Emergency Department Approach

EDEN FERRER LASALA, MD

 Know basic allergy principles
 Diagnose simple allergic or hypersensitivity
reactions
 Recognize Urticaria, Angioedema
 Familiarize basic emergency management for
anaphylaxis
 Allos : different / a change
 Eragon: action

 Different / Altered REACTION

 EXAGGERATION
 Immune system

 Foreign substances

 ALLERGENS
 Medication
 Infection
 Contact Allergens
 Food
 Insect Bite
 Transfusions
 Idiopathic
 Exposure
 Extent of characteristics
 Dermatographism
 Thyroid, Lymphnodes
 Fever
 Jaundice / organomegaly (neoplastic)
 Synovitis (SLE / JRA)
 Central swelling, reflex erythema
 Pruritus or burning sensation
 Fleeting ( 24 hrs)
 Erythematous circumscribed borders ,
 with pale and slightly elevated center
 Asymmetric non dependent swelling
 Non pruritic, sudden, with pain
 Increased vascular permeability
 Leakage of plasma
 Involvement of mucous membranes
 Avoid / remove triggers
 Monotherapy with 2nd generation
antihistamines
 Dose advancement of 2nd gen antihistamine
 Add another 2nd gen antihistamine
 Add H2 antagonist
 Add leukotriene receptor antagonist
 Add first gen antihistamine HS
 Dose advancement of potent antihistamine
 Add alternatives
 Anti inflammatory agents or
immunosuppresants
 First generation
 Diphenhydramine
▪ 2 hrs onset
▪ 12 hour duration
 Hydroxyzine
▪ 2 hours onset
▪ 24 hour duration
 Second generation
 Cetirizine (10 to 40 mg / day)
▪ 1 hr onset
▪ 24 hr duration
 Desloratadine (5 to 20 mg / day)
▪ 2 hr onset
▪ 24 hour duration
 Fexofenadine (180 to 540 mg / day)
▪ 2 hr onset
▪ 24 hr duration
 SERIOUS, LIFE THREATENING
 Generalized or systemic
 Hypersensitivity reaction
 Rapid onset
 may be FATAL
 Acute onset of symptoms on skin
/ mucous membranes and
 Respiratory symptoms or
decreased blood pressure /
syncope or loss of consciousness
 Skin and / or mucosa
 Respiratory compromise
 Decreased BP / hypotension /
end organ dysfunction
 Persistent GI symptoms :
vomiting / pain / diarrhea
 PLUS DECREASED BLOOD
PRESSURE /
 SHOCK
+ • Skin rashes
• Respiratory symptoms or hypotension

>2 •
•
Skin / mucous mem
Respiratory Sx
• Hypotension
• Persistent GI sx

• Exposure to known
↓BP allergen
 ABC’s (Oxygen supplementation)
 Trendelenburg
 Venous access, start Crystalloids
 Epinephrine 1:1000 (1mg/ml) (q 5-15 mins)
 0.01 mg/kg INTRAMUSCULAR injection
 0.3 mg child (Max 0.5 mg adult)
 Second line : H1 antagonist
 B2 agonist
 Intravenous : Glucocorticoid, H2 antagonist
 Oxygen inhalation by nasal cannula at 2 lpm
if O2 Saturation < 96 %
 Venous access : insert heplock
 Diphenhydramine 1 mg/kg IM or IV or
 Cetirizine 1o mg (adult)
 Prednisone 1 mg/kg per day
 Salbutamol nebulization