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Emergency - Allergic reactions

Emergency - Allergic reactions - ALLERGIC REACTIONS in the...

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Unformatted text preview: ALLERGIC REACTIONS in the in DENTAL OFFICE Allergic Reactions Allergic Allergy is defined as a hypersensitive state aquired through exposure to a particular allergen, reexposure to which produces a heightened capacity to react heightened Allergic Reactions Allergic Allergic reactions range from mild, delayed Allergic reactions occuring as long as 48 hours after exposure, to immediate life-threatening reactions that occur within seconds after exposure exposure Classification of Allergic Reactions Reactions Type Mechanism Time Type I Anaphylactic sec/min Anaphylactic II Cytotoxic -Cytotoxic III Immune 6-8hrs Immune complex IV Cell mediated 48 hrs Cell Example Angioedema Angioedema Transfusion rx Transfusion Serum sickness Serum Contact Contact dermatitis dermatitis Most Common in Dental Office Most Type I Immediate Localized or Generalized Anaphylaxis - The Type I allergic reaction is subdivided into several forms based upon the response the Type IV Contact Dermatits Contact Type I Type Immediate Hypersensitivity Generalized (Systemic) Anaphylaxis Localized Anaphylaxis Urticaria Urticaria Bronchial Asthma Bronchial Food Allergy Food Antigen Antigen A substance that elicits an allergic substance reaction reaction Antibody A substance in blood or tissue that responds and reacts with the antigen and (different in structure than the antigen) (different Atopy Atopy Clinical hypersensitivity state, subject to Clinical heredity (asthma, hay fever, etc.) heredity Urticaria Urticaria Wheals (hives) Smooth elevated patches surrounded by erythematous areas erythematous Pruritus (itching) Angioedema Angioedema Non-inflammatory edema involving Non-inflammatory skin, subcutaneous tissue, underlying muscle & mucous membranes. mucous Occurs in response to allergen Occurs Most critical in the larynx Predisposing Factors in Allergic Reactions Reactions Prior history of allergy Genetic predisposition to allergy - atopic patient atopic Patient with multiple allergies Drug that is utilized Drug Drugs that Cause Allergic Reactions Reactions Up to 70% of Allergic Reactions Penicillin Penicillin Meprobamate Meprobamate Codeine Codeine Thiazide Diuretics Thiazide Other Substances Causing Reactions Reactions Iodines Vaccines Insulin Heparin Salicylates Sulfonamides Opiates Local Anesthetics Venom from stinging insects Antibiotic Allergy Antibiotic Highest incidence Penicillins (anaphylactic reaction may prove fatal in 15 minutes) prove Sulfonamides Sulfonamides Reactions to erythromycins rarely seen Analgesic Allergy Analgesic Incidence of true allergy to narcotics is low Incidence true "Allergy" is most often a side effect such as "Allergy" nausea, vomiting, drowsiness, dysphoria, or constipation constipation Antianxiety Drug Allergy Antianxiety Barbiturates -most common but occur less Barbiturates than aspirin and penicillin than Reactions -hives, urticaria, blood dyscrasia Reactions (agranulocytosis / thrombocytopenia) (agranulocytosis Allergy occurs more frequently with a history Allergy of asthma, urticaria, and angioedema of Local Anesthetics Local Reactions occur most frequently with Esters Preservatives also cause reactions Ester Drugs Ester Procaine Benzocaine Related compounds Procaine Penicillin G Procaine Procainamide Procainamide Propoxycaine Tetracaine Amide Allergy Amide The amide type anesthetic are essentially free The of allergic reaction when given in their pure form form Although true allergy to amide type anesthetic Although is extremely rare, patients have demonstrated allergic reaction to the contents of the dental cartridge contents Ingredient Ingredient - Function Anesthetic Agent - Conduction blockade Vasoconstrictor - Decrease absorption of local anesthetic Sodium Metabisulfite - Preservative for Preservative vasoconstrictor vasoconstrictor Methylparaben - Preservative to increase Preservative shelf life; bacteriostatic shelf Sodium Chloride - Isotonicity of solution Sterile Water - Diluent Paraben Reactions Paraben Preservative found in many non-drug items Allergic reactions to topical anesthetics Allergic are those of contact stomatitis; erythema, edema, ulcerations - almost exclusively a dermatologic type reaction dermatologic Clinical Options Clinical Determine type of “allergic” reaction Substitute different drugs for those which Substitute cause the allergic reaction. cause Have patient evaluated by allergist Have Management of Allergic Reactions Reactions Most severe allergic reactions are immediate A number of organ oystems may be involved number Skin Skin Cardiovascular Cardiovascular Respiratory Respiratory Gastrointestinal Gastrointestinal Management of Allergic Reactions Reactions Generalized anaphylaxis involves all of the Generalized previously mentioned systems