Internal Medicine

P1: SBT

0521779407-03 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 19:6

Anaphylaxis 121

■Skin testing or RAST testing w/ specific allergens

➣Helpful for suspected allergy to foods, some drugs, insects, latex

differential diagnosis

■Vasovagal syncope

■Flushing syndromes (carcinoid)

■Systemic mastocytosis

■Panic attacks

■Angioedema (hereditary, acquired, secondary to ACE inhibitors,

idiopathic)

■“Restaurant syndromes” (eg, MSG, sulfites)

■Vocal cord dysfunction syndrome

■Other causes of shock, cardiovascular or respiratory events

management

What to Do First

■Maintain adequate airway & support blood pressure

➣Administer epinephrine 1:1,000 dilution, IM or SC

➣Repeat every 15 min for 3 doses

➣Add plasma volume expanders if hypotension persists

➣Administer oxygen to maintain O2 saturation

➣Administer diphenhydramine, repeat q4–6h

➣Treat bronchospasm w/ inhaled beta-2 agonist

General Measures

■Consider systemic steroids if initial response is inadequate or reac-

tion is severe

■Monitor for several hours; biphasic reactions may occur after appar-

ent recovery

■Hospitalize pts w/ protracted anaphylaxis unresponsive to therapy

specific therapy

■Identify & teach avoidance of responsible allergen

■Educate in early symptom recognition

■Prescribe epinephrine for self-administration

■Have pt wear a medical alert bracelet

■Make available an antihistamine preparation for injection

follow-up

■Assess risk factors

➣Atopy

➣Asthma

➣Hidden allergens