Some Points to Consider in the Case of Anaphylaxis

Anaphylaxis

In 2017, the Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium recommended the following definition: “Anaphylaxis is a serious allergic reaction that is rapid in onset and may cause death.”
The Signs and Symptoms may include the following:

Dyspnea (bronchospasm or upper airway swelling). Difficulty in breathing can be accompanied with coughing and wheezing. If untreated, the condition may lead to obstructed airway as the lips, tongue, throat and larynx swell.

  • Urticaria, and Pruritus,
  • Angioedema also leads to obstructed airway
  • Flushing
  • Gastrointestinal symptoms (e.g., nausea, vomiting, diarrhea)
  • Hypotension, Dizziness, and even Syncope
  • Weakness, nausea, vomiting or stomach cramps

The person can go into shock.

There is Risk for Misdiagnosis

Many symptoms of anaphylaxis suggest other diseases and conditions. Cutaneous manifestations of anaphylaxis (e.g., itching, urticaria, angioedema) suggest an allergic reaction, but gastrointestinal symptoms or cardiopulmonary collapse may cause diagnostic confusion. Some other conditions to rule out include the following:

  1. Acute anxiety (e.g., panic attack)
  2. Myocardial dysfunction
  3. Pulmonary embolism
  4. Acute poisoning
  5. Hypoglycemia

Treatment

  • Call 9-1-1 as soon as any emergency situation is observed
  • Assess and maintain an airway, breathing, circulation and level of consciousness. Altered mental state could suggest hypoxia.
  • Epinephrine injection is the treatment of choice for anaphylaxis.

Depending on the patient’s response to epinephrine, the physician may need to do the following:

  • Place the patient supine with the legs elevated to slow the progression of hemodynamic compromise.
  • Establish and maintain an airway (e.g., using a one-way valve face mask with an oxygen inlet port).
  • Provide oxygen to a patient who has a prolonged anaphylactic reaction.
  • Benadryl may need to be given to reduce the allergic reaction
  • Albuterol may be needed to bring the bronchospasm under control

Prevention and Future Plan for Emergency

Avoid the allergens or triggering factors like:

  1. Foods (e.g., peanuts, eggs, shellfish, etc.),
  2. Medications like Penicillin, NSAIDs;
  3. Radiographic Contrast Media,
  4. Latex products.

Try to minimize the risk of getting stung by insects

Keep SELF-INJECTABLE EPINEPHRINE handy:

If a diagnosis of anaphylaxis is confirmed, or if idiopathic anaphylaxis is diagnosed, self-injectable epinephrine (Epipen, Epipen Jr., Twinject) can be prescribed. Patients for whom self-injectable epinephrine may be prescribed include the following:

  1. Patients who have experienced anaphylaxis and may re-encounter the trigger allergen outside of a medical setting.
  2. Patients who lack access to emergency care.
  3. insect sting.
  4. Patients who have a clinical history of symptoms after eating peanut and/or evidence of a positive food challenge to peanut.

The physician and the patient should draw up a personalized emergency action plan that lists potential anaphylaxis symptoms, gives instructions on how and when to use self-injectable epinephrine, and emphasizes the necessity of going to an emergency care facility after an epinephrine injection. A copy of this emergency action plan should be given to someone at the patient’s place of work, or, for a child, to the school nurse and other people in authority at the school. The patient’s action plan should be reviewed on a regular basis. Also, instruct the patient to wear or carry identification that denotes his or her condition.