Anaphylaxis
DEFINITIONS
1. Anaphylaxis: A severe, systemic, potentially life-threatening allergic reaction affecting multiple body systems.
INFORMATION
(b) skin: itching or burning, hives, rash, swelling of face or extremities, flushing;
(c) stomach: nausea, abdominal cramps, vomiting, diarrhea;
(d) throat: tightening of throat, hoarseness and/or hacking, repetitive cough;
(e) lung: shortness of breath, wheezing, chest pain/tightness;
2. Systemic allergic reactions may range from mild to life-threatening anaphylactic shock. Individuals with asthma are at higher risk for severe allergic reaction.
3. Causes of anaphylaxis may include, but are not limited to, stinging insects, foods especially peanut and tree nuts, medications, latex and exercise.
4. Anaphylaxis can occur immediately or up to 2 hours after exposure to the allergen. Usually, reactions occur within the first 5-10 minutes after exposure. In some cases, symptoms resolve, then recur or progress up to 6 hours later.
5. The severity of symptoms can change quickly. An asthma inhaler and/or antihistamine cannot relied upon to replace epinephrine as an effective treatment of anaphylaxis
6. All individuals receiving emergency medication for anaphylaxis should be transported immediately to a hospital for observation, even if symptoms appear to have resolved. A second delayed reaction (bi-phasic reaction) may occur.
7. Reactions may also present as joint pain, aching or localized inflammation days after an exposure. These individuals should be referred for medical follow-up.
8. A recent study published in The Journal of Allergy and Clinical Immunology (Jarvinen, Sicherer, Sampson & Nowak-Wegrzyn, 2008) found that 19% of food-induced anaphylactic reactions in children required treatment with more than one dose of epinephrine. Children requiring multiple doses were more likely to have asthma. The amount of food ingested or a delay in initial administration were not risk factors for receiving multiple doses.
9. "There are no contraindications for the use of epinephrine for a life-threatening allergic reaction." (American Academy of Allergy, Asthma and Immunology, 1998). However, a common side effect of epinephrine is an increased heart rate and slight jitteriness.
10. Epinephrine auto-injectors are available in two dosages: (a)patients weighing between 33-66 pounds (14-30 kg)-0.15 mg. auto-injector is recommended; (b) patients weighing over 66 pounds (30 kg)- 0.3 mg. auto-injector is recommended.
11. Two brands of auto-injector are currently available: EpiPen and Twinject. The Twinject auto-injector provides two doses of epinephrine in one device. The EpiPen 2-Pak provides two auto-injector devices. In some cases, a second injection may be ordered.
12. Identifying, controlling and avoiding allergic triggers are essential for patients safety
13. Individuals known to have severe allergic reaction should be encouraged to wear a medical alert tag.