1. Anaphylaxis and Syncope
Communicable Disease Control – Population, Public and Indigenous Health
Anaphylaxis and Syncope
September 3, 2019

2. Communicable Disease Control – Population, Public and Indigenous Health
Anaphylaxis
Anaphylaxis is a potentially life-threatening allergic reaction
Very rare (about 1 per 1,000,000 doses) but even so, it should be anticipated with every client
Pre-immunization screening can prevent episodes – ask questions about possible allergy to the vaccine or any vaccine component
Every immunizer should be familiar with the symptoms of anaphylaxis and be ready to initiate appropriate interventions
Most instances begin within 15 minutes after immunization
All clients are encouraged to wait for 15 minutes after immunization
For clients with any known anaphylactic allergies, extend this recommended wait period to 30 minutes
Have clients remain within a short distance and return immediately for assessment if they feel unwell

3. Anaphylaxis recognition & treatment
Communicable Disease Control – Population, Public and Indigenous Health
Anaphylaxis recognition & treatment
The immunizer must:
be able to identify allergic reactions and anaphylaxis, and know how to respond appropriately
be able to distinguish between fainting, breath-holding spells, anxiety, and anaphylaxis
always have an up-to-date anaphylaxis kit readily available when immunizing

4. Histamines – do what?? They cause:
Communicable Disease Control – Population, Public and Indigenous Health
Histamines – do what??
They cause:
- Capillary permeability and therefore the escape of plasma into the tissues
- Widespread dilatation of arterioles and capillaries (vasodilation)
- Bronchial smooth muscle contraction
- Over secretion by mucous glands
Histamines are mediators of hypersensitivity reactions including anaphylaxis.

5. … which is why we see these symptoms…
Communicable Disease Control – Population, Public and Indigenous Health
… which is why we see these symptoms…
Respiratory:
dyspnea - wheezing - sneezing
choking - drooling
cyanosis – angioedema - tightness
in throat/chest
Dermatologic (skin):
urticaria - erythema - pruritus
flushing - pale/grey - facial swelling
tingling of mouth or face followed by a feeling of warmth

6. ... and these symptoms... Vascular Collapse (cardiovascular)
Communicable Disease Control – Population, Public and Indigenous Health
... and these symptoms...
Vascular Collapse (cardiovascular)
rapidly falling blood pressure
sweating
rapid, thready pulse
a feeling of uneasiness, restlessness or anxiety
weakness or dizziness
throbbing in the ears or a headache
Gastrointestinal:
nausea, vomiting
diarrhea
abdominal cramps

7. Anaphylactic shock intervention
Communicable Disease Control – Population, Public and Indigenous Health
Anaphylactic shock intervention
The Initial Response …
Call for help
Lie the client on his/her back with feet elevated, if possible
Loosen restrictive clothing around the neck
Establish an adequate airway
Note the time

8. What would you do? Would you give this child epinephrine?
Communicable Disease Control – Population, Public and Indigenous Health
What would you do?
Would you give this child epinephrine?
Why or why not?
If in doubt, give!

9. Prompt administration of epinephrine is essential
Communicable Disease Control – Population, Public and Indigenous Health
Prompt administration of epinephrine is essential
Refer to your local Anaphylaxis Management Guideline and information in your anaphylaxis kit for direction on how to proceed with administration of epiNEPHrine and diphenhydramine hydrochloride (e.g., Benadryl®)
Remember:
Failure to administer epiNEPHrine promptly is more dangerous than administering it in a situation where anaphylaxis is not truly present!

10. Syncope post immunization
Communicable Disease Control – Population, Public and Indigenous Health
Syncope post immunization
Fainting is also known as syncope or vasovagal syncope
Vasovagal syncope is triggered by a stimulus (anxiety) that causes an exaggerated response in the part of the nervous system that regulates involuntary body functions (like heart rate and blood flow)
When a stimulus triggers an exaggerated response, both heart rate and blood pressure drop, quickly reducing blood flow to the brain and leading to loss of consciousness

11. Syncope post immunization
Communicable Disease Control – Population, Public and Indigenous Health
Syncope post immunization
In about 25% of cases, reduced blood flow can result in jerking movements that resemble seizures
These movements are more common when fainting occurs soon after immunization, and disappear when consciousness is regained
Clients fainting due to vasovagal syncope recover quickly, usually within seconds or a few minutes

