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ANAPHYLAXIS

ANAPHYLAXIS. AIM. To provide the background to anaphylactic reactions and to provide you with the opportunity to practice using the epi-pen,anapen and to draw up adrenaline. OBJECTIVES. By the end of the session you will:

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ANAPHYLAXIS

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  1. ANAPHYLAXIS

  2. AIM • To provide the background to anaphylactic reactions and to provide you with the opportunity to practice using the epi-pen,anapen and to draw up adrenaline.

  3. OBJECTIVES • By the end of the session you will: • Be able to describe the causes of anaphylaxis and how to treat the condition • Have had the opportunity to look through the shock box and practice drawing up adrenaline • Have practiced administering the epi-pen,anapen

  4. All healthcare professionals advising on immunisation or administering vaccines must have received specific training in immunisation, including the recognition and treatment of anaphylaxis • (Taken from “Immunisation procedures”, Chapter 4, • Immunisation Against Infectious Disease. 2006 (The Green Book) • This lecture is intended as an overview of anaphylaxis as it relates to immunisation. Specific training in anaphylaxis and resuscitation must be undertaken as per PCT and/or Professional requirements.

  5. DEFINITIONS • An systemic allergic reaction can be mild, moderate or severe but have neither of the potentially life threatening features present >>> may lead to anaphylaxis

  6. DEFINITION • Anaphylaxis is a “severe ,life threatening generalised or systemic hypersensitivity reaction”

  7. Types of adverse event • Local Reactions • Generally more common following live vaccine, but less severe with subsequent doses (Fever, headache, loss of appetite) • Systemic Reactions • More common with non-live vaccines containing adjuvants (Pain, redness, swelling at injection site) • Allergic Reaction • Anaphylaxis/Severe systemic allergic reaction

  8. DEFINITIONS • Anaphylaxis occurs when the sensitising antigen reaches the circulation and stimulates the bodies immune system to form antibodies. Histamine is released in this process causing anaphylaxis

  9. Characterised by • Rapid developing life threatening airway and or breathing and or circulation problems usually associated with skin and mucosal changes.

  10. ANAPHYLAXIS • What are the causes of anaphylactic reactions?

  11. CAUSES • Food 13 • Bee, wasp stings and sea creature 47 • Drugs • Latex rubber 3 • Blood/blood products • Exercise (mechanism unknown) • List is not exhaustive • Links with spina-bifida and hydrocephalus

  12. FOODS • Peanuts 32 • Tree nuts (e.g. brazil, hazelnut, almond) • Fish, shellfish • Eggs • Milk • Soy • Wheat • Some fruit

  13. DRUGS • Antibiotics 27 • Local anesthetics 39 • Aspirin • Non-steroidal anti-inflammatory drugs • Narcotic analgesics • Vaccines • Desensitization agents • Contrast media 11

  14. Latex • In 40,000 commonly used items – rubber bands, elastic in underwear, hospital and dental equipment

  15. Reactions • Reactions are more common and are likely to be more severe when drugs are given by injection. Reactions may occur at the first exposure but are more likely to occur following the 2nd or 3rd dose.

  16. Time scales • Reactions can occur up to 72 hours after exposure to the allergen

  17. stats • One in a million for immunization • 1 in 1,333 have experienced anaphylaxis at some point in their lives • 20 deaths per year in the UK attributed to anaphylaxis • Risk of death increases in pre existing asthma

  18. Time • Death usually occurs very quickly after exposure • Food 30-35 mins • Stings 10-15 mins • IV medication 5 mins • Deaths are very rare after 6 hours

  19. ABCDE • ABCDE approach to a sick patient

  20. COMMON SIGNS AND SYMPTOMS • Sense of uneasiness/impending doom • Skin – flushing, pruritis (an unpleasant sensation leading to itching), urticaria (weals), oedema (localized or general swelling) • Upper resp. tract – rhinitis (inflammation of the mucus membrane) , congestion

  21. COMMON SIGNS AND SYMPTOMS • Lower resp. tract - bronchospasm ( sudden temporary constriction of the bronchial tubes) , throat or chest tightness, hoarseness, wheezing, shortness of breath, cough.

