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Anaphylaxis and angioedema

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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


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