1. Anaphylaxis Dr. Stella Yiu Emergency Physician, TOH

2. LMCC Objectives Acute/Chronic/Systemic illness Allergic reaction: Severity, cause Investigations Manage patient with urticaria and anaphylaxis

3. URTICARIA Photo credit: kiwinky, Flickr commons

4. 50% has angioedema (lips/face/upper airway) If airway/tongue -> potential airway obstruction

5. © anaphylaxisweb

7. ACUTE/CHRONIC SYSTEMIC ILLNESS

8. Types of urticaria 1.Acute: – Self limiting – Onset < 30 minutes 2.Chronic (>6 weeks)

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

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

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

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

13. Systemic illness: transfusion reactions Credit: online nursing CEUS

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

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

16. ALLERGIC REACTION

17. ANTIGEN MEETS CELLS -> IGE

18. © McGraw Hill

23. © anaphylaxisweb Does he have an anaphylaxis reaction?

24. Definition > 2 systems: CVS (  BP), airway, GI, skin Skin + airway/  BP  BP

25. Investigations for allergic reaction/anaphylaxis Acute urticaria/allergic reaction: None Chronic: Maybe CBC with ESR After reaction: Skin tests with allergist

26. MANAGEMENT

27. © McGraw Hill Antihistamines H1: Benadryl (Diphenhydramine) H2: Ranitidine

28. © McGraw Hill Fluids

29. © McGraw Hill Bronchodilators Epinephrine

30. Management Airway Breathing Circulation Drugs

31. Management Airway Breathing Circulation Drugs Epinephrine Intubate Bronchodilators Fluids, epinephrine iv Ranitidine Diphenhydramine

32. Discharge meds Steroid -  2 nd phase reaction (6-72 hours) - Prednisone po or solumedrol iv Continue Antihistamines

33. Discharge instructions Allergy testing outpatient Patient to carry Epi-Pen at all times Photo credit: gregfriese, flickr creative commons

34. Management: Angioedema ACE inhibitor Consider C1 esterase inhibitor concentrate or FFP

35. LMCC Objectives Acute/Chronic/Systemic illness Allergic reaction: Severity, cause Investigations Manage patient with urticaria and anaphylaxis