxis refractory to treatment or where airway interventions were required should be admitted to the intensive care unit. Patients who receive epinephrine should be observed in the ED, but the duration of observation is based on experience rather than clear evidence.
  9. 9. Disposition and Follow-Up Admission/Discharge If patients remain symptom free after appropriate treatment following 4 hours of observation, the patient can be safely discharged home. prolonged observation periods should be considered in patients with a past history of severe reaction and those using -blockers
  10. 10. Disposition and Follow-Up
  11. 11. URTICARIA AND ANGIOEDEMA
  12. 12. Urticaria Treatment of urticarial reactions is generally supportive and symptomatic, with attempts to identify and remove the offending agent. Antihistamines, with or without corticosteroids, are usually sufficient, although epinephrine can be considered in severe or refractory cases. The addition of a histamine-2 receptor blocker, such as ranitidine, may also be useful in more severe, chronic, or unresponsive cases.
  13. 13. Angioedema Angioedema of the tongue, lips, and face has the potential for airway obstruction. Management is supportive, with special attention to the airway, which can become occluded rapidly and unpredictably. Epinephrine, antihistamines, and steroids are often still used, but benefits have not been clearly demonstrated.
  14. 14. Angioedema Patients with mild swelling and no evidence of airway obstruction can be observed in the ED and discharged if swelling diminishes. Patients with moderate to severe swelling, dysphagia, or respiratory distress are best admitted for close observation.
  15. 15. Take home message
  16. 16. ANY QUESTION?

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