23 Questions
What is the first step in managing an anaphylactic reaction?
Apply oxygen
What is the recommended dose of IM epinephrine for anaphylaxis in children?
0.01 mg/kg, maximum dose 0.3 mg
What should you do if a patient develops a cutaneous rash after taking prescribed pain medicine, but has no other associated symptoms?
Stop the offending agent and recommend OTC Benadryl and possibly hydrocortisone
What are worrisome symptoms of anaphylaxis?
Facial/oral swelling, breathing difficulties, and vesicles/skin sloughing
What is the recommended time interval for repeating IM epinephrine administration if necessary?
Every 5-10 minutes
What should you do if a patient reports a rash after taking prescribed pain medicine, but also has associated symptoms such as lip/facial swelling and shortness of breath?
Advise patient to go to ED immediately
What is the concentration of epinephrine in an EpiPen?
1:1,000 dilution
What is the time frame for an immediate reaction to evolve after drug exposure?
Within 1st hour
What percentage of patients with anaphylaxis will have urticaria and angioedema?
90%
What is the characteristic of a late phase reaction?
Within 3-4 hours after a decline in immediate reaction
What is the characteristic of an accelerated reaction?
1-72 hours
What is the characteristic of a delayed reaction?
After 72 hours
What percentage of patients with anaphylaxis will have airway complaints?
50%
What percentage of children in the U.S. have a food allergy?
8%
What is the most common immune reaction to something that does not affect most other people?
Allergy
Which of the following is a risk factor for allergy?
Tobacco smoke
What is the most consequential finding of anaphylaxis that causes decreased blood pressure, perfusion, and possible death?
Hypotension
What is the most important treatment for anaphylaxis?
Epinephrine
What is the term for the process by which an immune response becomes sensitized to a particular substance?
Sensitization
Which of the following is a common sign or symptom of allergy or anaphylaxis?
Itching
What percentage of anaphylaxis cases exhibit dyspnea or wheeze?
45-50
How much of intravascular volume can be lost within 15 minutes in anaphylaxis?
~50%
What is a common symptom of anaphylaxis that affects the gastrointestinal system?
Nausea, vomiting, diarrhea, cramping pain
Study Notes
Allergy and Anaphylaxis
- An allergy is an immune reaction to something that does not affect most other people.
- 8% of children in the U.S. have a food allergy.
Risk Factors for Allergy
- Asthma
- Atopic Dermatitis
- Environmental factors:
- Tobacco smoke
- Socioeconomic factors
- Air pollution
- Obesity
- Respiratory infections
- Indoor/outdoor allergens
Phases of Allergic Response
-
- Sensitization
-
- Early phase reaction
-
- Late phase reaction
- Early phase reaction subsides in 30-90 minutes
- Late phase reaction occurs within 3-4 hours after decline in immediate reaction
Drug Allergy
- Immediate Reaction: evolves within the 1st hour of drug exposure (e.g., anaphylaxis, pruritis, urticaria, angioedema)
- Accelerated Reaction: 1-72 hours (e.g., pruritis, urticaria, angioedema)
- Delayed Reaction: > 72 hours (e.g., benign skin eruptions, fever, serum sickness-like reaction, systemic disorders)
Hypersensitivity Reactions
- Type I: immediate hypersensitivity reaction
- Type II: antibody-dependent cytotoxicity
- Type III: immune complex-mediated hypersensitivity reaction
- Type IV: delayed hypersensitivity reaction
Anaphylaxis
- 90% of patients will have urticaria and angioedema
- 50% of patients will have Airway Complaints:
- Shortness of breath
- Wheezing
- Dyspnea
- ~50% of intravascular volume can be lost within 15 minutes
- Signs and symptoms:
- Cutaneous: 85-90%
- Respiratory: 45-50%
- Hypotension, dizziness, syncope, diaphoresis: 30-35%
- Abdominal: 25-30%
- Miscellaneous: 1-8%
Treatment of Anaphylaxis
- Call for help (911)
- Epinephrine pen!!!!
- High flow oxygen
- Cardiac monitoring
- IV access
Test your knowledge on allergies, risk factors, and phases of allergic response. Learn about the immune reaction, food allergies, and environmental factors that contribute to allergies.
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