ANAPHYLAXIS
Anaphylaxis means a
severe allergic reaction to an allergen to which an individual has
previously been exposed to.
It occurs due to antigen specific cross linking of IgE on
surface of tissue mast cells and peripheral basophils.
History Taking
Usually there is a clearly identifiable allergen /
precipitant which has caused anaphylaxis.
If the allergen is not identifiable we have to ask the following points in
History :
Any past history of similar allergic reaction
Any known allergies.
Did this reaction occur after eating a particular food ?
Was the patient bitten by an insect eg bee, wasp, ant etc?
Did he wear any new jewelry or used any new cosmetic product
,hair dye etc.
Any latex / rubber allergy?
Any history of allergy in the family?
Investigations
Full blood count including Eosinophils
Skin prick testing
Serum mast cell tryptase : Elevated after anaphylaxis
C1 inhibitor deficiency
Clinical features
Patient develops symptoms within seconds to minutes.
These occur due to development of tissue oedema as a result
of release of inflammatory mediators.
The common Signs and Symptoms include :
Difficulty breathing
Facial and tissues swelling
Rash over body
Itching of eyes
Sneezing and conjunctivitis to name a few.
Sometimes if the reaction is severe, it will prove to be
life threatening.
Management :
Assessemnt of ABC : Airway , Breathing , Circulation
Administer High Flow Oxygen
Monitor Oxygen Saturations
Establish iv access / cannulation
In case of respiratory distress or wheeze / stridor, give adrenaline
/epinephrine 0.5 ml of 1:1000 solution
intramuscularly.
This can be repeated in 5 minutes if no improvement.
Administer iv hydrocortisone from 100 mg upto 500 mg
depending on the severity of anaphylaxis.
Administer Chlorpheniramine 10 mg iv .
In case of wheeze /
bronchospasm , give nebulization by salbutamol / ipratropium or Clenil .
If patient is hypotensive give iv fluids eg Normal saline
0.9 % 1 litre straight away.
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