project: ghana emergency medicine collaborative document title: anaphylaxis author(s): peter moyer...
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Project: Ghana Emergency Medicine Collaborative
Document Title: Anaphylaxis
Author(s): Peter Moyer (Boston University), MD, MPH 2012
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Definition
• A rapid onset allergic reaction which may be life threatening
• True emergency – requires immediate diagnosis and Rx
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Terminology
• Anaphylaxis - IgE mediated after previous exposure
• Anaphylactoid - not IgE but immune complex complement mediated; no prior exposure required
• Therapeutically identical
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Common Causes
• Drugs b lactam antibiotics: penicillins and
cephalosporins aspirin and other NSAIDs sulfa drugs aminoglycosides
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Common Causes
• Foods and additives – more common in children shellfish nuts milk eggs sulfites wheat soybeans
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Common Causes
• Stings• Vaccines• Latex• X-Ray contrast material
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Pathophysiology
• Release of vasoactive and bronchial mediators from mast cells and basophils (histamines, prostaglandins, leukotrienes, etc.)
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Clinical Picture• 2 or more of following:
skin pruritus urticaria
respiratory upper airway lump in throat hoarseness stridor
lower airway bronchoconstriction
wheezing
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Clinical Picture
• Hypotension - distributive shock
• GI - cramps and vomiting
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Clinical Picture
• Rapid onset - minutes to hours, most within 1 hour
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Recurrence
• Up to 20% recur within 8 hours
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Treatment
• 1st line: • Epinephrine - has both alpha and beta-2 effects - reduces mucosal edema, reduces
capillary leakage, vasoconstricts, bronchodilates
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Treatment
• Epinephrine dosing and administrationo 0.3 (kids) to 0.5 mg (adults); (0.3-0.5ml of 1:1000) IM
in thigho Repeat q 5 min as necessary o Epinephrine auto injector (Epipen) is easiest
and safest (comes in 0.3 and 0.5 mg dosages)
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Treatment
• Epinephrine – if refractory to IM Rx or cardiovascular collapse – 0.1 mg IV epi over 5-10 minutes (0.1 mg of the 1:10,000)
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Treatment
• Shock – IV fluids wide open
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Treatment
• IV steroids and antihistamines (H1 and H2 blockers) to prevent recurrence
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Observation
• Admit or observe for 8 hours to watch for recurrence
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