Anaphylaxis Management. Pic 1 Severe allergic reaction which led to anaphylaxis

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1 1 Anaphylaxis Management Pic 1 Severe allergic reaction which led to anaphylaxis

2 What is an allergic reaction? 2 An allergy is when someone has a reaction to something (usually a protein) which is either ingested, inhaled, inject or placed on the skin Sometimes (in people who have allergies) the immune system gets mixed up and mistakes a harmless substance (ignored by most people s immune system) for something that may cause damage Results in an allergy

3 What is an allergic reaction? Substance that may cause an allergy = ALLERGEN In people with allergies ALLERGEN + antibodies (IgE) = i.e. Histamine It is the histamine that affects other tissues and cells in the body to cause the allergic symptoms 3

4 Symptoms of an Allergic Reaction Reaction may affect many organs of the body including: Skin Respiratory tract (nose, throat & lungs) Gastrointestinal system Cardiovascular system (blood vessels) 4

5 Symptoms of an Allergic Reaction Allergic symptoms may occur: 1. Locally i. i.e. large local swelling and redness may occur at the site of a bee sting 2. Generalised 1. Result in a generalised skin rash and/or affect organs in the body which have not directly been exposed to the allergen 5

6 Symptoms of an Allergic Reaction When a generalised allergic reaction affects the respiratory and/or cardiovascular system, this is then called anaphylaxis 6

7 7 Allergic Triggers

8 Allergic Triggers Inhaled Airborne Allergens Skin contact or inhalation of an airborne allergen can lead to symptoms of: Skin rash Swelling of the eyes Hay fever Wheeze Are not generally regarded as a trigger for anaphylaxis 8

9 Allergic Triggers 9 Food Allergens Any type of food can be a trigger Vas majority are triggered by: Egg * Cow s mil (dairy food) * Peanuts Tree nuts^ Soy Wheat Seeds Seafood ^ * = common in infants ^ = common in older children, adolescents and adults

10 Allergic Triggers Egg & dairy allergy frequently resolve with age Symptoms of food additives are commonly reported by parents but rarely trigger anaphylaxis 10

11 Insect Venom Allergic Triggers Stinging insects include bees, wasps and ants Being allergic to 1 insect venom does NOT mean that an allergy will occur to another 11

12 Allergic Triggers Medication Any medications, including natural and herbal products, may trigger an allergic reaction Antibiotics (usually penicillin) are the most common reported trigger for medication allergy Medications may trigger an allergic reaction at any age 12

13 Allergic Triggers Other Triggers Allergy to latex in rubber products (i.e. balloons or gloves) Exercise rarely triggers an allergic reaction 13

14 Statistics Food allergy affects: 1 in 100 children 1 in 30 infants A similar number of people are at risk of severe allergic reactions to stinging insects 14

15 Some allergies resolve with Age Food Most food allergies to dairy products, soy, wheat and egg will resolve with age People with severe allergic reactions to multiple foods are less likely to resolve with age Only 10-20% of people allergic to peanuts, tree nuts or seeds grow out of the allergy Seafood allergy is usually a life-long problem 15

16 Some allergies resolve with Age Insect Venom Most adults and some children with serious allergic reactions usually remain sensitive for many years Medication Usually life long allergy 16

17 Allergic Reactions & The Atopic Diseases Atopic Diseases include: Eczema - skin Hay fever - nose Asthma - lungs Conditions caused by an inappropriate inflammatory reaction in the body Allergic reactions to food, insect venom and medication may be more severe in individuals who have asthma compared with those individuals which do not have asthma 17

18 Anaphylaxis General definition Anaphylaxis is a generalised allergic reaction that: Has symptoms and/or signs that indicate that the respiratory (lungs) and/or cardiovascular (blood vessels) have been affected) Usually occurs soon after exposure to the allergen trigger, with progression of symptoms and signs Usually involves more than 1 body system, i.e. skin & lungs Anaphylaxis is the most severe form of an allergic reaction 18

19 Anaphylaxis Deaths from anaphylaxis are rare 19 Risk less than 1% Approximately 10 people die in Australia each year Very rare in children less than 5 years of age Recorded deaths from food allergy show: Most common in teenagers or young adults Have asthma Who DO NOT receive adrenaline soon after the onset of anaphylactic symptoms Recording of ALL symptoms and/or signs during a generalised allergic reaction is important

20 Recognition of Anaphylaxis Key Features of Anaphylaxis are: 1. A generalised allergic reaction with respiratory and/or cardiovascular involvement 2. Involvement of many parts of the body 3. Rapid onset and progression IT IS VERY IMPORTANT TO RECOGNISE THE SYMPTOMS & SIGNS OF AN ALLERGIC REACTION AND TO DETERMINE IF THIS HAS PROGRESSED TO ANAPHYLAXIS 20

21 Recognition of Anaphylaxis 1. A generalised allergic reaction with respiratory and/or cardiovascular involvement Allergic reactions may include the following symptoms, which may (a) precede the onset of anaphylaxis or (b) occur as part of reaction: Swelling of face, lips & eyes Congestion and watering of the nose and eyes Hives or welts on the skin Headaches, anxiety, flushing 21

22 Recognition of Anaphylaxis The following indicates that there is involvement of the lungs or blood vessels: 22 Difficulty/noisy breathing Swelling of tongue Swelling/tightness in throat Difficulty talking and/or hoarse voice Wheeze or presistent cough Chest tightness Abdominal pain, nausea and vomiting Confusion Pale and floppy (in young children)

