Anaphylaxis

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Anaphylaxis

Allergy
Author Credentials 

Benjamin Anthony, MD
Assistant Professor and Director of Indiana University Voice Center
Department of Otolaryngology - Head & Neck Surgery
Indiana University School of Medicine
Indianapolis, IN

Module Summary

Anaphylaxis is a rare but very serious systemic reaction that otolaryngologists encounter. Anaphylactic reactions are more common in individuals with atopy, therefore inducing anaphylaxis in the office setting during evaluation and treatment of allergic disease is of utmost concern. Anaphylaxis may also mimic other medical conditions more commonly seen by otolaryngologists and so recognition and knowledge of treatment algorithms is essential for optimal patient care. This anaphylaxis module aims to cover topics regarding anaphylaxis as it relates to the practicing otolaryngologist. By reviewing the pathophysiology, signs, symptoms, and strategies for treating anaphylaxis this module will help the practicing otolaryngologist provide rapid and correct intervention for their patients with this serious condition.

Module Learning Objectives 

 

  1. Differentiate anaphylaxis from other similar conditions (e.g., vasovagal episodes)
    1. Be familiar with the differential diagnosis of those with suspected anaphylaxis
    2. Explain physical manifestations of vasovagal episodes
      1. Decreased pulse, normotensive or slight hypotension, sweating, pallor, no cough/wheezing/itching/urticaria
    3. Describe physical manifestations of anaphylaxis
      1. Increased pulse, hypotension, cough, wheeze, itch, urticaria, skin red/warm
  2. Recognize the pathophysiology of anaphylactic reactions
    1. Explain the timing and patterns of anaphylaxis
      1. Uniphasic, biphasic, protracted
    2. Cite the four types of Gell and Coombs reactions
  3. Recognize risk factors for immunotherapy-related anaphylaxis
    1. Be familiar with the most common causes of anaphylaxis
    2. Be familiar with the most common presenting symptom of anaphylaxis
  4. State when not to proceed with allergy testing or treatment
    1. Understand interaction of epinephrine treatment and beta-blockers
  5. Summarize treatment algorithms for treatment of anaphylaxis
    1. Be familiar with dosing of frequency of medications to treat anaphylaxis
      1. Epinephrine
      2. Histamine blockage
        1. Diphenhydramine, ranitidine, cimetidine
      3. Corticosteroid injectable
      4. Aerosolized beta agonist
      5. IV fluids
      6. Role of dopamine, glucagon, atropine, ipratroprium
  6. Recognize what precautions and supplies are needed to treat anaphylaxis
    1. Recognize signs of hypertensive crisis following treatment of anaphylaxis
      1. Phentolamine
      2. Nitroglycerin or Nitroprusside

 

References

  1. LoVerde D, Iweala OI, Eginli A, Krishnaswamy G. Anaphylaxis. Chest. 2017; Aug 8. pii: S0012-3692(17)31332-6.
  2. Krouse JH. Treatment of Anaphylaxis. Academy U: Clinical Fundamentals. American Academy of Otolaryngology-Head & Neck Surgery/Foundation. http://academy.entnet.org.  Accessed December 20, 2017.
  3. Wood RA, Berger M, Dreskin SC, et al. An algorithm for treatment of patients with hypersensitivity reactions after vaccines. Pediatrics. 2008;122(3):e771-777.
  4. Ruggeberg JU, Gold MS, Bayas JM, et al. Anaphylaxis: case definition and guidelines for data collection, analysis, and presentation of immunization safety data. Vaccine. 2007;25(31):5675-5684.
  5. Sampson HA, Munoz-Furlong A, Bock SA, et al. Symposium on the definition and management of anaphylaxis: summary report. J Allergy Clin Immunol. 2005;115(3):584-591.
  6. Webb L, Greene E, Lieberman PL. Anaphylaxis: A review of 593 cases. J Allergy Clin Immunol. 2004;113(2): S240.
  7. Bergmann K-C, Ring J (eds). History of Allergy. Chem Immunol Allergy. Basel, Karger, 2014, vol 100, pp 54-61.

Review

Review Questions 
  1. What is the most common cause of anaphylaxis?
  2. What is the most common symptom in anaphylaxis?
  3. What is the first medication and dosage used to treat an adult with anaphylaxis?
  4. Why are corticosteroids given in anaphylaxis?
  5. How do beta blockers interfere with the treatment of anaphylaxis?
  6. What is the correct disposition for a patient who has had a true anaphylactic episode in the office?
  7. What steps should be performed if a patient experiences symptoms of anaphylaxis following exposure to latex during surgery?
Resources 

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  1. Annual Meeting Webcast (AMW):
  2. Clinical Practice Guideline (Cpg):
  3. ENT for the PA-C:
  4. Patient Management Perspectives (Pmp):