Anaphylaxis Dr. Stella Yiu Emergency Physician, TOH LMCC Objectives History and Physical of allergic reaction pts Determine urticaria with systemic diseases Investigations to identify allergens Manage urticaria and anaphylaxis in ED 1. History and Physical CDMQ:What can cause allergic reactions? (5 categories) Urticaria: triggers Photo credit: ambert, cwulmer, Norm & Debra, FlickR creative commons Drugs Food allergens Insects Physical stressors (cold, exercise) Respiratory allergy (Pollen) What systems are involved? Blood vessels Photo credit: kiwinky, Flickr commons Lungs GI tract Soft tissues © anaphylaxisweb 50% has angioedema (lips/face/upper airway) If airway/tongue -> potential airway obstruction Investigations for allergic reaction/anaphylaxis No Labs Maybe skin testing later 2.Acute/chronic + systemic illness Urticaria Photo credit: kiwinky, Flickr commons Systemic illness -> urticaria Serum sickness Transfusion reactions Viral/bacterial infections Vasculitis Systemic illness: serum sickness Photo credit: mrmason.ca Systemic illness: serum sickness Fever, rash, arthralgia Photo credit: mrmason.ca Systemic illness: transfusion reactions Systemic illness: transfusion reactions Systemic illness: transfusion reactions Systemic urticaria:Viral/Bacterial infection Photo credit: Dermatolog Information System Systemic urticaria:Vasculitis Associated with SLE, Sjogren, Leukemia Drugs Systemic unwell: Arthralgia, fever, abdo pain, lymphadenopathy Photo credit: Dermatology image atlas Definition of anaphylaxis MCQ 5:Who does not have anaphylaxis? A. Ate peanut butter. Swollen lips and wheezing. VS normal. B. Shrimp fest at Red Lobsters. Vomiting and tight throat. C. Stung by bee. Low BP. D. Flu shot. Hives. VS normal. E. Hay fever, swollen throat, low BP. Anaphylaxis Definition > 2 systems: CVS (BP), airway, GI, skin Skin + airway/BP BP 3. Manage anaphylaxis CDMQ: Management steps of patient with anaphylaxis (8) Airway (2): Epinephrine im Intubate if needed (what indications) Breathing (1): Oxygen B2 agonist (Ventolin) Bronchodilators Epinephrine Circulation (2) Iv fluids if hypotensive Iv epinephrine if no better Fluids Drugs (3) Antihistamines (H1- Benadryl, H2- Ranitidine) Steroids Antihistamines H1: Benadryl (Diphenhydramine) H2: Ranitidine Fluids, Symptomatic Discharge instructions Allergy testing outpatient Carry Epi-Pen at all times Photo credit: gregfriese, flickr creative commons Discharge meds Steroid - 2nd phase reaction (6-72 hours) - Prednisone po or solumedrol iv Continue Antihistamines LMCC Objectives History and Physical of allergic reaction pts Determine urticaria with systemic diseases Investigations to identify allergens Manage urticaria and anaphylaxis in ED