1. Anaphylaxis Dr. Stella Yiu Emergency Physician, TOH

2. LMCC Objectives History and Physical of allergic reaction pts Determine urticaria with systemic diseases Investigations to identify allergens Manage urticaria and anaphylaxis in ED

3. 1. History and Physical

4. CDMQ: What can cause allergic reactions? (5)

5. Urticaria: triggers Photo credit: ambert, cwulmer, Norm & Debra, FlickR creative commons

6. Drugs Food allergens Insects Physical stressors (cold, exercise) Respiratory allergy (Pollen)

9. What systems are involved?

10. Photo credit: kiwinky, Flickr commons Blood vessels

11. Lungs

12. GI tract

13. © anaphylaxisweb Soft tissues

14. 50% has angioedema (lips/face/upper airway)

15. If airway/tongue -> potential airway obstruction

16. Investigations for allergic reaction/anaphylaxis No Labs Maybe skin testing later

17. 2. Acute/chronic + systemic illness

18. Urticaria Photo credit: kiwinky, Flickr commons

19. Systemic illness -> urticaria Serum sickness Transfusion reactions Viral/bacterial infections Vasculitis

20. Systemic illness: serum sickness Photo credit: mrmason.ca

21. Systemic illness: serum sickness Photo credit: mrmason.ca Fever, rash, arthralgia

22. Systemic illness: transfusion reactions

25. Photo credit: Dermatolog Information System Systemic urticaria: Viral/Bacterial infection

26. Systemic urticaria: Vasculitis Associated with SLE, Sjogren, Leukemia Drugs Systemic unwell: Arthralgia, fever, abdo pain, lymphadenopathy Photo credit: Dermatology image atlas

27. Definition of anaphylaxis

28. MCQ 5: Who does not have anaphylaxis? A.Ate peanut butter. Swollen lips and wheezing. VS normal. B.Shrimp fest at Red Lobsters. Vomiting and tight throat. VS normal. C.Stung by bee. Low BP. D.Flu shot. Hives. VS normal. E.Hay fever, swollen throat, low BP.

29. Anaphylaxis Definition > 2 systems: CVS (  BP), airway, GI, skin  BP

30. 3. Manage anaphylaxis

31. CDMQ: Management steps of patient: swollen tongue, hives, BP 80/50, O 2 85% (6)

32. Airway (2): Epinephrine 0.3cc 1:1000 im Intubate if needed (what indications)

33. Bronchodilators Epinephrine

34. Fluids (+ epi)

35. Iv fluid 1-2 L bolus (1) Drugs (3) Antihistamines (H1- Benadryl, H2- Ranitidine) Steroids: Prednisone or Solu-Medrol

36. Antihistamines H1: Benadryl (Diphenhydramine) H2: Ranitidine

37. Discharge instructions Allergy testing outpatient Carry Epi-Pen at all times Photo credit: gregfriese, flickr creative commons

38. Discharge meds Steroid -  2 nd phase reaction (6-72 hours) - Prednisone po Continue Antihistamines

39. LMCC Objectives History and Physical of allergic reaction pts Determine urticaria with systemic diseases Investigations to identify allergens Manage urticaria and anaphylaxis in ED