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Anafilaksis

Pembimbing:
dr. Dony Siregar Sp.An

Kepaniteraan Klinik
Anestesiologi
RSUD dr. Abdul Aziz Singkawang
2018
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Definitions

What is allergy?
An immune system reaction to a normally
harmless substance (allergen )
• affects 30% of Canadians
• results from interaction of genetic tendency and
sensitization
• includes such things as dust, pets, pollen, molds,
and foods
• cannot be cured but can usually be controlled
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Definitions

What is allergy? (continued)


Allergic reactions can occur
• In the upper respiratory system, resulting in allergic
rhinitis (hay fever)
• In the lower respiratory system, resulting in asthma
• In the digestive system with nausea, vomiting, diarrhea
• In the skin, with swelling or hives or eczema
• As a generalized reaction called anaphylaxis
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Definitions

What Is Anaphylaxis?
Potentially life-threatening reaction requiring
immediate treatment
Affecting about 2% of Canadians
Involving more than one body system (“systemic”)
Typical triggers include insect stings, medication,
food, natural latex
Trace amounts can cause a severe or even fatal
reaction
Cannot be cured – avoidance is key
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Symptoms
There are a wide variety of potential symptoms
 Hives */ Itching *
 Change in skin color – flushed / pale
 Tingling in mouth (possible early sign)
 Nausea or vomiting *
 Diarrhea / stomach cramps *
 Coughing, wheezing, choking, change in voice
 Swelling in lips, tongue, throat, etc.
 Difficulty breathing and/or swallowing
 Cold clammy skin
 Fear, panic and/or sense of doom
 Dizziness / light-headedness
 Loss of consciousness / coma / death
*Many of these symptoms can result from conditions other than anaphylaxis
but in a person at risk of anaphylaxis they should not be ignored.
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Progression of a Reaction
• Most anaphylactic reactions begin within minutes of
exposure
• In some cases, can occur several hours later (delayed
reaction)
• Some are in two phases (biphasic reaction)
• Biphasic reactions are potentially dangerous if mild
initial symptoms are ignored or under treated (false sense
of security)
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Progression of a Reaction
(continued)
• When someone says a reaction is beginning, take it
seriously!
• Symptoms may be felt before they are noticeable to
others
• It is easier to stop a reaction in its early stages and
epinephrine is most effective if used early
Triggers 8

Possible Triggers of an
Anaphylactic Reaction
Food
Medications
Stinging Insects
Natural Latex
Exercise
Unknown cause (idiopathic)
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Triggers

The Most Common Food Triggers

• Peanuts
• Milk
• Tree nuts
• Wheat
• Fish
• Soy
• Shellfish / Seafood
• Sesame
• Eggs
• Mustard
• Sulphites*
* Sulphites are food additives
Triggers 10

Medications Known to
Trigger Anaphylaxis
• Penicillin and other antibiotics
• ASA (Aspirin)/anti-inflammatory drugs
• Anaesthetic agents
• Radiographic contrast media (used for x-rays)
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Triggers

Stinging Insects
Most Frequent Culprits

• Bees
• Yellow jackets
• Hornets
• Wasps
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Triggers

Natural Latex
Products that may contain natural latex include:
• Surgical gloves
• Dental supplies
• Condoms
• Erasers
• Balloons
• Carpet backing
• Adhesive bandages (e.g., BAND-AID®)
• Medical tubes / supplies
Note: Synthetic latex is not allergenic.
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Triggers

Exercise
Strenuous exercise can trigger anaphylaxis in some
individuals. The following factors may play a role
• Food (that can normally be eaten without problem)
• Medication, weather and menses (menstruation)
• Gender (more women than men are affected)
• Having another allergy
Experts usually advise those at risk of exercise-
induced anaphylaxis not to eat for at least four hours
preceding exercise
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Triggers

Unknown origin (idiopathic)


Reactions are classified as idiopathic when an
individual has an anaphylactic reaction and an
allergist has been unable to identify a specific cause.

These reactions are particularly dangerous since the


patient doesn’t know what to avoid.
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Diagnosis
Based on
Medical history of patient and family
Previous reactions
Skin testing and/or blood testing
“Food Challenge” where appropriate

A physician who specialized in allergy is the


most qualified person to diagnose anaphylaxis
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Standard Care
• Most patients will be prescribed an epinephrine auto-
injector to be carried at all times
• Patient education on allergen avoidance is essential
• Patients and caregivers must be taught how to use an
auto-injector and manage reactions
• A MedicAlert® bracelet should be worn

Keeping asthma under control is extremely


important for those at risk of anaphylaxis.
Uncontrolled asthma can increase the severity of
the reaction.
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Prevention Strategies
These are the usual recommendations for
patients and their caregivers:
• Learn exactly what allergens have to be avoided
• Be especially careful when eating out, traveling or
far from a medical facility
• Make sure friends, family, caregivers, and medical
professionals know about the allergy
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Prevention Strategies
For Food Allergies:
• Wash hands before/after handling food
• Learn how to read a food label and check ingredient
labels carefully each time
• Do not share drinking cups, straws, and utensils
• Be aware of cross contamination and avoid bulk foods
• If product ingredients are unlisted, check with
manufacturer
• If unsure, DO NOT EAT
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Handling Emergencies - What to


do
• Administer epinephrine IMMEDIATELY
• Call 911 or ambulance
• Transport to the nearest emergency facility for
further treatment and observation
• Ensure additional epinephrine is available, in case
it is needed
• Call family, parents or guardian
Handling Emergencies -
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Epinephrine
• Epinephrine is the only proven emergency
treatment for anaphylaxis
• Do not hesitate to use the epinephrine auto-injector
as prescribed; it is easier to stop a reaction in its
early stages
• Harmful side effects are rare
• Beneficial effects of injection should last 15 to
20 minutes, but if symptoms do not subside or if
symptoms recur, a second injection may be needed
within 5 to 15 minutes after the first dose.
Handling Emergencies –
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Using the EpiPen ®