1. Allergies and Anaphylaxis
Chapter 14
Allergies and Anaphylaxis 1

2. Objectives 14.1 Define the following terms:
allergy
allergic reaction
anaphylaxis
antigen
hypersensitivity
14.2 List four routes by which an antigen may enter the body.
14.3 List four potential allergy sources.
continued 2

3. Objectives
14.4 List the signs and symptoms of an anaphylactic reaction.
14.5 Describe and demonstrate the steps for properly using portable epinephrine auto-injectors. 3

4. Topics Anatomy and Physiology
Common Causes of Allergies and Anaphylaxis
Assessment
Management
Chapter Summary 4

5. Case Presentation
A hiker complains of shortness of breath and that her tongue feels “fat” after photographing some wild flowers 15 minutes ago. She denies any medical problems but states, “I am deathly allergic to bees!” Although she does not believe she was stung, you notice a few honeybees buzzing around a stump a few feet away.
Discussion Points:
What should you do?
This is an excellent example of the importance of using thorough assessment protocols, especially SAMPLE.
Discuss some potential distractions from the key complaint such as wild flowers and the fact that the hiker has no known medical problems. 5

6. Anatomy and Physiology
Immune system: Protects the body from foreign substances, or antigens, by developing antibodies.
Primary components: Mast cells, white blood cells, hormones, bone marrow, thymus, and spleen.
Discussion Points:
Content should be a review anatomy and physiology discussed earlier, but with more detail.
Include a description of the lymphatic system to help students understand the allergic process.
continued 6

7. Anatomy and Physiology
Antibody-antigen reaction: Mast cells attack the offending antigen, which causes a reaction that destroys it without harming normal cells.
Allergic reaction: An acquired, abnormal over-reaction by the immune system to an otherwise harmless substance that results in a hypersensitivity.
Discussion Point:
Emphasize that antibody-antigen reaction is normal and unnoticeable and the allergic reaction is not as signs and symptoms will occur. 7

8. Common Causes of Allergies and Anaphylaxis
Foods , especially peanuts and shellfish
Environmental irritants
Pollen
Molds
Discussion Points:
This list includes the main categories of allergens.
Discuss examples within each list, and highlight those that might most likely occur within the context of patrol work.
continued 8

9. Common Causes of Allergies and Anaphylaxis
Animal dander
Medications
Chemicals
Other such as blood transfusion
Discussion Points:
This list includes the main categories of allergens.
Discuss examples within each list, and highlight those that might most likely occur within the context of patrol work. 9

10. Common Causes of Allergies and Anaphylaxis
• Almost any substance can trigger an allergic reaction and allergies can affect anyone, regardless of age.
• Allergies are one of the most common medical conditions, affecting over 600 million people worldwide. 10

11. Mild Allergic Reaction
Typically results in local dermatologic changes, especially on the face and/or neck. Nasal mucosa and/or congestion are also common.
Symptoms may take minutes, hours, or even days to develop.
Effects usually disappear over time or with treatment.
Discussion Points:
Examples and/or photos of skin changes can be helpful to clarify what a mild allergic reaction looks like.
continued 11

12. Mild Allergic Reaction
Signs and Symptoms
Itching (pruritis)
Flushed skin
Rash or hives (urticaria)
Watery, reddened eyes
Nasal congestion
Increased heart rate
Tingling in/around mouth
Fatigue
Discussion Points:
With a mild reaction, most signs and symptoms resolve without treatment. It’s important for students to understand that the severity of a reaction is an important clue in their assessment process (i.e., not every rash needs treatment). 12

13. Moderate Allergic Reaction
Effects include those in a mild reaction, but more pronounced.
The respiratory and gastrointestinal system are usually involved.
Symptoms may take minutes, hours, or even days to develop.
Discussion Points:
Emphasize the skill of ongoing assessment, which relies on close observation of changes in a patient’s condition.
continued 13

14. Moderate Allergic Reaction
Effects might disappear over time, or increase in severity, depending on individual chemistry and response.
Discussion Points:
The shift from mild to moderate to severe allergic reactions can be subtle or dramatic, slow or fast. Watching the patient carefully is critical.
continued 14

15. Moderate Allergic Reaction
Signs and Symptoms
Anxiety and confusion
Tightness in the throat
Difficulty swallowing and/or breathing
Wheezing
Rash, hives, swelling in face, neck, chest, arms
Discussion Points:
As patients progress through allergic reaction stages, clarify how many body systems this process affects and that we are integrated/”whole” beings.
continued 15

16. Moderate Allergic Reaction
Signs and Symptoms
Persistent itching
Angioedema
Abdominal pain or cramping
Nausea and/or vomiting
Elevated vital signs
Discussion Points:
This generalized reaction can make assessment and treatment decisions challenging, especially for less experienced patrollers. 16

