17861 - Anaphylaxis & Acute Allergic Reactions in the...

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Anaphylaxis & Acute Allergic Reactions in the Emergency Department Theodore J. Gaeta, DO, MPH Sunday Clark, MPH Carlos A. Camargo, Jr., MD, DrPH On behalf of the MARC Investigators www.emnet-usa.org
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Outline Case Presentation Prevalence and Natural History Pathophysiology ED Diagnosis and Management Food-related Allergic Reactions Post-care Plans www.emnet-usa.org
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Case Presentation 19 year old female with acute onset dyspnea Dyspnea, wheezing, vomiting and generalized flushing “minutes after eating a chocolate chip cookie” Past medical history: eczema www.emnet-usa.org
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Case Presentation (continued) Vital signs SBP 80/p, P 124, R 40, T 98.8 o F (37.1 o C) Airway patent, diminished breath sound at the bases with wheezing in the upper fields Weak pulses with delayed capillary refill Diffuse erythematous rash observed and Medic Alert tag indicates peanut allergy www.emnet-usa.org
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Anaphylaxis Multi-system syndrome resulting from mediator release Acute onset Varies from mild and self-limited to fatal IgE and non-IgE mediated www.emnet-usa.org
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Anaphylaxis Incidence 21 per 100,000 person-years (95% confidence interval [CI]: 17 - 25 per 100,000 person-years) 1 10.5 per 100,000 person-years among children (95% CI: 8.1 – 13.3 per 100,000 person-years) 2 1 Yocum et al. J Allergy Clin Immunol 1999 Yocum et al. J Allergy Clin Immunol 1999 2 Bohlke et al. J Allergy Clin Immunol 2004 Bohlke et al. J Allergy Clin Immunol 2004 www.emnet-usa.org
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Estimated prevalence of Generalized Allergic Reaction* Insect sting Food Drug RCM Allergen immuno Tx Latex All causes of adults of children of adults of cases of patients of adults of adults 3% 1-3% 1% 0.1% 3% 1% 5% *urticaria / angioedema or dyspnea or hypotension *urticaria / angioedema or dyspnea or hypotension
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Anaphylaxis - Clinical Manifestations Cardiovascular: Tachycardia then hypotension Shock: 50% intravascular volume loss Bradycardia (4%) (transient or persistent)* Myocardial ischemia Lower respiratory: bronchoconstriction wheeze, cough, shortness of breath Upper respiratory: Laryngeal/pharyngeal edema Rhinitis symptoms Fisher. Anesth Intens Care 1986 Fisher. Anesth Intens Care 1986 www.emnet-usa.org
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Anaphylaxis - Clinical Manifestations Cutaneous: Pruritus, urticaria, angioedema, flushing Gastrointestinal: Nausea, emesis, cramps, diarrhea Ocular: Pruritus, tearing, redness Genitourinary: Urinary urgency, uterine cramps www.emnet-usa.org
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Anaphylaxis -Temporal Pattern Uniphasic Biphasic Initial allergic reaction Recurrence of same manifestations up to 8 hours later Protracted Up to 32 hours May not be prevented by glucocorticoids www.emnet-usa.org
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Histamine H1: smooth muscle contraction vasc permeability H2: vascular permeability H1+H2: vasodilatation, pruritus Leukotrienes Smooth muscle contraction
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17861 - Anaphylaxis & Acute Allergic Reactions in the...

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