Anaphylaxis I.

Definition/General Consideration * Anaphylaxis: Sudden, immunologically mediated reaction to foreign substance that produce life-threatening reaction A) Unimodal: Begins rapidly and ends rapidly B) Bimodal: Begins within minutes transient impro ement recurs after !-" hours #) $rotracted: Begins suddenly or gradually, but lasts fore er * Anaphylactoid: Same as anaphylaxis, but not mediated by %g& - &xamples ' %# formation when gi ing %(%g, direct triggering of mast cell degran by contrast, opiates, dextrran, )SA%*s * $athophysiology - Allergen binds to preformed %g& on mast cells release histamine type % hypersensiti ity reaction II. Clinical Findings * +espiratory: ,hee-ing, hoarseness, stridor, coughing * #(: .achycardia, hypotension * S/in: 0lushing, urticaria, angioedema, pruritus * 1%: Ab2 pain, omiting, diarrhea, uterine contractions * )euro: *isorientation, sei-ures, anxiety III-IV. Workup/Laboratory Findings * #linical diagnosis with history * 3 causes of death: #( collapse and respiratory failure V. Differential Diagnosis * %g& mediated ' .ype % hypersensiti ity A) 0oods: $eanuts, tree nuts, seafood, eggs B) *rugs: $enicillin, cephalosporins, insulin, extracts #) Stinging bugs *) 4ther: 5atex, seminal proteins * *irect stimulation of mast cell degranulation A) *rugs: 4piates, ancomycin B) +adiocontrast material #) $hysical stimuli: &xercise, cold *) %diopathic * %ncreased 5. synthesis * #omplement acti ation: %(%g, transfusion VI. reat!ent * Algorithm !) +emo e inciting agent 3) Assess AB#s 6) $harmacologic treatment * $harmacologic treatment 7in order and dose) !) &pinephrine A) Subcutaneous !:!,888 828! ml9/g 7up to 826 m5) e ery !8-38 minutes B) %( !:!8,888 32: m5 ; :-!8 min inter als if hypotensi e #) %< 826 mg 7up to 6 times) 3) =! and =3 bloc/ers A) *iphenhydramine ! mg9/g $4, %(, %< :8 to !88 mg B) +anitidine 6) Steroids A) $rednisone ! mg9/g $4 >?hrs B) <ethylprednisolone !-3 mg9/g %( >?hrs @) )ebuli-ed b-adrenergics and oxygen as needed :) 0luids * %f beta-bloc/ers on board, may get refractory hypotension and bradycardia when epi is also gi en - <ay get coronary (# from unopposed alpha-adrenergic stimulation