1. Allergies and Anaphylaxis

2. How Many Have Allergies? 1.None 2.A few 3.Will make me sick 4.Can’t breath

3. What are Allergies Overreaction of the immune system? “A definite, vigorous attack aimed, unfortunately, at harmless agents.” Immune system confuses the good guys with the bad guys.

4. Allergic Reaction (Allergic Cascade) Body gets sensitized with initial encounter –IgE coating of mast cells (tissue) and basophils (blood) –Now primed Subsequent exposure starts allergic response (early phase) –Release of chemical mediators –Histamine most important one –Hits H1 receptors --- allergic response in that area –Stronger response later by leukotrienes and prostoglandins Some have “late phase” reaction –4-6 hours later –Increased inflammation

5. Why? People with allergies have 10 times the amount of TH2 cells. Ideally TH1 and TH2 cells should be balanced Over production of IgE “Hygiene Hypothesis”? Partially inherited from parents

7. What People Allergic To? Best I can figure — everything!!!

9. Penicillin, cephalosporin, anesthetics, streptokinase, sulfa drugs, hornet wasp, yellow jacket, honey bee, fire ant, peanuts, tree nuts, fish, shellfish, eggs, milk, soy, wheat, allergy shots, insulin, latex, horse serum (snake antivenoms, old tetanus), ASA, Motrin, Morphine, Robaxin, Norflex, Gamma Globulin, Sulfites, and Unknowns

10. Subjective Symptoms Objective Signs CutaneousSkinPrutitusSkin flushing or erythema Pilor erection Urticaria Eczema Angioedema Oral cavityPruritusEdema Eyes, conjunctivaPruritusPeriorbital edema, redness, tearing GINausea, painVomiting, diarrhea abdominal pain

11. RespiratoryNosePruritusNasal congestion, runny nose, sneezing Larynx, throatPruritus, dryness, tightness Swelling around the larynx and vocal cord, voice hoarseness, stridor, cough LungsShortness of breath, chest pain/tightness Rispiratory distress, cough, wheezing Heart and CardiovascularChest pain/tightness, feeling of faintness, dizziness Syncope, hypotension or shock, dysrhythmia Other“Sense of impending dome” Uterine contractions

15. Allergic reaction to bee stings occurs when a person becomes sensitized to the venom from a previous sting. This reaction is different from the reaction to the poison in the bite of a black widow spider, which injects a potent toxin into the blood. Ordinarily, bee venom is not toxic and will only cause local pain and swelling. The allergic reaction comes when the immune system is oversensitized to the venom and produces antibodies to it. Histamines and other substances are released into the bloodstream, causing blood vessels to dilate and tissues to swell. Severe reactions can lead to anaphylactic shock, a life-threatening series of symptoms including swelling of the throat and difficulty breathing. Persons who develop an allergy to bee stings should carry prescription bee sting kits to counteract the reaction to bee venom.

17. ANAPHYLAXIS What’s the difference? It’s systemic, usually in the blood stream –Injected or ingested More rapid, usually more severe History of asthma compounds symptoms

18. Symptoms Flushed Urticaria (Hives) Facial/Airway swelling Feeling of impending doom Hypovolemia/Shock Death

25. Treatment Epinephrine –Sympathetic agonist –  HR –  Contractile force –Vasoconstrictor –  Bronchospasm –  Capillary permeability

26. Diphenhydramine (Benadryl) –Antihistamine –H 1 and H 2 receptors Treatment

27. Corticosteroids –Solu-Medrol –Decadron –Suppress inflammatory response Treatment

28. IV Fluids –Hypovolemia reversal Vasopressors –Maintain blood pressure Treatment

31. Best Treatment Know your potential Avoidance Preparation Rapid recognition/treatment –Medic Alert –EpiPen Appropriate EMS recognition and care