Reviewed and updated September 2010
Anaphylaxis and Allergic Reactions
(1) Background: Anaphylaxis refers to a severe allergic reaction in which
prominent skin and systemic signs and symptoms manifest. The full-blown
syndrome includes hives and/or welts, with hypotension and bronchospasm.
Complete airway obstruction is the most common cause of death in
anaphylaxis.
The elderly and immunocompromised have the greatest risk of mortality from
anaphylaxis due to the presence of preexisting disease.
(2) Risk Factors: The most common inciting agents in anaphylaxis are
medications, IV contrast materials, Hymenoptera stings, and certain foods.
•
Drugs: most common are penicillin and cephalosporin antibiotics
IV administration: result in faster and more severe reactions
Aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs)
•
Hymenoptera: Stings from wasps, bees, ants, sawflies
Local reaction and hives are much more common than full-blown anaphylaxis
•
Food allergy: Symptoms usually are mild and limited to the GI tract
Full-blown anaphylaxis can occur. Common foods include nuts (especially
peanuts), legumes, fish, shellfish, milk, and eggs
•
Latex allergy: Most common in medical settings, where use of gloves and
other latex products is everywhere.
Most reactions involve the skin and/or mucous membranes
(3) Signs & Symptoms:
Airway/respiratory signs and symptoms may include:
• Nasal congestion
• Sneezing
• Runny nose
• Cough
• Sensation of tightness in the throat **(may precede significant airway
obstruction)
• Marked swelling of the tongue and lips may obstruct the airway
• Increased respiratory rate
• High or low-pitched wheezing
• Hoarse or quiet voice and may lose speaking ability as the swelling
progresses
Reviewed and updated September 2010
•
Anxiety and restlessness is common with difficulty breathing and air
hunger
Cardiac signs and symptoms may include:
• Increased heart rate
• Low blood pressure (hypotension)
• Describes a sensation of cold
• Shock**
• Low blood pressure may cause weakness, dizziness, or syncope
• Altered level of consciousness (related to hypotension)
Skin & mucous membranes signs and symptoms:
• Anaphylactic reactions almost always involve the skin and mucous
membranes
• Hives (can occur anywhere on the skin)
• Redness
• Welts (most often appear on the lips, palms, soles, and genitalia)
• Eyes may itch and tearing may be noted
• In a local reaction, lesions occur near the site of the exposure (eg, insect
bite) and are red, swollen and itchy
(4) Management: Follow the “Anaphylactic Reaction Protocol” (next page).
For clients with signs & symptoms of severe anaphylaxis, arrange immediate
transfer to Emergency Department (ED) care.
“Anaphylaxis Kits” containing: oxygen mask, epinephrine devices (i.e. Epipen,
Twinject), diphenhydramine (oral and injectable), and intravenous (IV) equipment
and fluids, should be available at each OICH facility.
(5) Follow up and Prevention: Most patients with anaphylaxis may be treated
successfully in the ED and then discharged. Following discharge, warn patients
of the possibility of recurrent symptoms, and instruct them to seek further care if
this occurs. Refer clients to their primary care physician/nurse practitioner or to
an allergist for follow-up if appropriate.
Consider an epinephrine auto-injector prescription for clients who experience
severe reactions to bites, stings, food, or other possibly unavoidable causes.
Anaphylactic Reaction Protocol
For clients with signs & symptoms of severe anaphylaxis
Client Care Workers (CCW)
Registered Nurses (RN)
1. Assess airway patency. Obtain
1. Call 911.
client respiratory rate, heart rate, blood 2. Immediately assess airway patency.
pressure and oxygen saturation. Call
Administer oxygen by face mask.
On-call Nurse. Report vitals and
3. Have client use own epinephrine
general condition.
device (i.e. Epipen, Twinject) if
Reviewed and updated September 2010
2. Call 911 if unable to contact On-call
Nurse.
3. Have client use own epinephrine
device (i.e. Epipen, Twinject) if
available.
4. If unable, or if client has no device,
the CCW will administer epinephrine
using the client’s device or one found in
the “Anaphylaxis Kit” located in the
facility.
5. With authorization of the On-call
Nurse, the CCW may:
(a) Administer oxygen by face mask;
and/or
(b) Give diphenhydramine (Benadryl)
50 mg PO, only if client is able to
tolerate oral meds.
6. Observe closely and prepare client
for transfer to hospital until ambulance
arrives.
7. Document event.
available.
4. If unable, or if client has no device,
the Nurse will administer epinephrine
using the client’s device or one found in
the “Anaphylaxis Kit” located in the
facility.
5. Obtain client respiratory rate, heart
rate, blood pressure and oxygen
saturation.
6. Initiate IV line with large caliber (#18
or >), with Normal Saline or Ringer’s
Lactate. A keep vein open (KVO) rate
is appropriate for clients with stable
vital signs and only cutaneous
manifestations.
7. If hypotension or tachycardia is
present, administer a fluid bolus of 1 L.
8. Give diphenhydramine (Benadryl)
50 mg PO. If client is unable to tolerate
oral meds, Give diphenhydramine 2550 mg IV or IM.
9. Observe closely and prepare client
for transfer to hospital until ambulance
arrives.
10. Document event.
Reference: Krause, R. S. (2006). Anaphylaxis. E-Medicine [Electronic version].
Retrieved 11 January 2007 from http://www.emedicine.com/EMERG/topic25.h