AllergenAllergen
Something that causes Something that causes an an allergic reactionallergic reaction
Allergic ReactionAllergic Reaction
An exaggerated reaction by the body’s immune system to any substance
AnaphylaxisAnaphylaxis
A A LIFE-THREATENINGLIFE-THREATENING allergic allergic reaction which causes reaction which causes shockshock (hypoperfusion) and (hypoperfusion) and airway airway swellingswelling
Common causes of allergic reactions:
The usual suspects:
• Insect Stings (Bees, Wasps)
• Plants (Poison Ivy, Poison Oak)
• Foods ( Peanuts, and Shellfish)
• Medications
• Environmental (Dogs, Cats, Molds)
Signs & SymptomsSigns & Symptoms
Skin Itching
Rash/Hives – red, itchy, raised blothches
Flushing
Warm, tingling feeling
Swelling (especially face, neck, hands, feet, tongue)
Signs & SymptomsSigns & Symptoms
Respiratory Tightness in throat/chest
Cough
Rapid, labored, noisy breathing
Hoarseness
Stridor and wheezing
Signs & SymptomsSigns & Symptoms
With a SEVERE allergic reaction: Decreasing mental status Signs and symptoms of shock
(hypoperfusion) or respiratory distress
LatexLatex A latex allergy is a reaction to a material on A latex allergy is a reaction to a material on
or contained in latex.or contained in latex. Mild AcuteMild Acute
RednessRedness Itching, burning, and tinglingItching, burning, and tingling
Mild ChronicMild Chronic Dry, cracked and scaly skinDry, cracked and scaly skin
No way to predict how serious reactions will No way to predict how serious reactions will develop.develop.
Severe (Urticaria/asthma/anaphylaxis)Severe (Urticaria/asthma/anaphylaxis) Immediate (Immediate (0-30 minutes0-30 minutes) with spread to areas ) with spread to areas
remote to site contact (respiratory distress to remote to site contact (respiratory distress to anaphylaxis)anaphylaxis)
TREATMENT TREATMENT Perform initial assessmentPerform initial assessment Perform focused history and physical Perform focused history and physical
examexam
1.1. History of History of allergiesallergies??
2.2. WhatWhat was the patient exposed to? was the patient exposed to?
3.3. HowHow was the patient exposed? was the patient exposed?
4.4. What effectsWhat effects??
5.5. ProgressionProgression
6.6. InterventionsInterventions
TREATMENT TREATMENT
Assess baseline v.s. & SAMPLE historyAssess baseline v.s. & SAMPLE history Administer oxygen if not already doneAdminister oxygen if not already done Determine if pt. has Determine if pt. has prescribed epi penprescribed epi pen
available. Assist with administrationavailable. Assist with administration Follow Follow local protocollocal protocol for epi pen use when for epi pen use when
working with an EMS serviceworking with an EMS service Contact M/CContact M/C Reassess in Reassess in 2 minutes2 minutes & document & document
findingsfindings
Relationship to Airway Relationship to Airway ManagementManagement
The pt. may need The pt. may need aggressiveaggressive airway management airway management immediatelyimmediately because of because of swellingswelling in the airway in the airway or respiratory compromiseor respiratory compromise
The pt’s condition may be stable The pt’s condition may be stable initially but deteriorate to the point initially but deteriorate to the point where he/she needs aggressive where he/she needs aggressive airway managementairway management
MedicationsMedications Epinephrine Auto-injectorEpinephrine Auto-injector
Generic – Generic – epinephrineepinephrine Trade – Trade – adrenalineadrenaline
DoseDose Adult – one adult auto-injector (Adult – one adult auto-injector (0.3mg0.3mg)) Child/Infant – one child/infant auto-injector Child/Infant – one child/infant auto-injector
((0.15mg0.15mg)) ActionAction
Dilation of Dilation of bronchiolesbronchioles ConstrictionConstriction of blood vessels of blood vessels Improves perfusionImproves perfusion
Epinephrine is needed if the Epinephrine is needed if the pt.pt. Has come in contact with something that Has come in contact with something that
caused caused an allergic reactionan allergic reaction in the past in the pastAND IFAND IF
The patient has prescribed epinephrine The patient has prescribed epinephrine auto-injectorauto-injector
AND IFAND IF Patient shows S/S of Patient shows S/S of shockshock
(hypoperfusion)(hypoperfusion) OROR
Complains of Complains of respiratory distressrespiratory distress (sometimes BOTH)(sometimes BOTH)
3. Place the tip of the auto-injector on the side of the thigh,
between the hip and the knee. Push firmly against the leg
until the auto-injector activates, and hold for at least 10
seconds, or until all the medication is injected.
