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2 Emergency Medicine
2.31 Anaphylaxis
Adapted Form EMJ Jan 2002
History
This may be immediately obvious with previous episodes of similar events. However it may not be clear that there has been an allergic reaction. Anaphylaxis commonly results as a reaction to drugs, peanuts, seafood particularly shellfish but may also be due to exercise, sex or an unidentified insult.
Always consider in the shocked patient with no obvious cause.
Examination
The features of anaphylaxis are:
- Airway oedema with obstruction
- Acute bronchospasm
- Circulatory collapse Syncope
- Rash
- Diarrhoea
- Vomiting
Key Messages
- Continuous assessment and monitoring is required to detect those who are deteriorating and require more aggressive treatment.
- If the patient is stable and needs admission then discuss with the CDU doctor.
- Upon discharge , severe cases should be referred on to an immunologist and considered for Epipen. This can be organised via the CDU.
Treatment: The key treatment in acute severe anaphylaxis is Adrenaline
A: Protect the airway.
B: If the patient is self ventilating and in bronchospasm treat with nebulised salbutamol or adrenaline.
C: Large volume of IV fluids may be required due to distributive shock .Adrenalin given parentally is the key to maintain the BP.
The following guidelines distinguish minor allergic reactions (grade I) from true anaphylaxis (grades II-IV). Initial treatment is determined by a high index of suspicion and the clinical features on presentation.
2.32 C1 Esterase Inhibitor Deficiency
This is a rare condition causing intermittent dermal and submucosal swelling. Attacks are precipitated by infection or trauma, or may occur spontaneously. Laryngeal oedema may mimic anaphylaxis and is a medical emergency. Intestinal oedema may mimic an acute abdomen. The standard form of therapy has been treatment with C1 Inhibitor Concentrate or Octaplas (solvent detergent treated plasma). There is unfortunately little evidence to decide on which treatment is superior and the LTHT Immunuologists have differing opinions on the best lines of treatment. C1 Concentrate is very expensive and so should be kept in reserve for AIRWAY probelms and for use in children.
Patients in Leeds with C1 Inhibitor Deficiency usually carry a letter to alert medical staff to their condition and its appropraite treatment. There are various versions in circulation. The LATEST letters for Children & Adults are below.
Please be aware that treatment should ONLY be given in line with the policies below. Please also be aware that some of the LTHT C1 patients are highlighted. Please check beofre treating.
If any doubt persists the Consultant Immunologists (Dr Gooi & Dr Wood) are on call 24/7.
SYMPTOMS DO NOT RESPOND TO ADRENALINE, ANTIHISTAMINES OR CORTICOSTEROIDS.
C1 Inhbitor Prescribing Guide
To try to reduce errors in treatment protocols & prescriptions the following document should be found inside the C1 packaging. Please adhere to it.