1. Anaphylaxis and angioedema

2. Anaphylaxis Multisystem disorder
Skin – urticaria, erythromderma
Airway – rhinitis, swelling,
Respiratory – bronchospasm
CVS – hypotension, tachy/brady, arrest
GIT – nausea/vomiting, cramping
Children die from respiratory issues, adults from hypotension
Onset <1 hour after medication, <6 hours after food

3. Treatment Adrenaline, fluids, oxygen Adrenaline:
Adults 0.5mg IM – IM is first line even if an IV is in place
Children 10mcg/kg
Give several IM injections, then consider IV infusion
If bronchospasm or airway oedema concern, consider neb adrenaline 5mg
IV fluids 10-20mL/kg initially, up to 50mL/kg in first 30 minutes

4. Other treatments
Antihistamines: Probably not useful. May worsen hypotension. May be sedating.
Give non-sedating antihistamines for relief of skin symptoms if not systemically unwell
Consider adding ranitidine
Steroids: No great evidence. Usually given. May reduce delayed reactions
Hydrocortisone mg IV or dexamethasone 10mg IV
Vasopressors – give lots of adrenaline first, then consider second agent

5. Time course Uniphasic, protracted or biphasic.
Most people have uniphasic reactions.
4 hours observation safe for vast majority of people
If initially haemodynamically unstable keep in CDU overnight
Small numbers have biphasic reaction up to hours later
If first episode on anaphylaxis patients should receive a script for epipen with education and referral to immunologist

6. Angioedema Swelling of oropharynx, tongue, upper airway
No associated urticaria
No other systemic symptoms.
2 main types – inherited C1 esterase deficiency or ACEI related.
ACEI related – most likely soon after starting but can happen years later. Rate 1/200

7. Angioedema - treatment
Steroids, antihistamines, adrenaline all used but not effective
C1 esterase inhibitor concentrate
Icatibant
We have neither
Can use FFP, but much less effective