1. ANAPHYLAXIS YOGESH NATALY AK ED
“ITS TYPICAL EXPLOSIVE ONSET AND UNFORESEEN NATURE OF SEVERITY IS FRIGHTENING”
(Bochner B.S, Lichtenstein L.M. Anaphylaxis: Current Concepts. New England Journal of Medicine, : )

2. ANAPHYLAXIS
“IMMUNE-MEDIATED LIFE-THREATENING SYNDROME RESULTING FROM THE SUDDEN RELEASE OF MAST CELL AND BASOPHIL-DERIVED MEDIATORS INTO THE CIRCULATION”
(Kemp S.F, Lockey R.F. Anaphylaxis: a review of causes and mechanisms.J Allergy Clin Immunol.2002 Sep;110(3):314-8)

3. ANAPHYLACTOID
“CLINICALLY INDISTINGUISHABLE SYNDROME, INVOLVING SIMILAR MEDIATORS BUT NOT MEDIATED BY IgE ANTIBODY AND NOT NECESSARILY REQUIRING PREVIOUS EXPOSURE TO THE INCITING SUBSTANCE”
(Bochner B.S, Lichtenstein L.M. Anaphylaxis: Current Concepts. New England Journal of Medicine, : )

4. EPIDERMIOLOGY 1 PER 1,500 PATIENT
154 FATAL CASES PER 1,000,000 HOSPITALISED CASES
USA
84,000 ANAPHYLAXIS AND 840 FATALITIES
BETA-LACTAM
1 IN 5,000 EXPOSURES WITH 400 TO 600 FATALITIES
FOOD
150 FATALITIES FOR 30,000 ANAPHYLACTIC REACTIONS.

5. COMMON CAUSES FOOD: peanuts, other nuts, fish, shellfish, egg, milk.
INSECT VENOM: bee and wasp sting, fire ants, snake.
DRUGS: antibiotics, iv anaesthetic drugs, aspirin, nsaids, opioids, haemaccel.
LATEX RUBBER.
RARELY, exercise, vaccines, heat, cold, sunlight.
IDIOPATHIC.

6. MECHANISM in ANAPHYLAXIS

7. MECHANISM in ANAPHYLAXIS

8. MECHANISM in ANAPHYLACTOID REACTION
COMPLEMENT FIXATION:
release of anaphylatoxins (C3a, C5a) e.g. incompactible transfusions, radioconstrast media.
KININ PRODUCTION:
ACE inhibitors.
DIRECT RELEASE:
HISTAMINE RELEASE: opioids, haemaccel
ARACHIDONIC METABOLISM: aspirin, nsaids

9. MEDIATORS
A VARIETY OF CHEMOTACTIC, VASOACTIVE AND SPASMOGENIC COMPOUNDS MEDIATE THE ANAPHYLACTIC REACTION.
IMMEDIATE (5-30 mins): histamines, leukotrienes
Intense reaction characterised by oedema, mucus secretion, and smooth muscle spasm.
LATE (2-8 hours): leukotrienes, PAF, TNF-, cytokines
Recruit other inflammatory cells and release additional waves of mediators that cause injury

10. Ewan P.W. Anaphylaxis. BMJ May 1998; 7142: 1442-45
EFFECTS
Ewan P.W. Anaphylaxis. BMJ May 1998; 7142:

11. DIFFERENTIAL DIAGNOSIS
Facial swelling or oedema
Bronchial asthma, pulmonary oedema, chemical irritant exposure, FB airway obstruction and tension pneumothorax
Vasovagal reaction
CASE PRESENTATION
19 yo F
8 weeks pregnant presenting with hypotension
Quick history and examination were diagnostic

12. LABORATORY TESTING NO SPECIFIC IMMEDIATE DIAGNOSTIC LAB TEST
NO REPLACEMENT FOR A BRIEF BUT SUCCINCT HISTORY
FBC, GLUCOSE, ELECTROLYTES, LFTs, CXR, ECG, ABG
MAST CELL TRYPTASE ASSAY
highly sensitive indicator of anaphylaxis
serum levels parallel histamine (half-life of mins.)
peaks in an hour following the reaction
elevated for 4 hours (half-life of 2 hours)
used more in postmortem diagnosis of anaphylaxis
$ per test

13. TREATMENT FIRST-LINE SECOND-LINE O xygen
Adrenaline (Dose: ml im 1:1000 q5-10min)
-adrenergic
1-adrenergic
2-adrenergic
cAMP
Fluids
colloids or crystalloids
SECOND-LINE
Anti-histamines(H1 and H2)
promethazine
ranitidine
Steroids
hydrocortisone
Glucagon (in patients on -blockers)
Nebulised salbutamol and other bronchodilators

14. Combined H1 and H2 receptor blocker use
TREATMENT
Combined H1 and H2 receptor blocker use
“Consensus regarding the use of antihistamines in acute anaphylaxis now favours a combination of an H1 and H2 receptor blocker”
“Acute urticaria should now be given H1 receptor blocker together with H2 receptor blocker”
(Brown AFT 1998 Therapeutic controversies in the management of acute anaphylaxis. Journal of Accident and Emergency Medicine 15: 89-95)

15. DISCHARGE BIPHASIC ANAPHYLAXIS (5%) DISCHARGE MEDICATION (3days)
prednisone 40mg daily
ranitidine 150mg Bd
loratidine 10mg daily
INSTRUCTIONS TO RETURN
PROTECT AGAINST FURTHER ATTACKS / EDUCATE
REFERAL TO AN ALLERGIST

16. ESSENTIALS DIAGNOSIS IS ENTIRELY CLINICAL
NEVER UNDERESTIMATE THE POTENTIAL FOR DETERIORATION
PARENTAL ADRENALINE IS SAFE AND EFFECTIVE
6-8 HOUR OBSERVATION IN PATIENTS RECEIVING ADRENALINE
CAREFUL DISCHARGE PLANNING