Anaphylaxis Overview and Causes

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Questions and Answers

What percentage of fatal cases of anaphylaxis is documented?

4% (correct)

10%

Which of the following is not listed as a risk factor for anaphylaxis?

Asthma

Obesity (correct)

Sex

Age

What is the most reported trigger for fatal anaphylactic reactions between 1992-2001 in the UK?

Nuts (correct)

Food

Antibiotics

Anaesthetic Drugs

Which of the following findings is typically associated with post-mortem observations of anaphylaxis?

Gastrointestinal hemorrhage Signup and view all the answers

Based on the content, which drug has the highest incidence of triggering anaphylactic reactions?

Anaesthetic Drugs Signup and view all the answers

What is the primary characteristic of anaphylaxis?

Severe, life-threatening systemic hypersensitivity reaction Signup and view all the answers

Which of the following symptoms is NOT typically associated with anaphylaxis?

Gradual swelling of limbs Signup and view all the answers

What initial assessment finding suggests an airway compromise in anaphylaxis?

Shallow and labored breathing Signup and view all the answers

In the management of anaphylaxis, which of the following is a definitive approach?

Administer adrenaline (epinephrine) promptly Signup and view all the answers

What is one of the common causes of anaphylaxis mentioned?

Bee stings Signup and view all the answers

Which of the following best describes the respiratory assessment finding of a person in anaphylaxis?

Dyspnea with a respiratory rate of 32 breaths per minute Signup and view all the answers

What demographic characteristic was noted in the case presentation of the anaphylaxis patient?

30-year-old female with a prior history of asthma Signup and view all the answers

Which patient symptom indicates agitation in a case of anaphylaxis?

Expressing concerns in incomplete sentences Signup and view all the answers

Which symptom is least likely to be associated with the respiratory system during anaphylaxis?

Hypotension Signup and view all the answers

What is a common cardiovascular symptom observed during anaphylaxis?

Tachycardia Signup and view all the answers

In managing anaphylaxis, which of the following is a crucial first step?

Removing the offending agent Signup and view all the answers

A patient is experiencing a biphasic reaction in anaphylaxis. What time frame should the healthcare provider observe for recurrence?

Up to 8 hours later Signup and view all the answers

Which of the following is NOT a component of the focused secondary assessment for anaphylaxis?

Complete blood count Signup and view all the answers

What is the recommended flow rate for oxygen administration to a patient in respiratory distress during anaphylaxis?

15L/min Signup and view all the answers

In the context of anaphylaxis, which of the following describes protracted reactions?

Can last up to 32 hours Signup and view all the answers

Which vital sign would likely indicate a severe anaphylactic response related to the cardiovascular system?

Tachycardia of 133 b/min Signup and view all the answers

Study Notes

Anaphylaxis Definition

Severe, life-threatening, generalised or systemic hypersensitivity reaction involving multiple organ systems, including the airway, vascular system, gastrointestinal (GI) tract, skin, and central nervous system.
Characterised by acute onset.
Patients experiencing anaphylaxis often face life-threatening airway, breathing, or circulation problems.

Anaphylaxis Causes

Stings: Bee stings are a common trigger.
Nuts: Another frequent cause.
Food: Various foods can trigger anaphylaxis.
Antibiotics: Particularly penicillin.
Anaesthetic drugs:
Contrast media: Used in imaging procedures.

Anaphylaxis Prevalence

Lifetime: 1 in 1,333 people in England have experienced anaphylaxis at some point.
Incidence: 30 to 950 cases per 100,000 persons per year present in the emergency department (ED) with anaphylaxis.

Anaphylaxis Mortality

Post-mortem findings:
- Airway (laryngeal) and tissue (visceral) edema
- Gastrointestinal Hemorrhage
- Myocardial injury
Fatal cases: 4%

Anaphylaxis Risk Factors

Asthmatics: Higher risk of severe reactions.
Mast Cell Disease: Rare condition affecting mast cells, which are involved in allergic reactions.
Personal/Familial History: Family history of anaphylaxis increases individual risk.
Age: Young children and older adults may be more vulnerable.
Sex: No clear gender difference in risk.

Anaphylaxis Clinical Presentation

Skin (Integumentary System):
- Pruritus (Itching)
- Urticaria (Hives)
- Angioedema (Swelling)
- Flushing
Respiratory System:
- Dyspnea (Shortness of breath)
- Tachypnoea (Rapid breathing)
- Wheezing or crackles in the chest
- Stridor (High-pitched whistling sound during breathing)
- Hoarseness
- Throat swelling
Cardiovascular System:
- Hypotension (Low blood pressure)
- Hypoxia (Low oxygen levels in the blood)
- Tachycardia (Rapid heart rate)
- Arrhythmias (Irregular heartbeats)
Gastrointestinal System:
- Nausea
- Diarrhea
- Stomach cramps
- Bloating or abdominal distension
- Vomiting
Central Nervous System (CNS):
- Confusion
- Dizziness
- Headache
- Agitation or anxiety

Anaphylaxis Initial Management

Immediate Actions:
- Remove the offending agent (if possible)
- Perform a rapid primary assessment: ABCDE
- Conduct a focused secondary assessment:
  - Head-to-toe physical examination
  - Non-invasive blood pressure (NIBP)
  - 12-lead ECG monitoring

Anaphylaxis Treatment

JRCALC (Joint Royal Colleges Ambulance Liaison Committee) ABC Assessment - Anaphylaxis:
- Oxygen: 15L if SpO2 <90%
- Epinephrine (adrenaline) intramuscularly:
 - 0.5 mg (adult dose)
 - 0.1 mg (child dose)
 - Can be repeated every 5-15 minutes if necessary
- Intravenous fluid resuscitation (IV)
 - Normal saline or Hartmann's solution
 - Can help restore blood volume and blood pressure
- Antihistamines (IV or orally):
 - Cetirizine or Loratadine
 - Helps to block the release of histamine, reducing symptoms
- Corticosteroids (IV or orally):
 - Methylprednisolone or Hydrocortisone
 - Reduce inflammation and prevent or reduce a delayed reaction

Transport Considerations

Rapid Transport to Accident & Emergency:
- ATMIST (Ambulance Treatment Management Information System) pre-alert en-route
- Consider HEMS (Helicopter Emergency Medical Services) if in a rural location or >45 minutes from hospital.

Anaphylaxis Temporal Pattern

Uniphasic:
- Single reaction, often self-limiting.
Biphasic:
- Initial reaction followed by a recurrence of the same symptoms up to 8 hours later.
Protracted:
- Can last up to 32 hours.
- May not be prevented by glucocorticoids.

Anaphylaxis: Hospital Admission Criteria

ED (emergency department) admission is considered if the patient:
- Experiences biphasic or protracted reactions.
- Has a first episode of anaphylaxis.

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Description

This quiz covers the definition, causes, prevalence, and mortality related to anaphylaxis. It provides crucial insights into this severe allergic reaction, detailing common triggers and the impact on patients. Test your knowledge on this life-threatening condition and its implications.