Management of an anaphylactic reaction to Omalizumab (Xolair) drug therapy

Transcription

1 Management of an anaphylactic reaction to Omalizumab (Xolair) drug therapy Turnberg Building Respiratory Medicine All Rights Reserved Document for issue as handout.

2 What is an allergic reaction? Symptoms may vary for each individual reaction, and may be dependant upon the type of contact with the substance causing the allergy. Not all of the symptoms outlined below need to be present at the same time in an allergic reaction. Mild reaction l Headache l Shivering, itching, tingling l Rash (urticaria) l Nausea l Flushing l Aching May progress to a severe reaction l Difficulty swallowing and breathing l Change in voice l Pressure / pain in the chest l Tightness / swelling in throat including the tongue and face l Fainting / collapse You may not display all of these symptoms. It is important to make friends, family, work colleagues and anyone who has regular contact, aware of these symptoms. The correct treatment given early is very effective. What do I do in case of mild or moderate allergic reaction? l Take antihistamine as prescribed l Contact NHS 111 / GP / walk in centre or local accident and emergency department if necessary, for advice l If the reaction becomes more severe, or if you are at all unsure, use the EpiPen and seek medical assessment What do I do in case of severe allergic (anaphylactic) reaction? l Summon help as a matter of urgency l After every use, an ambulance must be called even if symptoms are improving, lie down with legs raised and, if at all possible you should not be left alone l Keep the used pen to show emergency services (in a screw top glass jar for safety, if available) l Wait for the ambulance to arrive and clearly alert them to the likelihood of an anaphylactic reaction to Xolair drug therapy l Repeat after 5 to 15 minutes if the ambulance has not arrived and you still feel unwell May progress to a moderate reaction l Swelling (eyes, lips) l Wheezing (bronchospasm) l Vomiting/diarrhoea l Ask friends, family or member of the public to stay with you and to call for an ambulance (999), explaining the problem is anaphylaxis l Give adrenaline (EpiPen) as instructed into the outer aspect of the thigh 1 2

3 What is adrenaline (Epinephrine)? Adrenaline is a natural hormone released when you are frightened or excited, which increases your heart rate and blood pressure. These effects would make it easier to breathe and help prevent shock during an allergic reaction. What should happen when I use the EpiPen? l Help breathing if this is difficult due to swelling in the throat or asthma l Help prevent fainting l Lessen any swelling or rash l Make you feel shaky or jittery l The benefits usually last 5-15 minutes, after that, you may recover or you may need to use another pen l If you inject your hand or thumb by mistake it may go white or blue because the adrenaline has cut off the blood supply. If this happens you should get medical help What is the dose of the Adrenaline (EpiPen)? The adult pen (0.3mg) is used for anyone above 30kg (4¾ stone) and a junior pen (0.15mg adrenaline) below this weight. Adrenaline works best if it is injected into muscle, not fat. The adult EpiPen needle is 16mm (5/8 ) long and the junior 13mm (1/2 ) long. What if it doesn t work? Check you have removed the safety cap and try again. If the pen has been properly injected then wait for a response. If the response if not adequate to relieve your symptoms or reduce them in severity then you may need a second injection from your spare epipen into the other leg, where possible. How to store and care for the EpiPens l Adrenaline is usually stored at room temperature, and protected from daylight (within the packaging) l It is important to ensure that the pen is accessible to everybody and that everybody knows where it is l A designated person should be made responsible for checking the expiry date on the pen and to ensure the pen is in no way damaged l Expired medication should be disposed of safely by your local pharmacy l When you have an adrenaline pen, you should always remind your doctor of this whenever you are prescribed other medication Do I need to know any other important points about the epipen? Severe reactions are extremely rare but should this occur the Omalizumab (Xolair) treatment will be discontinued. Pay particular attention on day trips and holidays, and ensure that the epipen(s) is readily available. A Medical alert bracelet is advisable for instant recognition of the potential for severe allergic response to your drug therapy. Replacement antihistamines and epipens are requested on prescription from your GP. 3 4

4 Your treatment is Notes Antihistamine (name): Strength: Take: Epipen: Chlorphenamine Maleate (Piriton) 4 milligrams Maximum six = 24milligams daily ONE tablet 4-6 Hourly for 5-7 days 0.3mg epipen (for all adults 30kg and above) 0.15mg epipen (for all adults below 30kg paediatric dose) Use as directed above NB Consideration must be given to the elderly that are more likely to experience neurological Anticholinergic effects. Consider using a lower daily dose (e.g. a maximum of 12 mg in any 24 hours) For further advice or information Hospital Specialist

5 G Design Services Salford Royal NHS Foundation Trust All Rights Reserved 2014 This document MUST NOT be photocopied Information Leaflet Control Policy: Unique Identifier: MED75(14) Review Date: August 2016 For further information on this leaflet, its references and sources used, please contact Copies of this information are available in other languages and formats upon request. If you need this interpreting please telephone In accordance with the Equality Act we will make reasonable adjustments to enable individuals with disabilities, to access this treatment / service. Salford Royal operates a smoke-free policy. For advice on stopping smoking contact the Hospital Specialist Stop Smoking Service on Salford Royal NHS Foundation Trust Stott Lane, Salford, Manchester, M6 8HD Telephone If you would like to become a Foundation Trust Member please visit: for-members If you have any suggestions as to how this document could be improved in the future then please visit: for-patients