12. Signs and symptoms of syncope
Communicable Disease Control – Population, Public and Indigenous Health
Signs and symptoms of syncope
Musculoskeletal
muscles relaxed
weakness
incontinence (rare)
clonic jerks of limbs and face
Respiratory
normal or yawning
Dermatologic
pallor/grey color - sweating

13. Signs and symptoms of syncope (cont’d)
Communicable Disease Control – Population, Public and Indigenous Health
Signs and symptoms of syncope (cont’d)
Gastrointestinal
vomiting
nausea
Cardiovascular
hypotension, slow weak pulse
ringing in ears
Neurological
light headedness, dizziness
spots before the eyes
dazed
unconsciousness

14. Communicable Disease Control – Population, Public and Indigenous Health
Facts about syncope
There is a clear incidence peak in age 10 to 19 years, with a smaller peak at age 4-6 years
- After the age of 20 years, the incidence decreases with age
57.5% of syncopal episodes occur in females
The incidence of fainting is under-reported
Most cases occur within 5 minutes of immunization
Fainting can result in head trauma if a client falls
The goal is to prevent falls!

15. Tips to prevent syncope
Communicable Disease Control – Population, Public and Indigenous Health
Tips to prevent syncope
Administer vaccine while client is seated
Maintain a calm and confident demeanor
Observe anxious client until anxiety has resolved after immunization
Have clients with a history of fainting lie down prior to administering vaccine
Clients with pre-syncopal symptoms (such as dizziness, anxiety, pallor, perspiration, trembling, or cool, clammy skin) should sit or lie down until symptoms resolve

16. Assisting clients after syncope
Communicable Disease Control – Population, Public and Indigenous Health
Assisting clients after syncope
Assist the client to lay down with feet elevated
Ensure the client’s airway is open (ABCs)
Monitor for signs of allergic reaction
Call for assistance if needed
Cover the client with a blanket for warmth if available
Wipe the client’s forehead with a damp cool cloth
May offer fluids
Have the client resume a standing position in stages (sit, stand, walk)
Observe the client until the symptoms have resolved

17. Anxiety spells Signs and Symptoms - Fearful - Pale - Diaphoretic
Communicable Disease Control – Population, Public and Indigenous Health
Anxiety spells
Signs and Symptoms
- Fearful
- Pale
- Diaphoretic
- Complains of light headedness, dizziness, numbness, and tingling of
face and extremities
- Hyperventilation
Treatment
- Reassurance
- Instruct to relax and breathe slowly

18. Breath holding Occurs in young children when upset Signs and symptoms:
Communicable Disease Control – Population, Public and Indigenous Health
Breath holding
Occurs in young children when upset
Signs and symptoms:
- Suddenly become quiet but still very agitated
- Facial flushing & perioral cyanosis
- Often ends with resumption of crying, or a brief period of
unconsciousness during which time breathing resumes
Treatment
- Reassurance

19. Anaphylaxis and Syncope Knowledge Check
Communicable Disease Control – Population, Public and Indigenous Health
Anaphylaxis and Syncope Knowledge Check
Review Questions
1. What is the incidence of anaphylaxis after immunization?
2. Should you withhold epiNEPHrine if you are not completely sure whether the client is experiencing anaphylaxis?
3. What is the percentage of people who experience jerking movements that resemble seizures after fainting?
Note: Answers can be found at the end of the power point.

20. Communicable Disease Control – Population, Public and Indigenous Health
Answer Key
Anaphylaxis & Syncope Knowledge Check Answers
1. What is the incidence of anaphylaxis after immunization?
Although anaphylaxis is very rare with an incidence of about 1 per 1,000,000 doses, it should be anticipated with every client.
2. Should you withhold epinephrine if you are not completely sure whether the client is experiencing anaphylaxis, but you are pretty certain?
No. Prompt administration of epinephrine is essential.
Refer to your local Anaphylaxis Guideline and information in your anaphylaxis kit for direction on how to proceed with administration of epinephrine and diphenhydramine hydrochloride (e.g., Benadryl®).
Failure to administer epinephrine promptly is more dangerous than administering it in a situation where anaphylaxis is not truly present!
3. What is the percentage of people who experience jerking movements that resemble seizures after fainting?
In about 25% of cases, reduced blood flow can result in jerking movements that resemble seizures. These movements are more common when fainting occurs soon after immunization and disappear when consciousness is regained.