1. Dr. Stella Yiu Emergency Physician, TOH
Anaphylaxis
Dr. Stella Yiu
Emergency Physician, TOH

2. LMCC Objectives
History and Physical of allergic reaction pts Determine urticaria with systemic diseases Investigations to identify allergens Manage urticaria and anaphylaxis in ED

3. 1. History and Physical

4. CDMQ: What can cause allergic reactions? (5 categories)

5. Urticaria: triggers
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6. Drugs Food allergens Insects Physical stressors (cold, exercise) Respiratory allergy (Pollen)

9. What systems are involved?

10. Blood vessels
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11. Lungs

12. GI tract

13. Soft tissues
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14. 50% has angioedema (lips/face/upper airway)

15. If airway/tongue -> potential airway obstruction

16. Investigations for allergic reaction/anaphylaxis
No Labs Maybe skin testing later

17. 2. Acute/chronic + systemic illness

18. Urticaria
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19. Systemic illness -> urticaria
Serum sickness Transfusion reactions Viral/bacterial infections Vasculitis

20. Systemic illness: serum sickness
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21. Systemic illness: serum sickness
Fever, rash, arthralgia
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22. Systemic illness: transfusion reactions

23. Systemic illness: transfusion reactions

24. Systemic illness: transfusion reactions

25. Systemic urticaria: Viral/Bacterial infection
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26. Systemic urticaria: Vasculitis
Associated with SLE, Sjogren, Leukemia Drugs Systemic unwell: Arthralgia, fever, abdo pain, lymphadenopathy
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27. Definition of anaphylaxis

28. MCQ 5: Who does not have anaphylaxis?
Ate peanut butter. Swollen lips and wheezing. VS normal.
Shrimp fest at Red Lobsters. Vomiting and tight throat.
Stung by bee. Low BP.
Flu shot. Hives. VS normal.
Hay fever, swollen throat, low BP.

29. Anaphylaxis Definition
> 2 systems: CVS (BP), airway, GI, skin Skin + airway/BP BP

30. 3. Manage anaphylaxis

31. CDMQ: Management steps of patient with anaphylaxis (8)

32. Airway (2): Epinephrine im Intubate if needed (what indications)

33. Breathing (1): Oxygen B2 agonist (Ventolin)

34. Bronchodilators
Epinephrine

35. Circulation (2) Iv fluids if hypotensive Iv epinephrine if no better

36. Fluids

37. Drugs (3) Antihistamines (H1- Benadryl, H2- Ranitidine) Steroids

38. Antihistamines
H1: Benadryl (Diphenhydramine)
H2: Ranitidine

39. Fluids, Symptomatic

40. Discharge instructions
Allergy testing outpatient Carry Epi-Pen at all times
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41. Discharge meds
Steroid -  2nd phase reaction (6-72 hours) - Prednisone po or solumedrol iv Continue Antihistamines

42. LMCC Objectives
History and Physical of allergic reaction pts Determine urticaria with systemic diseases Investigations to identify allergens Manage urticaria and anaphylaxis in ED