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| :* Gastrointestinal manifestations | | :* Gastrointestinal manifestations |
| ♦ Reduced blood pressure after exposure to a known allergen. | | ♦ Reduced blood pressure after exposure to a known allergen. |
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| ==Management==
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| Shown below is an algorithm summarizing the approach to <nowiki>[[disease name]]</nowiki>.
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| {{familytree/start |summary=PE diagnosis Algorithm.}}
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| {{familytree | | | | | | | | A01 |A01=<div style="float: left; text-align: left; height: 45 em; width: 45em ">'''Characterize the symptoms & signs:''' <br> Skin, subcutaneous tissue and mucosa: <br> ❑ Flushing, itching, urticaria, angioedema, rash, piloerection <br> ❑ Periorbital itching, erythema and edema; conjunctival erythema, tearing <br>
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| Respiratory: <br> ❑ Nasal itching, congestion, rhinorrhea, sneezing <br> ❑ Throat itching and tightness, dysphonia, hoarseness, stridor, dry staccato cough <br> ❑ Tachypnea, dyspnea,chest tightness, wheezing/bronchospasm <br> ❑ Cyanosis <br> ❑ Respiratory arrest <br>
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| Gastrointenstinal: <br> ❑ Pain, nausea, vomiting, diarrhea <br>
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| Cardiovascular: <br> ❑ Chest pain, tachycardia, palpitations <br> ❑ Hypotension, feeling faint <br> ❑ shock <br> ❑ Cardiac arrest <br>
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| Central nervous system: <br> ❑ Anxiety, irritability <br> ❑ Throbbing headache <br> ❑ Altered vision and mental status </div>}}
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| {{familytree | | | | | | | | |!| | | | | | | | }}
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| {{familytree | | | | | | | | B01 | | | | | | | |B01=<div style="float: left; text-align: left ">'''Consider alternative diagnosis:''' <br> ❑ Acute asthma <br> ❑ Anxiety/Panic attack <br> ❑ Syncope </div>}}
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| {{familytree | | | | | | | | |!| | | | | | }}
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| {{familytree | | | | | | | | C01 | | | | | |C01=Remove patient from exposure/trigger }}
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| {{familytree | | | | | | | | |!| | | | | | }}
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| {{familytree | | | | | | | | D01 | | | | | |D01=<div style="float: left; text-align: left">Do all 3 simultaneously <br> ❑ Call for help <br> ❑ '''Inject aqueous epinephrine (adrenaline) IM in the mid-anterolateral aspect of the thigh, 0.01 mg/kg of a 1:1,000 (1 mg/mL) solution''' <br> Maximum dose 0.5 mg (adult) or 0.3 mg (child) <br> Record the time of the dose and repeat it in 5-10 minutes, if needed or <br> ❑ In patients with hypotension/cardiorespiratory arrest and those not responding: Intravenous epinephrine <br> 1:100,000 solution of epinephrine (0.1 mg [1 ml of 1:1000] in 100 ml saline) intravenously by infusion pump at an initial rate of 30-100 ml/hr (5-15 mg/min) <br> Titrate based on clinical response or epinephrine side effects <br> ❑ Place patient on back/comfortable position; elevate legs</div> }}
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| {{familytree | | | | | | | | |!| | | | | | | }}
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| {{familytree | | | | E02 |-| E01 | | | | | | | |E01= Patient has one of the following? <br> ❑ Respiratory distress <br> ❑ Recieved repeated doses of epinephrine <br> ❑ Asthma/other respiratory disease <br> ❑ Co-existing cardiovascular disease |E02=Yes}}
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| {{familytree | | | | |!| | | | | | | | | | | | }}
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| {{familytree | | | | F01 | | F02 | | | | | | |F01=Give high flow supplemental oxygen (6-8 L/min) |F02=No }}
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| {{familytree | | | | |!| | | | | | | | | | | | }}
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| {{familytree | | | | |`|-|-| G01 | | | | | | | |G01= Establish IV access <br> 1-2 litres of 0.9% saline rapidly}}
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| {{familytree/end}}
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| ==References== | | ==References== |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Vidit Bhargava, M.B.B.S [2]
Definition
An acute, severe, potentially life threatening type 1 hypersensitivity reaction, following repeated exposure to an allergen to which an individual is already sensitised.
Causes
Life Threatening Causes
Any of the factors precipitating anaphylaxis can be life threatening.
- Food: Peanuts, Tree nuts, walnuts, pecans, milk, soyabean, wheat, eggs, pistachios, filberts, cashews, almonds, etc.
- Shellfish: crab, crayfish, prawns, shrimp, lobster, etc.
- Medications: Penicillin, Sulfa antibiotics, Allopurinol, and many other drugs
- Diagnostic materials: IV contrast material and dyes
- Insect venom: including bees, wasps, ants
- Natural rubber latex
- Idiopathic/ Coital anaphylaxis
Diagnostic Criteria
It is diagnosed with one of the following criteria:[1]
♦ Acute onset of a reaction (mins to hours) involving skin, mucous membrane or both. Additionally including atleast one of the following:
- Respiratory compromise or
- Cardiovascular compromise/Evidence of end organ dysfunction.
♦ 2 or more of the following in a patient known to come in contact with an established allergen:
- Skin/mucosal tissue involvement
- Respiratory compromise
- Reduced blood pressure
- Gastrointestinal manifestations
♦ Reduced blood pressure after exposure to a known allergen.
References
- ↑ Sampson, HA.; Muñoz-Furlong, A.; Campbell, RL.; Adkinson, NF.; Bock, SA.; Branum, A.; Brown, SG.; Camargo, CA.; Cydulka, R. (2006). "Second symposium on the definition and management of anaphylaxis: summary report--Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium". J Allergy Clin Immunol. 117 (2): 391–7. doi:10.1016/j.jaci.2005.12.1303. PMID 16461139.
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