23 Recognition of Anaphylaxis 2. Involvement of many parts of the body In addition to affecting respiratory and/or cardiovascular system, it almost always affect other organs in the body Skin (skin rash) Gastrointestinal system (usually with food triggers) Sudden collapse (due to low blood pressure) 3. Rapid onset and progression 23 Symptoms of anaphylaxis (as compared to an allergic reaction) develop rapidly It is rare for symptoms to be delayed for hours after exposure

24 First Aid Management of Anaphylaxis All anaphylaxis patients should have an action plan Example of an action plan can be found to the right 24

25 First Aid Management of Anaphylaxis If patient has been diagnosed with anaphylaxis and they have their OWN Epipen 1. Lay person flat, do not stand or walk. If breathing is difficult allow to sit 2. Give Epipen/Anapen 3. Phone Ambulance/Surfcom 4. Contact Family/emergency contact 5. Further adrenaline doses may be given if no response after 5 minutes (if patient has another adrenaline autoinjector) 25

26 First Aid Management of Anaphylaxis If NO EpiPen available or patient experiencing for First Time. 1. Seek emergency medical assistance (i.e. 000) 2. Lay the person flat and elevate the legs if the person (unless it makes breathing more difficult) is: dizzy, seems confused, OR has a reduced level of consciousness 3. Follow DRSABCD if there is no breathing and no response If oxygen is available give at high flow rate 26

27 First Aid Management of Anaphylaxis If allergic reaction is due to insect sting REMOVE stinger as soon as possible in the appropriate method i.e. Bee Sting flick sting away. DO NOT PICK STING OUT DO NOT REMOVE TICKS 27

28 First Aid Management of Anaphylaxis After an episode of anaphylaxis 28 Seek emergency medical help EVEN if the EpiPen relieves symptoms or symptoms resolve without any treatment Stay in medical care under continuous observation for 4-6 hours Document the circumstances of the reaction and include the following: The trigger, if known The symptoms that occurred The treatment administered including the use of the EpiPen Any other important information

29 Medication Information Adrenaline is the ONLY medication proven to reverse the symptoms of anaphylaxis Works rapidly to: Reduce throat swelling, Open the airways Maintain blood pressure Adrenaline must be injected and cannot be taken by mouth 29

30 Medication Information Risks & Side Effects of Adrenaline Palpitations (fast strong heartbeat) Tremor General pallor Blanching Benefits would always outweigh the side effects 30

31 Medication Information Adrenaline treatment of allergic reactions Remember NOT all allergic reactions are dangerous 31

32 Medication Information Use of other Medication Adrenaline is the most important drug to use Antihistamines, corticosteroids or asthma medication generally have no effect Oxygen should be given at high flow rtes to people having a severe reaction if available 32

33 Autoinjectors There are currently 3 types of autoinjectors being used as medication: General EpiPen & EpiPen Jr New-look EpiPen & EpiPen Jr Anapen & Anapen Jr The next few slides will describe how to operate each of the above 33

34 EpiPen Is a disposable, preloaded automatic injecting device that delivers 1 measured dose of adrenaline Device has a spring activated and concealed needle EpiPen Junior (150ug) 10-20kg child (aged 1-5 years generally) EpiPen (300ug) when weight exceeds 20kg If anaphylactic symptoms return after use of EpiPen, it may be necessary to give an additional EpiPen (if available) after 5-10 minutes if needed. 34

35 Administering of an EpiPen Remove the grey safety cap Hold the EpiPen (firmly) with the black tip against the thigh (do not cover the end of the EpiPen with your thumb!!) Apply moderate pressure and hold for 10 seconds (can be applied through clothing) Discard the unit safely Observe for relapse as severe symptoms may sometimes reoccur after apparent recovery 35

36 Other EpiPen Information EpiPen Storage Should be stored in a cool dark place at room temperature but NOT refrigerated Should be readily available and not in a locked cupboard EpiPen Expiry Shelf life is normally months An expired EpiPen SHOULD be used in preference to NOT using an EpiPen at all HOWEVER, only if the colour of the liquid is clear Disposal after use 36 Placed in a rigid sharps disposal unit, or if not available, another rigid container

37 37 How to give the new-look EpiPen

38 38 How to give the Anapen

39 Long Term Management of Anaphylaxis Principles of Long Term Management include: Identification of avoidable triggers Education on avoidance of triggers Risk Assessment of recurrent and severity Provision of an emergency anaphylaxis action plan Reassessment regularly by a specialist 39

40 40 Anaphylaxis Management -SUMMARY

41 Background Information An allergy is when someone has a reaction to something (usually a protein) which is either ingested, inhaled, inject or placed on the skin Symptoms of an allergic reaction may be local or general Anaphylaxis is the most sudden and severe form of generalised allergic reaction 41

42 Background Information (cont d) Food, medication and insect venom are the commonest severe allergic triggers Asthmatic individuals have more severe allergic reactions if they have an underlying food, medication or insect venom allergy Anaphylaxis is not uncommon, but death from anaphylaxis is very rare Death from anaphylaxis usually occurs in adolescents and adults who have asthma 42

43 Recognition of Anaphylaxis Key features of anaphylaxis are: 1. A generalised allergic reaction with respiratory and/or cardiovascular involvement 2. Involvement of many parts of the body 3. Rapid onset and progression 43

44 First Aid Management of Anaphylaxis 44 All individuals who have had a previous episode of anaphylaxis should have a first aid anaphylaxis action plan The most important treatment for anaphylaxis is adrenaline The EpiPen is an adrenaline auto injector device if this is prescribed it is essential to have an anaphylaxis action plan and to know how to use the EpiPen

45 Long Term Management of Anaphylaxis Avoidance of offending allergens is the key to prevention of anaphylactic reactions 45

46 REFERENCE LIST Picture 1 image from anaphylaxis australia website 46

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