Anaphylaxis
Evaluation
Description—acute, potentially life-threatening hypersensitivity reaction with systemic effects
Clinical:
Cardiovascular—lightheaded and syncope secondary to hypotension
Respiratory—rhinitis, sneezing → stridor, chest tightness, shortness of breath, wheeze, respiratory arrest
Skin—pruritus, flushing, hives, angioedema
Neurologic—anxiety
Gastrointestinal (GI)—nausea, vomiting, diarrhea, cramping
Mechanism—antigen/antibody-mediated response involving immunoglobulin E (IgE)
Epidemiology
A total of 500 to 1,000 deaths occur annually in the United States.
More than 500,000 serious allergic reactions to medications occur annually in hospitals.
Risk factors
Age—children have more food-related anaphylaxis; adults more so with antibiotics, stings.
Common foods—peanuts, nuts, fish, shellfish, milk, eggs, sesame
Common drugs—penicillin, sulfa, nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, contrast, and so on
Sex—men have a higher occurrence with stings; women with latex, Aspirin, contrast.
Exposure—the more time since last exposure, the less likely a reaction will transpire.
Location—occurrence is higher in rural patients than in urban.
Management
Stop the agent causing the insult.
Assess airway, breathing, circulation (ABCs).
Treat!
Pharmacologic treatment
Epinephrine is the drug of choice for immediate therapy during anaphylaxis.
