Anaphylaxis

• Result of widespread response to antigen
  • Massive release of histamine and other substances from mast cells and basophils
• Triggers:
  • Food (nuts and shellfish), Latex, (B-lactams), Stings
    • Short term Foleys have latex
• Widespread IgE-mediated response to an allergen
  • Type 1 Hypersensitivity
  • Typically occurs in individuals with previous or repeated exposure
• Rapid-onset hypersensitivity reaction that is characterized by respiratory compromise (Wheezing, stridor, bronchospasm), rash (urticarial rash, flushing, hives, pruritus, erythema, wheals) and decreased blood pressure (systemic vasodilation)
  • +/- Oropharyngeal and laryngeal edema
  • Vasodilation (Hypotension and tissue edema), tachycardia
  • Upper airway edema (stridor/hoarseness), bronchospasm (wheezing)
    • Rhinoconjunctivitis, poor organ perfusion, dyspnea
  • Nausea, Vomiting, Abdominal pain
• Life threatening: Airway obstruction due to circulatory collapse (shock)
  • Severe dyspnea, labored breathing, tachypnea
    • Intubate
• Treatment
  • 1) IM Epinephrine
    • Prevents hypotension, upper airway edema
    • IV Epinephrine if no response
      • Higher risk of cardiac arrhythmia thus 2nd line
  • 2) Respiratory Support (airway management and resuscitation)
  • 3) IV Fluids
  • +/- Antihistamines, glucocorticoids