Allergy in 10 minutes DETECTIVE WORK Presenting episode Previous episodes Consistent trigger or pattern to episodes Contacts/Foods in previous 4 hours (most begin within 30 minutes) Co-factors - exercise/alcohol/NSAIDS/intercurrent illness Other drugs Atopic medical history - CONCURRENT ASTHMA Assess severity

GRADE Brown et al MILD Skin and subcutaneous tissues only: Generalised erythema, urticaria, periorbital oedema or angioedema 2MODERATE Respiratory, cardiovascular or gastrointestinal symptoms: Dyspnoea, stridor, hoarseness, wheeze Nausea, vomiting Dizziness (presyncope), diaphoresis Chest or throat tightness, abdominal pain 3SEVERE Hypoxia, hypotension or neurological compromise: Cyanosis or SpO 2 ≤92% Systolic blood pressure<90mmHg in adults Confusion, collapse, loss of consciousness GRADING SYSTEM FOR GENERALISED HYPERSENSITIVITY REACTIONS

Management of Anaphylaxis RESCUE KIT: MILD:Anti-histamine high dose INTRAORAL SWELLING: ADD Soluble prednisolone 30mg (0.5mg/kg) SEVERE:ADD Adrenaline auto injector 300mcg over 30kg 150mcg 15-30kg

Anaphylaxis Refer suspected severe anaphylaxis symptoms: Any combination of: Bronchospasm Laryngeal/pharyngeal oedema Hypotension USUALLY with flushing, urticaria, angioedema If blood sample taken: Gold top marked: ‘HOLD- allergens to be advised’

Urticaria & Angioedema Non –allergic cause suggested if: Spontaneous/overnight/early morning Physical triggers Several days duration No consistent relationship with food (ingestion/contact) In Food Allergy: Symptoms usually within 30 minutes of ingestion Delay of more than 2 hours is rare ACE-I with angioedema

Treatment: Urticaria only Check not following NSAID Potent long acting antihistamine Up to 4 x standard dose +/- Montelukast 10mg nocte +/- H2 Blocker Refer if symptoms intolerable despite Rx

Treatment: Angioedema with or without urticaria Rx as for urticaria Check not on ACE-I Isolated angioedema: check C3, C4, C1-inhibitor and electrophoresis If intraoral swelling: Add soluble prednisolone 30mg as stat PRN dose Consider need for adrenaline auto-injector REFER

Hay fever Start 2 weeks prior to earliest symptoms Continue daily treatment throughout season ‘Itchy –Sneezies’:Potent antihistamine up to 2 bd Nasal congestion:Intranasal Steroids up to 2 bd Ocular symptoms:opticrom/optilast Consider montelukast REFER: Rescue steroids/SLIT/IT

Eczema in Adults Adult patients often keen to find a dietary allergic cause Many demonstrate apparent sensitisation Routine blood testing not advised in the absence of symptoms of food allergy Contact eczema: Skin PATCH testing- Dermatology

SUMMARY: When to Refer Insect venom anaphylaxis Symptoms do not respond to treatment/avoidance Confirmed IgE mediated food allergy with asthma Tests are negative but a strong suspicion of allergy Anaphylaxis of uncertain cause Review of condition/for retesting/management