When hypotension occurs, it is termed Anaphylactic Shock Anaphylactic Affected Area - Manifestation Affected Skin Urticaria-Wheal & Flare pruritis, angioedema, erythema pruritis, Respiratory Dyspnea,wheezing,flushing, cyanosis,perspiration,tachycardia, cyanosis,perspiration,tachycardia, increased anxiety,use of accessory increased muscles of respiration muscles Affected Area Manifestation Manifestation Gastrointestinal Cardiovascular Cardiovascular Abdominal cramps, nausea, vomiting, diarrhea, nausea, incontinence incontinence Pallor, light-headedness, palpitations, tachycardia, palpitations, hypotension, dysrhythmias, hypotension, loss of consciousness, arrest arrest Sequence of Reaction Sequence 1. Skin reaction 2. Smooth muscle spasm (GI, GU, and bronchial) (GI, 3. Respiratory distress 4. Cardiovascular collapse Type of Reaction Type Quick Onset==> Rapid Progression==> Quick Intense Reaction Intense Delayed Onset==> Slow Progression==> Delayed Less Severe Reaction Less Drugs Used in Allergic Reactions Drugs Epinephrine Epinephrine Has Alpha and Beta adrenergic effects Acts as a physiologic antagonist to the events Acts that occur during an allergic reaction that Epinephrine Epinephrine Actions Include Bronchodilation Bronchodilation Increased heart rate Increased Arterial constriction Arterial Cutaneous, mucosal, and splanchnic Cutaneous, vasoconstriction vasoconstriction Reverses rhinitis and urticaria Reverses Epinephrine Epinephrine Risks of repeated use: Excessive elevation of blood pressure Excessive CVA CVA Cardiac rhythm abnormalities Cardiac Antihistamine Antihistamine Benadryl (chlorpheniramine) most often used H-1 blocker Inhibits action of histamine released during Inhibits reaction to allergen reaction Corticosteroids Corticosteroids Hydrocortisone used most often Stablilizes cell membranes against actions of Stablilizes histamines, bradykinins, and prostaglandins histamines, Supplements adrenal steroid output during Supplements stress stress Treatment of Treatment Immediate Skin Reactions Epinephrine 0.3 mg IM or SC (0.3ml of a 1:1000 Solution) (0.3ml Antihistamine Diphenhydramine (Benadryl) 50 mg IM Treatment of Treatment Immediate Skin Reactions Immediate Obtain medical consultation Obtain Observe patient for at least one hour Prescribe oral antihistamines Benadryl 50 mg PO Q6H for 3-4 days Benadryl Treatment of Treatment Delayed Skin Reactions Delayed Antihistamine Antihistamine Diphenhydramine (Benadryl) 50 mg IM Diphenhydramine Prescribe oral form Q6H for 3-4 days Arrange medical consultation Treatment of Treatment Respiratory Reactions Bronchial Constriction Terminate dental treatment Terminate Sit patient upright Sit Oxygen 6 L/min Oxygen Epinephrine aerosol or 0.3 mg IM or SC Epinephrine (0.3 ml of a 1:1000 solution) (0.3 Treatment of Treatment Respiratory Reactions Bronchial Constriction (cont.) Observe for at least 1 hr Observe Antihistamines - Benadryl 50 mg IM Antihistamines Obtain medical consulatation Obtain Prescribe oral antihistamines Prescribe (Q6H for 3-4 days) (Q6H Treatment of Treatment Respiratory Reactions Laryngeal Edema Sit patient upright Sit Epinephrine 0.3 mg IM or IV Epinephrine Maintain airway Maintain Summon medical assistance Summon Treatment of Treatment Respiratory Reactions Laryngeal Edema (cont.) Oxygen 6 L/min Oxygen Cricothyroidotomy Cricothyroidotomy Additional drug therapy Additional Diphenhydramine 50mg Diphenhydramine &/or &/or Hydrocortisone 100 mg Generalized Anaphylaxis Generalized with Signs of Allergy Place patient in a supine postion Place Basic Life Support (ABCs) Administer epinephrine 0.3 mg IM or SC (0.3 ml of a 1:1000 solution) (0.3 Summon medical assistance - call 911 Generalized Anaphylaxis Generalized with Signs of Allergy Monitor vital signs Additional drug therapy Antihistamines Antihistamines Corticosteroids Corticosteroids Repeat epinephrine Q5min prn Repeat Generalized Anaphylaxis Generalized without Signs of Allergy Place patient in a supine position Basic Life Support Monitor vital signs Summon medical assistance prn Generalized Anaphylaxis Generalized without Signs of Allergy Consider possible causes of unconsciousness Syncope Syncope Overdose Reaction Overdose Hypoglycemia Hypoglycemia CVA CVA Acute Adrenal Insufficiency Acute Prevention of Allergic Reactions Prevention HISTORY - a thorough, complete history of HISTORY any previous allergic response or tendency prior to starting treatment will avoid most prior emergencies emergencies Other Means of Prevention Other Medical consultation Dental office skin testing (not foolproof and not advisable) (not Take Home Lessons Take All positive responses to an allergy history are All true until exact nature is determined! true Patients reporting allergies should be critically Patients evaluated -refer for allergy testing if history, reaction, or management are suspect. reaction, Be prepared to manage difficulties! Always! ...
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