  22. COMMON SIGNS AND SYMPTOMS • GI tract – oral pruritis (an unpleasant sensation leading to itching), cramps, nausea vomiting, diarrhoea • Cardiovascular system – tachycardia (very rapid heart action), bradycardia (slow heart rate), hypotension (lowered blood pressure), shock, arrythmias (any deviation from normal rhythm of the heart), ischemia ( local temporary reduction of blood supply of an area due to obstruction in the blood vessels), chest pain

  23. PREVENTION • Management plan • Read product labels • Avoid high risk foods • Avoid sharing food, utensils or containers

  24. PREVENTION • Wear medicalert, ICE, Green cross box • Provide educational material • Train caregivers and teachers • Use latex free products where possible • Cross sensitivity with foods - banana - kiwi - avocado - others

  25. What happens during anaphylaxis • Essentially an inappropriate immune response • Occurs as a result of exposure to an allergen to which a person has been sensitised and previously made specific immunoglobulin E (IgE) • Anaphylaxis can occur on re-exposure to the antigen when explosive amounts of histamine and other chemical mediators are released following the binding of the antigen to IgE coated mast cells.

  26. TREATMENT • Consider diagnosis of anaphylaxis based on symptoms • Exposure to a known allergen • Call an ambulance • Lie patient flat with legs raised (unless respiratory distress increased) • If unconscious lie in left position and maintain airway

  27. TREATMENT • If judged to be immediately life threatening give CPR • Adrenaline 0.5ml 1:1000ml given intramuscularly for over 12s • Don’t wait, risks of anaphylaxis far outweigh the risks of adrenaline admin. • Repeat every 5 minutes if no improvement

  28. DOSAGES OF ADRENALINE • 12 years + 500mcg IM 0.5ml 300mcg IM if pt is sml 0.3m • 6-12 years 300mcg IM 0.3ml • Under 6 years 150mcg IM 0.15ml • These doses may be repeated at 5 minute intervals if no signs of recovery

  29. Cautions • Patients taking Beta blockers, tricyclic antidepressants or monoamine oxidase inhibitors should receive 50% of the normal adult dose because of potentially dangerous drug interactions • The Resus Council working group found it unhelpful in an acute situation to have this caveat and recommend to start with a safe dose and repeat if the response is not positive.

  30. ADRENALINE • Reverses peripheral vasodilation • Reduces oedema • Dilates airways • Increases the force of the contraction of the heart • Suppresses histamine release

  31. Treatment by a first medical responder may include: Anti-histamine Hydrocortisone Oxygen IV fluids

  32. FUTURE REACTIONS • No predictable pattern • Severity depends on: sensitivity of the individual dose of allergen • Need to identify specific causes: skin and challenge tests • Proper follow up care and education

  33. Yellow card • The Yellow Card Scheme is run by the MHRA and Commission on Human Medicines (CHM). The Scheme is used to collect information from health professionals and patients on suspected adverse drug reactions (ADRs).

  34. Anaphylaxis Suppresses release of inflammatory mediators decreasing angio-oedema Rapid systemic release of large quantities of histamine Reverses peripheral vasodilation Action of adrenaline in anaphylaxis Causes bronchodilation, improving respiration Causing angio-oedema and capillary leakage Increases cardiac contraction, improving BP and cardiac perfusion Mucosal oedema, Bronchospasm,asyphyxia Shock, BP drops, reduced cardiac output Adrenaline

  35. FAINTING • Signs and symptoms: • Pallor • Sweating • Cold clammy feeling • Brief loss of consciousness

  36. TREATMENT of a faint • If giddy and unsteady lay the person down, head supported by a pillow and raise their legs • If person unconscious and breathing normally, place in recovery position and maintain open airway • Loosen tight clothing • Check injury from falling

  37. TREATMENT of a faint • Reassure person when coming round • DO NOT give anything by mouth until fully conscious • DO NOT give alcohol

  38. Panic attack • Patients who think they have been exposed to an allergen can sometimes experience a panic attack that presents with many of the symptoms associated with anaphylaxis but non of the life threatening symptoms

  39. Epi-Pen/Anapen + Drug Box • The drug box has dosage information on the top of the lid. • Please take time to have a look in and practice drawing up adrenaline from the drug box • Have a look at and use the practice Epi-Pen/Ana-pen

  40. ANAPHYLAXIS REVIEW • What is anaphylaxis? • What are the signs and treatments? • Are you happy with drawing up Adrenalin? • Are you happy with the use of a Epi-pen?

  41. Thank You Epipen www.epipen.co.uk Anapen www.anapen.co.uk www.resusitationcouncil.uk Questions Evaluation Forms

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