QuestionSBA
QuestionChoice
This is the dose that should be given in anaphylaxis in adults or children >12 years old
32149
b
IM Adrenaline (1:1000) 500 micrograms
QuestionChoice
This may be considered in cases of anaphylaxis with severe or persistent bronchospasm. However, adrenaline takes priority in this situation
32151
d
Salbutamol nebulisers
QuestionChoice
This is the dose that should be given in a cardiac arrest as part of the paediatric advanced life support algorithm
32150
c
IV Adrenaline (1:10,000) 10 micrograms per kg
QuestionChoice
This may be given if the patient has hypotension due to anaphylactic shock. However, adrenaline takes priority in this situation
32152
e
IV Hartmann's bolus 10ml/kg
QuestionChoice
The patient has developed anaphylaxis, most likely to amoxicillin. Warning signs in this scenario include stridor, wheeze, hypotension and desaturation. The single most important medication to administer is adrenaline, which should be done as soon as possible. This is the dose that should be given in children 6-12 years old. IV adrenaline for anaphylaxis should only be given by experienced specialists in an appropriate setting
32148
a
IM Adrenaline (1:1000) 300 micrograms
QuestionComment
i forgot its a child
38457
User
subscriber
NICU Serotonin
Concept
Chapter
# Summary
 

Anaphylaxis is an acute, life-threatening allergic reaction characterised by multi-system involvement, typically involving the skin, respiratory, cardiovascular, and gastrointestinal systems. Triggered primarily by allergens such as certain foods, medications, and insect stings, anaphylaxis requires immediate management with adrenaline and patient monitoring for any rebound symptoms. Investigations commonly involve the measurement of serum mast cell tryptase levels. Upon discharge, patients newly diagnosed with anaphylaxis should be provided with two adrenaline auto-injectors and proper counselling on how to use them.
 

# Definition
 

Anaphylaxis is an acute and severe type 1 hypersensitivity reaction. It is a systemic, potentially life-threatening condition that involves multiple organ systems due to the release of mediators from mast cells and basophils.
 

# Epidemiology
 

Anaphylaxis is relatively uncommon, affecting 1-3 per 10,000 annually. Its incidence appears to be rising, particularly in Western countries. It affects people of all ages and both sexes, though certain groups, such as those with a history of asthma or atopy, are at higher risk.
 

# Aetiology
 
As a type 1 hypersensitivity reaction, an allergen reacts with specific IgE antibodies causing a rapid release of histamine and other vasoactive substances. This increases capillary permeability, causing oedema and shock. 

Common triggers of anaphylaxis include:
 

 -  Animals: Insect stings, animal dander
 -  Foods: Nuts, peanuts, shellfish, fish, eggs, milk
 -  Medications: Antibiotics, IV contrast media, NSAIDs
 

# Signs and Symptoms
 

The clinical manifestations of anaphylaxis can vary greatly but are best assessed following the ABCDE approach. 
 

 -  **A**irway: Hoarse voice, lip swelling, stridor indicative of upper airway obstruction and laryngeal oedema 
 -  **B**reathing: Wheezing, shortness of breath, fatigue, SpO2 < 94%
 -  **C**irculation: Tachycardia, hypotension/shock, angioedema, confusion
 -  **D**isability: Confusion
 -  **E**verything else: 
       -  Gastrointestinal: Abdominal pain, diarrhoea, vomiting
       -  Urticaria 
 

 [lightgallery]
 

# Differential Diagnosis
 

The differential diagnoses for anaphylaxis may include:
 
 -**Anaphylactoid Reaction**: These are similar reactions which cause similar mast cell activation but are not due to IgE. 
 -  **Vasovagal reaction**: Characterised by hypotension, bradycardia, pallor, diaphoresis, and nausea.
 -  **Panic attack**: Shortness of breath, tachycardia, sweating, tremors, and feeling of impending doom, but lacks skin involvement.
 -  **Asthma exacerbation**: Primarily respiratory symptoms such as wheezing, cough, and breathlessness, without systemic involvement.
 -  **Carcinoid syndrome**: Flushing, diarrhoea, abdominal pain, and wheezing due to serotonin release but generally has a more chronic course.
 