Case Scenario 1Case Scenario 1
40 year old male who was stung by a bee or hornet while workingoutside in the yard. Your patient has developed localized swellingand redness to the sting area, and uticaria throughout his left arm and chest.
He complains of pain to the effected area and a warm sensation around his arm and chest.
History: no meds unknown allergies, no Phx.
B/P 110/80 P 90 R 24
Allergic Reaction or Anaphylaxis
Case Scenario 2Case Scenario 270 year old male AOX2 was out side walking and was stung several times. He presents with uticaria and flushing throughout his head neck and chest. Skin is pale cool.
What would you do?
No known allergies has been stung once before, takes nitro prn, ASA daily lasix daily, atrovent, and vasotec.
B/P 100/70 R 28 P 110
Allergic reaction or Anaphylaxis
Case Presentation #3Case Presentation #3
You are dispatched to an electronics You are dispatched to an electronics manufacturing plant to see a 28-year-manufacturing plant to see a 28-year-old woman. The woman believes she is old woman. The woman believes she is having an allergic reaction. Security having an allergic reaction. Security officers will meet you at the front gate officers will meet you at the front gate and escort you to the patient.and escort you to the patient.
What specific information would you likeat this point?
Case Presentation #3Case Presentation #3
You find this patient in an office area sitting at You find this patient in an office area sitting at her desk. From a distance, you notice she is her desk. From a distance, you notice she is awake and speaking clearly. She does not awake and speaking clearly. She does not appear to have any breathing difficulty. She appear to have any breathing difficulty. She states she had just returned from lunch and states she had just returned from lunch and began to feel hot and light headed. Her friend began to feel hot and light headed. Her friend pointed out that the patient’s arms and neck pointed out that the patient’s arms and neck are very red, and that her face appears are very red, and that her face appears “puffy”.“puffy”.
Case Presentation #3Case Presentation #3 The patient states she is allergic to peanuts but The patient states she is allergic to peanuts but
has not eaten any. She went to a health food has not eaten any. She went to a health food café where she had grilled chicken and steamed café where she had grilled chicken and steamed vegetables. She has no other past history and vegetables. She has no other past history and takes no medications. Her last allergic rx was takes no medications. Her last allergic rx was similar to this. Vitals are: BP-116/70; Pulse-100; similar to this. Vitals are: BP-116/70; Pulse-100; RR-20; Lung sounds-clear and equal. No RR-20; Lung sounds-clear and equal. No difficulty swallowing, redness to her arms, chest, difficulty swallowing, redness to her arms, chest, neck and face. neck and face.
Would you like to perform any other procedures/exams/testing or obtain other history before treating?
MEDICATIONSMEDICATIONS
AntihistaminesAntihistamines: block histamine release : block histamine release caused by the antibody/mast cell reaction. caused by the antibody/mast cell reaction. These will start to work the first day you These will start to work the first day you take them, but are the most effective after take them, but are the most effective after at least 3 days of round the clock useat least 3 days of round the clock use
Nasal and pulmonary steroid inhalersNasal and pulmonary steroid inhalers: : block the allergic response. These start to block the allergic response. These start to be effective after 2-3 days of regular use, be effective after 2-3 days of regular use, but are most effective at 2 weeks.but are most effective at 2 weeks.
MEDICATIONSMEDICATIONS DecongestantsDecongestants: shrink membranes of the : shrink membranes of the
nose and sinuses, or if in an eye drop “get nose and sinuses, or if in an eye drop “get the red out”. They do not treat or prevent the red out”. They do not treat or prevent the allergic response, but do help control the allergic response, but do help control symptoms immediately.symptoms immediately.
Oral steroidsOral steroids: block the allergic response. : block the allergic response. Because of serious possible side effects Because of serious possible side effects related to blocking the immune system, related to blocking the immune system, these are rarely used for allergic rhinitis, these are rarely used for allergic rhinitis, but may be used for severe asthma but may be used for severe asthma symptoms.symptoms.