Anaphylaxis - Clinical Features,Management,Causes

4th Pediatric Infectious Diseases Conference

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Anaphylaxis

Allergic Disorders

Asthma

Anaphylaxis

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ANAPHYLAXIS

Dr. Swati Gadewar (Kolpuru)
DCH

Anaphylaxis is a life-threatening immediate hypersensitivity reaction. It is an acute multisystem allergic reaction that follows an exposure to a foreign substance.

CLINICAL FEATURES OF ANAPHYLAXIS

Premonitory symptoms:

Pruritus of the palms and soles

Generalized warmth

Tingling of lips and tongue

Lump in the throat

Tightness in the chest

Feeling of impending doom

Cutaneous manifestations:

Urticaria

Angioedema

Gastrointestinal manifestations:

Vomiting

Diarrhea

Abdominal cramping

Respiratory manifestations:

Laryngeal edema

Bronchospasm

Angioedema of tongue, uvula and lips

Cough

Wheezing

Cardiac manifestations:

Ventricular arrhythmias

Myocardial infarction

Hypotension

Neurological manifestations:

Disorientation

Coma

Seizures

MANAGEMENT OF ANAPHYLAXIS

First the basic principle, take care of airway, breathing and circulation

Provide 100% oxygen

Endotracheal intubation if there is complete airway obstruction

Epinephrine: 0.01 ml/kg (1:1000 dilution) subcutaneously to a maximum of 0.5 ml. Repeat at 10 to 20 minute interval. If no response administer epinephrine intravenously as a 1:10,000 solution at a rate of 0.1 ml/kg over 1-2 minutes.

Fluid bolus 20ml/kg if there is hypotension. Repeat if necessary

H1-receptor antihistamines such as diphenhydramine, 0.5-1.5 mg/ kg or hydroxyzine 0.5-1 mg/kg should be given either IV, IM or by mouth

H2- receptor antihistamines such as cimetidine can be given in refractory cases.

Hydrocortisone 8-9mg/kg or methylprednisolone, 2-3mg/kg should be given at 4-6 hour intervals.

Albuterol, aminophylline or other inhaled beta agonists are useful in the treatment of bronchospasm refractory to epinephrine.

In stings and drug injections, tying a tourniquet proximal to the site may slow further absorption.

Admit the patient if there is airway obstruction, shock or respiratory distress.

COMMON CAUSES OF ANAPHYLAXIS

A careful history should be taken to find the cause so that further precautions can be taken to prevent another attack.

Insect sting and bites

Drugs: Antibiotics, local anesthetics, radiocontrast media

Foods: Peanuts, fish, egg

Blood products

Latex

Last created on 23-02-2001
Last updated on 01-07-2006

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