# Investigations
 

The primary investigation in anaphylaxis is the measurement of serum levels of mast cell tryptase, which rises within an hour of onset and can confirm the diagnosis. **However, this should not delay management**
 
During the A to E assessment, investigations may include:

- Pulse oximetry to detect hypoxia
- Bloods to include:
	- Mast cell tryptase: These levels peak 1 hour following anaphylaxis, but remain elevated for up to 6 hours.  In children, mast cell tryptase is only indicated if the trigger is believed to be idiopathic or related to venom or drugs. 


# Management
 

Prompt management of anaphylaxis is crucial and includes:
 

 -  Immediate administration of adrenaline (1:1000, IM):
     -  Child > 12 years: 500 micrograms IM (0.5 mL)
     -  Child 6-12 years: 300 micrograms IM (0.3 mL)
     -  Child 6 months - 6 years: 150 micrograms IM (0.15 mL)
     -  Child < 6 months: 100-150 micrograms IM (0.1-0.15 mL) 
 -  Removing the trigger if possible
 -  Early call for help
 -  Placing the patient in a supine position and raising their legs
 -  Managing the airway and administering high-flow oxygen when skills and equipment are available
 -  Administering IV fluids (10 mL/kg bolus) if patient 
 -  Attaching the patient to monitoring equipment
 -  If no response 5 minutes after IM adrenaline: 
 	- Repeat adrenaline 
   - If no improvement despite 2 doses of IM adrenaline 
   - Follow refractory anaphylaxis guidelines
 

Post-crisis, patients should be monitored for 6-12 hours after the initial presentation in case of a rebound episode. Children are admitted to hospital under the care of the paediatric medical team. Upon discharge, newly diagnosed patients (and their carers) should receive:
 

 -  Counselling on the use of adrenaline auto-injectors
 -  A supply of two auto-injectors
 -  Written advice
 -  A referral to the local allergy service for follow-up
 
# References
 

[UK Resuscitation Council Guidelines](https://www.resus.org.uk/sites/default/files/2020-06/EmergencyTreatmentOfAnaphylacticReactions%20%281%29.pdf)

 [A simple summary of managing anaphylaxis in all groups](https://www.resus.org.uk/EasySiteWeb/GatewayLink.aspx??alId=793)
 
 [RCPCH Anaphylaxis Care Pathway](https://www.rcpch.ac.uk/resources/allergy-care-pathway-anaphylaxis)
 
 [Patient Info Anaphylaxis and its treatment](https://patient.info/doctor/anaphylaxis-and-its-treatment)
1986
Picture
Angioedema seen in someone with anaphylaxis.
970
Angioedema.jpeg
images/4nkhcpjm1665036171692.jpg
images/4nkhcpjm1665036171692_256.jpg
images/4nkhcpjm1665036171692_512.jpg
XlkOFQQHZ3Z4F5hoiHV5dxaOcJAI
441
Anaphylaxis (Paediatrics)
Topic
29
Paediatrics
6430
In children aged 6-12 years old, the recommended dose of intramuscular (IM) adrenaline (1:1000) for anaphylaxis is 300 micrograms (0.3 mg). This dose can be repeated every 5-15 minutes if necessary, depending on the severity of the reaction and clinical response.
A 10-year-old boy collapses in the Emergency Department after being administered a dose of amoxicillin for otitis media. He has no other past medical history of note.

He develops a sudden onset wheeze and shortness of breath.

Observations:

- Temperature 37.5°C
- pulse 150
- BP 80/60
- SpO<sub>2</sub> 88% room air

What is the next most important medication to administer?
a