Home Forums Other Specialities General Topics ANAPHYLACTIC REACTION- THE BASICS

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      Anonymous
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      1.Document the acute clinical features of the suspected anaphylactic
      reaction (rapidly developing, life-threatening problems involving the
      airway [pharyngeal or laryngeal oedema] and/or breathing
      [bronchospasm with tachypnoea] and/or circulation [hypotension
      and/or tachycardia] and, in most cases, associated skin and
      mucosal changes).

      2. Record the time of onset of the reaction.

      3.Record the circumstances immediately before the onset of
      symptoms to help to identify the possible trigger.

      4. After a suspected anaphylactic reaction in adults or young people
      aged 16 years or older, take timed blood samples for mast cell
      tryptase testing as follows:

      a sample as soon as possible after emergency treatment has
      started

      a second sample ideally within 1–2 hours (but no later than
      4 hours) from the onset of symptoms.

      5. After a suspected anaphylactic reaction in children younger than
      16 years, consider taking blood samples for mast cell tryptase
      testing as follows if the cause is thought to be venom-related,
      drug-related or idiopathic:

      a sample as soon as possible after emergency treatment has
      started

      a second sample ideally within 1–2 hours (but no later than
      4 hours) from the onset of symptoms.

      Inform the person (or, as appropriate, their parent and/or carer) that
      a blood sample may be required at follow-up with the specialist
      allergy service to measure baseline mast cell tryptase.

      Adults and young people aged 16 years or older who have had
      emergency treatment for suspected anaphylaxis should be
      observed for 6–12 hours from the onset of symptoms, depending
      on their response to emergency treatment.

      In people with reactions
      that are controlled promptly and easily, a shorter observation period
      may be considered provided that they receive appropriate
      post-reaction care prior to discharge.

      Children younger than 16 years who have had emergency
      treatment for suspected anaphylaxis should be admitted to hospital
      under the care of a paediatric medical team.

      After emergency treatment for suspected anaphylaxis, offer people
      a referral to a specialist allergy service (age-appropriate where
      possible) consisting of healthcare professionals with the skills and
      competencies necessary to accurately investigate, diagnose,
      monitor and provide ongoing management of, and patient
      education about, suspected anaphylaxis.

      After emergency treatment for suspected anaphylaxis, offer people
      (or, as appropriate, their parent and/or carer) an appropriate
      adrenaline injector as an interim measure before the specialist
      allergy service appointment.

      Before discharge a healthcare professional with the appropriate
      skills and competencies should offer people (or, as appropriate,
      their parent and/or carer) the following:

      information about anaphylaxis, including the signs and
      symptoms of an anaphylactic reaction

      information about the risk of a biphasic reaction

      information on what to do if an anaphylactic reaction occurs (use
      the adrenaline injector and call emergency services)

      a demonstration of the correct use of the adrenaline injector and
      when to use it.

      advice about how to avoid the suspected trigger (if known)

      information about the need for referral to a specialist allergy
      service and the referral process
      information about patient support groups.

      Each hospital providing emergency treatment for suspected
      anaphylaxis should have separate referral pathways for suspected
      anaphylaxis in adults (and young people) and children.

      G Mohan.

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