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60 Cards in this Set
- Front
- Back
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What is the definiton of anaphylaxis?
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severe allergic reaction that is rapid in onset and may cause death
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What are some of they prominent dermal and systemic signs and symptoms?
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urticaria (hives)
angioedema hypotension bronchospasm |
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What does the classic form of anaphylaxis involve?
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Prior sensitization to an allergen with later re-exposure producing symtoms via an immunologic mechanism.
An anaphylactoid reaction has very similar clinical syndrome but is not immune-mediated. Treatment for both is similar |
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What are some of the physiologic changes produced by the release of histamine, leukotriene, C4, prostaglandin d2, and typtase?
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rapid onset of increased secretion from mucous membranes, increased bronchial smooth muscle tone, decreased vascular smooth muscle tone, and increase capillary permeability occur after the exposure to the substance.
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In the classic form, when does mediator release occur?
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Mediator release occurs when the antigen (allergen) bings to antigen-specific immunoglobulin E (IgE) attached to previously sensitized basophils and mast cells. The mediators are released almost immediately when the antigen binds.
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T or F:
In an anaphylactoid reaction, the direct release of mediators is a process that is NOT mediated by IgE. |
True
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Describe the respiratory effects of anaphylaxis
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increased mucous secretions and increased bronchial smooth muscle tone.
airway edema. |
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What are the cardiovascular effects of anaphylaxis caused from?
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decreased vascular tone and capillary leakage
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What are the skin effects caused from?
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histamine release in skin causes urticarial skin lesions
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What are some of the most common agents that most likely cause anaphylaxis?
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parenteral antibiotics (esp. PCN)
IV contrast Hymenoptera stings (bees, wasps, ants) Certain foods (peanuts, shellfish) Oral medications (NSAIDS) |
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Can Anaphylaxis be idiopathic?
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Yes.
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what is the inciting agent in the classic form of anaphylaxis?
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a foreign protien (antigen).
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What exposures tend to result in faster and more severe reactions?
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parenteral exposures.
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What factors influence the severity of a reaction?
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degree of host sensitivity and
dose route rate of administration of the offending agent |
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When do most severe parenteral reactions develop?
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Most severe reactions occur soon after exposure.
The faster the reaction develops, the more severe it is likely to be. While most reactions occur within hours, symptoms may not occur for as long as 3-4 days after exposure. |
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True or False: Anaphylaxis is an acute systemic (multi-system) and very severe Type I Hypersensitivity allergic reaction?
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True
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True or False: It take large amounts of allergens to cause an anaphylaxis reaction?
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False. It can only require minute amounts of allergens to cause a life-threatening anaphylactic reaction.
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Anaphylactic reactions almost always involve the ___ or
____ ______ |
skin or mucus membranes
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More than 90% of patients have some combination or urticaria, erythema, pruritis, or angioedema (swelling under the skin, welts),. What may happen to the eyes?
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tearing, redness, itching.
conjunctival injection (bloodshot eyes) |
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What are some common upper respiratory symptoms?
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nasal congestion
sneezing coryza (inflammation of lining of mucus memb. of the nose) cough, horseness, sensation of tightness in the throat may precede airway obstruction |
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What is dyspnea a sign of?
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Dyspnea is present when patients have bronchospasm or upper airway edema
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What will the GI symptoms be?
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abd. pain
nausea vomiting diarrhea These are less common except for food allergies |
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What are some of the more severe symptoms?
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hypoxia and hypotension, leading to weakness, dizziness, or syncope. Chest pain due to bronchospasm, or Myocardial ischemia due to hypotension/hypoxia
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True or false: The skin findings (dermal) will be more common in adults than in children?
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False...more common in children
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When a patient expiences severe air hunger as a result of respiratory tract involvement, what will some of the symptoms be?
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depressed level of consciousness
or agitated/combative Can have tachycardia or if severe, bradycardia |
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What is the CLASSIC mainfestation of an allergic reaction?
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Urticaria (hives)
Lesions are red, raised sometimes have central blanching. Ithcing. Borders are irregular Hives can occur anywhere on the skin. |
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If it's a local reaction (insect bite), lesions will occur near the site of exposure.
If local reactions are present are systemic manifestations (respiratory distress) likely? |
not as likely with a local trythematous, edematous and pruritic local reaction.
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IF you have angioedema, deeper skin layer lesions may occur. Where might these lesions occur?
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lips
palms soles genitalia |
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What are some pulmonary symptoms?
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upper airway compromise when tongue and oropharynx are involved
stridor hoarse or quiet voice may lose ability to speak as edema progresses complete airway obstruction |
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What is a major cause of death with anaphylaxis?
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complete airway obstruction
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When a patient has lower airway compromise due to bronchospasm or mucosal edema, what is the symptom you'll see?
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wheezing
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If your patient is having a reaciton due to ACE inhibitors, what symtom are you most likely to see?
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marked edema in the tongue and lips....may obstruct the airway
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For cardiovascular symptoms, what might you see in sever cases and why/
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compensatory tachycardia due to loss of vascular tone
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Why might you have intravascular volume depletion?
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capillary leakage. This will lead to development of hypotension and cardiovascular collapse.
