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Friday, February 6, 2009 Y 6:17 PM Management of Anaphylaxis Anaphylaxis management can be divided into 4 categories, they are immediate or initial treatment, unresponsive after treatment, post treatment and long term treatment. 1. IMMEDIATE/ INITIAL TREATMENT When an individual first experiences severe anaphylaxis, it is advisable that he/she consults a doctor immediately. Medical specialist will first administer epinephrine injection followed by antihistamines or steroids. If initial anaphylaxis reactions are mild, diphenhydramine and hydrocortisone should be provided first. Epinephrine will help to ease breathing difficulties and enhance blood circulation. Antihistamines and steroids will help to reduce itchiness, swells and other allergic reactions. Treatment for anaphylaxis should be prompt to prevent further worsening of the condition. Further medical checks at hospital are necessary to evaluate the cause of anaphylaxis. Uncontrolled asthma increases the risk of death for children. Whereas in adults, those age over 35 and those who had previous severe experience of anaphylaxis are at risk of death.  Table 1: Types of drugs, dosage required for child and adult. If symptoms of allergy still persist or the patient experiences breathing difficulties and hypotension, re-injection of epinephrine should be conducted once every 5-15 minutes until signs of hyperadrenalism[1] cease. The signs include palpitations (rapid and irregular heart beat), tremor, uncomfortable apprehension and anxiety. 1:10 000 dilution of epinephrine should be administered ONLY in severe hypotensive shock as it may be potentially harmful. Airway should be adequate and maintained for patients with anaphylaxis allergy reaction. Sufficient amount of oxygen should be given. 2. UNRESPONSIVE AFTER TREATMENT If the patient is not responsive to the treatment (epinephrine, antihistamines or steroid), there are three treatments that can be given to the patient depending on the condition. The three treatments are bronchodilators, nebulised adrenaline and vasopressors. Bronchodilators are given when the patient experiences persistent bronchospasm[2]. However if the bronchospasm continues, intubation will be necessary. Intubation can be accompanied by continuous puffs of salbutamol through aerosol port directly into the ventilation circuit which may have to ease the difficulty in breathing during bronchospasm. Nebulised adrenaline 5 mg in 5 mL together with parenteral adrenaline may be given when persistent stridor[3] occurs. Surgical airway intervention may be required if stridor continues. Vasopressors such as metaraminol or vasopressin may be prescribed when persistent hypotension[4] occurs. Persistent hypotension may be due to cardiac failure. Phosphodiesterase inhibitor such as glucagon may be given to patients who have pre-existing heart failure or are taking β-blockers. 3. POST TREATMENT Patients are not encouraged to be discharged as further observations of the patients are required. If they are discharged, there should be adequate supervision at home. They should have easy access to emergency medical response at home, in case anaphylaxis relapses. 4. LONG TERM MANAGEMENT Venom immunotherapy[5] can help to prevent allergy due to insect stings. It will help to lessen allergy reactions induced by stings. Long term treatment of anaphylaxis includes getting professional help from medical specialists on allergy profile and progress of illness, enquiring on the causes of anaphylaxis. Patients should avoid allergens that may trigger anaphylaxis. Common triggers of anaphylaxis include food, stinging insects and medication (as mention above in the mechanism of anaphlaxis). Food allergens may be avoided by reading labels on food packaging before consuming the food. It is important to know that treatment and medications may complicate management of anaphylaxis. Patients should learn more about the treatment given to them and try to stick to the treatment process. Patients should learn to identify early warning symptoms of anaphylaxis and develop an action plan if anaphylaxis is to occur. DEFINITIONS: 1. Hyperadrenalism is the state in which there is an excessive amount of adrenal hormones in the body. Symptoms depend on the hormone involved and the degree of involvement. 2. Bronchospasm is an abrupt constriction of muscles in the walls of the bronchioles. It is due to the release of substances from mast cells or basophils under the influence of anaphylatoxins. It causes very mild to severe difficulty in breathing. 3. Stridor is a term that describes noisy breathing produced by turbulent airflow through a narrowed segment of the airway. It usually originates from the larynx (voice box) or trachea (windpipe). 4. Hypotension is the condition of having unusually low blood pressure, 90/60 or lower, on a regular or semi-regular basis. 5. Venom immunotherapy is the process whereby venom is injected to treat various medical conditions. The most common form of venom immunization is bee venom therapy (BVT), with venom or stingers used to treat conditions. |
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