Anaphylaxis before and after the emergency

Transcription

1 Anaphylaxis before and after the emergency Mike Levin Paediatric Asthma and Allergy Division University of Cape Town Red Cross Hospital

2 Why is this important? Increasing in frequency Risk of death Effects of quality of life Lacks of data of public education of support for people with allergies of legislation

3 Anaphylaxis a sudden, severe, potentially fatal, systemic allergic reaction. skin, respiratory tract, gastrointestinal tract, and cardiovascular system. Symptoms occur within minutes to two hours after contact with the allergycausing substance.

4 Anaphylaxis Many systems can be involved: skin, gut, airways, circulatory system Must recognise mild versus severe reactions

5 Skin Reactions Urticaria Angioedema Itching, redness and flushing Immediate worsening of eczema

6 Reactions in the Gut UPPER GIT Angioedema of the lips, tongue, or palate Oral itching LOWER GIT Nausea Colicky abdominal pain Vomiting Diarrhoea

7 Reactions in the Airways UPPER RESPIRATORY TRACT Hoarseness Dry staccato cough Swelling of the larynx Stridor Blocked nose Itchy, runny, sneezy nose

8 Reactions in the Airways LOWER RESPIRATORY TRACT Cough Chest tightness Shortness of breath Wheezing

9 Reactions in the Eyes Itching Redness Tearing Swelling around the eyes

10 Neurological Signs Change in activity level Anxiety Feeling of impending doom Dizziness Loss of Consciousness

11 Circulatory System Tachycardia Hypotension End-organ dysfunction: Dizziness Fainting Loss of consciousness

12 Manifestations Urticaria, angioedema 88 % Upper airway oedema 56 % Wheeze, dyspnoea 47 % Flush 46 % Many others far lower % Shock.. very rare But may be fatal

13 Variation in manifestations Skin involvement progressing to additional systems Multiple systems involvement without skin / mucous membranes Hypotension only shock, seizures, syncope Bradycardia Myocardial infarction Venticular tachycardia

14 Clinical criterion 1

15 Clinical criterion 2 Known allergic patient exposed to likely allergen

16 Clinical criterion 3 Reduced BP occurring rapidly after exposure to known allergen for that patient

17 Clinical diagnosis Skin PLUS resp or CVS or Likely allergen with TWO of Skin Resp CVS GIT or Known allergen with reduced BP

18 Risk factors for fatal anaphylaxis Previous anaphylactic reaction History of asthma Current poor asthma control Reactions with trace exposure Peanut > age 5 Adolescents Remote from medical help

19 Emergency treatment 1. Recognise that the child may be reacting 2. Recognise how bad the reaction is 3. Treat accordingly

20 Action Plan for anaphylaxis MILD TO MODERATE ALLERGIC REACTION Swelling of lips, face, eyes Hives or welts Tingling of the mouth Itchy feet or palms of hands Abdominal pain, vomiting

21 Action Remove allergen or sting Give Anti-histamine Stay with the person and call for assistance Locate the EpiPen or Adrenaline Contact parents or ambulance

22 Watch for signs of anaphylaxis: Difficult / noisy breathing Swelling of tongue Swelling, tightness of throat, throat clearing Difficulty in talking and/or hoarse voice Wheeze or persistent cough Persistent dizziness or collapse Very anxious Pale and floppy (young children)

23 Action Lay person flat - they should not stand or walk, if breathing is difficult allow to sit up Administer Adrenaline Start going to an emergency room by Ambulance or car Contact parent/emergency contact Further adrenaline doses may be given if no response after 5 min

24 S/C vs IMI IMI S/C 2136 pg/ml tmax minutes 1802 pg/ml tmax minutes Simons, F.E.R., Gu, X., Roberts, J.R., Simons, K.J. Epinephrine absorption in children with a history of anaphylaxis. J. Allergy Clin. Immunol. 1998;101:33-37.

25 EpiPen Adrenaline Auto-injector

26 Adrenaline ampoule with syringe and needle

27 Vial & Syringe Parents slower than doctors / nurses Parents doses varied 40 fold!! Parents times 140 secs secs Simons FER, Chan ES, Gu X, Simons KJ. Epinephrine for the out-of-hospital (first aid) treatment of anaphylaxis in infants: is the ampule/syringe/needle method practical? J Allergy Clin Immunol 2001;108:1040-4

28 EpiPen Junior - 0,15mg or EpiPen - 0,3mg? EpiPen Junior If the child s weight is between 8 and 25kg EpiPen When the child s weight reaches 25 to 30kg

29 When to use adrenaline ampoules 8 Kg or under: EpiPen Junior dose too large Very over weight: EpiPen dose too small (or use 2 epipens) Very Obese EpiPen needle too short Financial constraints

30 If in doubt... Give The EpiPen or Adrenaline!

31 Risk reduction Death from anaphylaxis is rare, but completely preventable Avoid foods: Carry emergency medication: Communication:

32 Risk reduction Death from anaphylaxis is rare, but completely preventable Avoid foods: dietician, ensure nutrition Carry emergency medication: Communication:

33 Risk reduction Death from anaphylaxis is rare, but completely preventable Avoid foods: dietician, ensure nutrition Carry emergency medication: epipen or vial / syringe Communication:

34 Risk reduction Death from anaphylaxis is rare, but completely preventable Avoid foods: dietician, ensure nutrition Carry emergency medication: epipen or vial / syringe Communication: Medic alert, action plans

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36 Avoid foods Dietician, ensure nutrition Educate the family on how to avoid foods. Provide alternatives Age appropriate education of children regarding sharing food, avoiding food Develop an individualised health care plan for each environment regarding sharing food, identified safe areas or completely food (peanuts usually) free school.

37 Carry emergency medication Training about when to give medication Training about how to give medication Provide a second device for alternate homes, school, preschool or childcare Store adrenaline appropriately: safely, accessible, out of direct heat/light If carried by child preferably be in specified location: pocket, bag, beltbag, pouch.

38 Communication Individualised (signed) action plan, including photo Medic alert Notify school principal or preschool supervisor and teacher Individualised health care plan for environment Training of alternative caregivers, school staff

39 Allergy Society of South Africa Information for patients Anaphylaxis Food Allergy overview Specific foods (Egg, Soy, Peanut, Wheat, Milk, Fish and Seafood) Bee and Wasp Allergy Information for doctors Treatment of Anaphylaxis Anaphylaxis Action Plan Anaphylaxis Emergency Instructions

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