Recognition, Management and Treatment:

Overview:

– The importance of timely recognition and treatment of allergic reactions.

– Impact on patient outcomes.

Definition:

Hypersensitivity reactions of the immune system to a typically harmless substance.

Common Allergens:

– Foods (nuts, shellfish, eggs).

– Medicines (penicillin, aspirin).

– Insect stings (bees, wasps).

– Environmental factors (pollen, pet dander).

Types of Allergic Reactions:

Type I: Sudden Hypersensitivity (Anaphylaxis)*

– Pathophysiology: IgE-mediated response.

– Symptoms: Urticaria, angioedema, respiratory distress, hypotension.

Type II: Cytotoxic Reactions*

– Pathophysiology: IgG or IgM mediated.

– Examples: Hemolytic anemia.

Type III: Immune Complex Reactions*

– Pathophysiology: Antigen-antibody complexes.

– Examples: Serum sickness.

Type IV: Delayed Hypersensitivity*

– Pathophysiology: T cell mediated.

– Examples: Contact dermatitis.

Symptoms:

– Skin: Rash, itching, swelling.

– Respiratory: Wheezing, shortness of breath, stridor.

– Cardiovascular: Hypotension, tachycardia.

– Gastrointestinal: Nausea, vomiting, diarrhea.

*Importance level:*

– Mild: Localized rash.

– Moderate: Systemic symptoms not accompanied by hypotension.

– Severe: Anaphylaxis, shock.

Diagnosis:

– History and Physical Examination:

Patient history (exposure to allergens, previous reactions).

Physical symptoms (rash, swelling, respiratory distress).

– Diagnostic Tests:

Blood tests (tryptase levels).

Skin prick tests (for certain allergens).

RAST (Radioallergosorbent test).

Initial and Advanced Management in the Emergency Department:

-*Primary Research (ABCs):*

– Airway: Ensure patency, consider intubation if necessary.

– Breathing: Give oxygen.

– Circulation: Provide IV access, monitor vitals.

– *Emergency Interventions:*

– Epinephrine: First-line treatment for anaphylaxis (IM administration).

– Antihistamines: H1 and H2 blockers.

– Corticosteroids: To reduce delayed symptoms.

– IV Fluids: For hypotension and shock.

– *Additional Medicines:*

– Bronchodilators: For bronchospasm.

– Vasopressors: For refractory hypotension.

- *Tracing:*

– Continuous monitoring of vitals.

– Post-treatment observation period.

Prevention and Patient Education:

– *Preventive measures:*

Avoiding known allergens.

Use of medical alert ID.

Prescription for emergency epinephrine auto-injectors.

- *Education:*

How to use an epinephrine auto-injector?

Recognizing the early signs of allergic reactions.

When to seek medical help?

Challenges and Things to Consider:

– *General Difficulties:*

Distinguishing allergic reactions from other conditions.

Management of patients with multiple comorbidities.

To ensure rapid and appropriate use of epinephrine.

– *Thoughts:*

Variability in presentation.

The need to make quick decisions.

Dr. Ali Al Sahli
Elite Hospital Emergency Service

Contact Us For Appointment:

Telephone line: 0392 444 3548 (ELIT)

Contact Form: https://www.elitenicosia.com/iletisim/