17. Moderate Allergic Reaction
Itching is one of the symptoms of an allergic reaction.
continued 17

18. Severe Allergic Reaction
Causes a massive inflammatory response in the respiratory, integumentary, circulatory, and gastrointestinal systems due to massive histamine release.
Effects are almost immediate- within seconds or minutes.
If not treated quickly, it can lead to anaphylactic shock and/or death.
Discussion Points:
These sudden, severe reactions require a quick and careful response.
It is critical that students thoroughly understand the signs and symptoms, and later, the critical nature of assessment and management.
continued 18

19. Severe Allergic Reaction
Signs and Symptoms
Severe anxiety, impending doom
Decreased level of responsiveness
Severe respiratory distress;
Severe angioedema, hives
Abnormal lung sounds
Inability to swallow
Discussion Point:
Discuss/show how the symptoms indicate a serious emergency.
continued 19

20. Severe Allergic Reaction
Signs and Symptoms
Tachycardia, weak peripheral pulses
Hypotension, pallor, cyanosis
Discussion Point:
Discuss/show how the symptoms indicate a serious emergency. 20

21. Preventing Allergic Reaction
Triple A Approach:
Awareness – of one’s allergies and the triggers
Avoidance – of contact with known allergens
Action – know what to do if an allergic reaction occurs (emergency and self-care)
Discussion Points:
Prevention of allergic reaction is better than treatment; this is simple to remember using the Triple A Approach. 21

22. Case Update
She looks pale and appears to be in mild respiratory distress. Once you determine that the ABCDs are intact, you notify dispatch to send additional personnel with oxygen and an airway kit. You also request that an ALS provider respond. Respirations are 38 per minute and labored. The patient’s face appears swollen.
Discussion Points:
Scene safety issues and actions?
What do her ABCDs and vitals tell you?
What requests do you make for assistance and/or supplies?
Secondary assessment?
What complications should you be looking for?
Students may ask what is most important to address, and when or how to manage it quickly.
Discuss their input and ideas on this before moving ahead to the management section. 22

23. Assessment Moving patient may be necessary before assessment.
Severity of allergic reaction determines timing, esp. if anaphylaxis is present.
Observe closely skin, face, neck, and eyes for rash, swelling, breathing.
Extend questioning during known allergies part of SAMPLE (EpiPen)
Discussion Points:
Observing physical symptoms can raise discussion questions about severity levels and management issues.
What might be some concerns when moving the patient?
How might students determine if anaphylaxis is present? 23

24. Management Initial management is similar- ABCDs.
Try to identify the allergen.
Remove the patient from the allergen if possible.
Monitor and check vitals frequently.
If signs of anaphylaxis appear, treat ABCDs and seek transport and ALS.
Insect bite? Remove stinger if possible.
Discussion Points:
Clarify the mnemonics as you discuss ABCDs.
Could there be concerns about safety when trying to identify the allergen or move the patient?
Students might ask how often to check vitals in this situation. 24

25. Management
One technique for removing a stinger, which prevents further injection of venom. 25

26. Epinephrine Drug of choice for managing severe allergic reaction.
Promotes bronchodilation and vasoconstriction to relieve dyspnea and hypotension.
Comes pre-packed in adult and pediatric doses (“EpiPen”).
Discussion Point:
Discuss how the presence of an EpiPen can become known quickly using good SAMPLE questioning.
continued 26

27. Epinephrine
Those with severe allergies will often have an EpiPen with them.
continued 27

28. Epinephrine
Epinephrine pens: (a) EpiPen auto-injectors for infants/children and adults.

29. Epinephrine
Epinephrine pens: (b) Twinject auto-injectors for infants/children and adults.

30. Case Disposition
Other OEC Techs soon arrive with oxygen and a wheeled litter basket. You place the patient on a nonre-breather mask at 15 LPM. You locate her EpiPen™ and assist her in administering the medication in the lateral side of her thigh. Within a few minutes, she is breathing more easily, and her facial swelling begins to diminish.
Discussion Points:
What crucial question did you ask her? Why?
What care was given to this patient at the scene? Why was this important?
Did her condition change at the scene? If so, how? If not, why not?
How was ALS involved in the process?
Noting the hiker has a serious allergy is key to the successful and rapid management of this case.
Using her EpiPen, (if on her person) would make a difference in how her condition changes at the scene, and in how you decide to involve ALS. 30

31. Chapter Summary
An allergy is the body’s overreaction to a foreign substance.
Allergies are caused by antigens called allergens.
Many people do not know they have an allergy until they suffer
an allergic reaction.
Discussion Point:
What are allergic reactions? Why is it important to know how to recognize and treat them?
What are the major types, signs and symptoms, and sources of allergic reactions? How do they differ?
How do you assess and manage the treatment of a patient experiencing an allergic reaction?
Have the students provide the summary using this slide to guide them.
continued 31

32. Chapter Summary
Tongue swelling is an ominous sign of an allergic reaction.
Anaphylaxis can be fatal unless rapidly treated.
Peanuts are the number one food allergy in the world.
Allergic reactions may be prevented using the Triple A approach.

33. Chapter Summary Triple A Approach:
Awareness – of one’s allergies and the triggers
Avoidance – of contact with known allergens
Action – know what to do if an allergic reaction occurs (emergency and self-care)