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What are the 2 most commonly reported medical agents (in reactions) in anaphylaxis?
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Penicillin
Cephalosporin Atbs |
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Why would we see more allergic/anaphylactic reactions to PCN and cephalosporins?
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Because of the immunogenicity and frequent use of these agents.
Because of their molecular and immunologic similarity, cross-sensitivity may exist. |
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True or False: The reaction to a medication will be more severe and rapid onset when the antibiotic administered is done so orally?
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No, parenterally. (IV, IM)
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What are some of the common medications that cause anaphylaxis?
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NSAIDs and aspirin are commonly implicted in allergic reactions. Bronchospasm should be anticipated with those with reactive airway disease and nasal polyps.
Ace Inhibitors...common for angioedema. Systemic anaphylaxis is rare with these agents. IV contrast: presents similarly to full anaphylaxis and will be treated the same. |
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True or False: The reaction to IV contrast is related to prior exposure?
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False
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True or False: Shellfish or Iodine Allergy is a contraindication for using IV contrast?
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False. You can give these patients low molecular weight contrast. when you give LMW contrast, the incidence of reactions is 0.5%.
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Is anyone really allergic to iodine?
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Iodine is a naturally occurring substance in the body. Noone irs really allergic to it.
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What can be done to decrease the risks of anaphylaxis r/t radiocontrast media (IV dye)?
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Pretreat with antihistamines
or corticosteroids Use LMW agents. |
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What is a hymenoptera sting?
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A sting from a bee, wasp or ant.
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What is the most common reaction of a hymenoptera sting?
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local reaction and urticaria is much more common than full-blown anaphylaxis
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True or False: Urticaria is a risk factor for subsequent anaphylaxis?
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True. But a local reaction is not a risk factor.
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What are some effective measures in preventing or ameliorating future reactions to bee/ant/wasp stings?
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carry an epi pen and oral antihistamine
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Food allergies are common. Most allergies are limited to the GI tract. but full blown anaphylaxis can occur. What foods are common for allergies?
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peanuts,
tree nuts, legumes, fish, shell fish |
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Latex is increasingly recognized as an allergic problem. Most reactions involve cutaneous and mucous membranes. Can it cause anaphylaxis?
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yes
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What is a latex allergy?
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It's a reaction to certain proteins found in natural rubber latex, a product manufactured from a milky fluid derived from the rubber tree. If you have a latex allergy, your body mistkakes latex for a harmful substance.
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What are some ways patients can be exposed to latex?
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In almost everything we use...foleys, gloves, tubes, etc.
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Describe what happens with your immune system with a latex allergy
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In a latex allergy, your immune system identifies latex as a harmful substance. Your immune system triggers certain cells to produce immunglobulin E (Ige) antibodies to fight the latex component (the allergen). The next time you come in contact with latex, the IgE antibodies sense it and signal your immune system to release histamine and other chemicals into your bloodstream.
These chemicals cause a range of allergic signs and symptoms. Histamine is partly responsible for most allergic responses, including runny nose, itchy eyes, dry throat, rashes and hives, nausea, diarrhea, labored breathing, and even anaphylactic shock. |
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Describe irritant contact dermatitis
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common with protective gloves.
This isn't an allergy. It's most likely due to sweating or rubbing under the gloves from detergent left on hands before wearing them. Hands will be red, dry, cracked. |
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Describe allergic contact dermatitis
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An allergy to latex or chemical additives used during the manufacturing process. Can cause a rash 24-48 hours after contact. Rash starts in areas of exposure then can spread. Also can have oozing blisters
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Decribe the Hypersensitivity immunie system response to latex
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This response is an actual latex allergy. It occurs when your immune system reacts to proteins found in natural rubber latex. Itching, redness, swelling , sneezing, wheezing, etc.
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What is the most common cause of latex allergy?
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DIRECT CONTACT with latex.
Once you've had an exposure, you can become sensitized. Sensitization is the process in which the immune system learns to recognize and attack allergens, causing an allergic reaction. |
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How is inhalation of latex a possibility?
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You can develop a latex allergy by inhaling latex particles. This happens, especially with gloves, when latex products shed large amounts of latex particles which can become airborne.
EX: cornstarch powder is used inside gloves and, when the glove is snapped, can carry latex particles into the air. |
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Types of Latex
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Hardened : tires, shoes, etc
Dipped latex: stretchy items...gloves, balloons, rubber bands, condoms. *most allergic rxns occur with this because they are mostly in direct contact with skin synthetic latex: latex paint |
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Some products in the hospital:
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BP cuffs
Stethescopes Iv tubing Syringes Respirators Electrodes Masks |
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Who are the people most at risk for a latex allergy?
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Healthcare workers
Children with spina bifida - they are exposed early and frequently to latex products People with food allergies...those with allergies to avocados, bananas, kiwis, chestnuts and passion fruits contain same allergens as found in latex People with a family hx of allergies |
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How do you prevent latex allergies?
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Reduce your exposure
Figure out how you're being exposed at work Choose alternative gloves Notify healthcare workers of your allergy Avoid inhaling latex Wear a medical alert bracelet Beware of products labeled hypoallergenic: they don't include latex ask for advice Use nonlatex condoms |
