ANAPHYLAXIS

ANAPHYLAXIS
• Clinical response to immediate (Type 1 Hypersensitivity) immunologic reaction between
specific antigen and antibody
• Reaction results from IgE antibody

CLINICAL MAIFESTATIONS OF ANAPHYLACTIC REACTIONS

3 CATEGORIES
• Mild Systemic Reactions
o Peripheral tingling
o Sensation of warmth
o Possible accompanied by fullness in mouth and throat
o Nasal congestion
o Periorbital swelling
o Pruritus
o Sneezing
o Tearing of eyes
o Onset symptoms begins within first 2 hours of exposure

• Moderate Systemic Reactions

o Above symptoms with added:
o Flushing
o Warmth that increases in intensity
o Anxiety
o Itching that increases in intensity
o Serious Reactions
 Bronchospasm and edema of airways or larynx and dyspnea, cough and
wheezing
o Onset same as mild
 Begins within the first 2 hours of exposure

• Severe Systemic Reactions

o Abrupt onset with same S/S as mild and moderate
o Within approx 30 min:
 CV, Resp, GI, Integumentary are affected

o Progress rapidly to bronchospasm, laryngeal edema, severe dyspnea, cyanosis

o Dysphasia (difficulty swallowing)
o Abdominal cramping due to increased GI secretions
o Vomiting
o Diarrhea
o Seizures
 o Rarely: Cardiac arrest and coma result

PREVENTION
• Single most important aspect for client at risk for anaphylaxis
• People sensitive to insect bites and stings
o Those experience food or medication reaction
o Those experience idiopathic or exercise induced anaphylactic reaction (EPI-PEN)
• Careful History any sensitivity to suspected antigens obtained before administration of
any medications particularly parenteral form because this route associates with most
severe anaphylaxis
• Clients predisposed to anaphylaxis should wear some form of identification (Medic Alert
Bracelet: Naming allergies to meds, food, and other substances)
• Epi Pen 0.3mg
• Epi Pen Jr 0.15mg
o Administer mid portion of thigh
• Client allergic to insect venom may require venom immunotherapy
o Used as a control measure and not a cure
• Insulin-allergic diabetic clients and penicillin-sensitive clients may require desensitization
o Desensitization based on controlled anaphylaxis with gradual release of mediators
o Clients who undergo desensitization cautioned there should be no lapses in
therapy because may lead to reappearance of allergic reaction when medication is
reinstituted

MEDICAL MANAGEMENT
• Depends on severity of reaction
• Cardiovascular and respiratory function evaluated closely
• Increase O2 Concentration
• Epinephrine 1:1000 dilution: given SQ in upper extremity or thigh and may be followed
by continuous IV infusion – Why Given????????????
• Antihistamines and Corticosteroids: May be given to prevent recurrences of reaction and
treat urticaria and angioedema
• Volume Expanders and Vasopressor Agents(Dopamine): Given to maintain BP and
normal hemodynamic status (LR, Plasma)
o Brings Blood Pressure Up
• Aminophylline and Corticosteroids: Administer to improve airway patency and function
o Episodes bronchospasm or history of bronchial asthma or COPD
• Glucagon IV: Hypotension unresponsive to vasopressors; administer IV; also acute
inotropic and chronotriopic effects
o Improves muscle contractility in heart
• Severe reaction observed closely 12-14 hours because potential recurrence even with
mild reactions must be educated concerning risk