Allergic Reactions Your immune system gone wrong….

Allergic Allergic ReactionsReactions

Your immune system Your immune system gone wrong….gone wrong….

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)

Allergic Reaction - Allergic Reaction - Signs & SymptomsSigns & Symptoms

Signs & SymptomsSigns & Symptoms

Respiratory Tightness in throat/chest

Cough

Rapid, labored, noisy breathing

Hoarseness

Stridor and wheezing

Signs & SymptomsSigns & Symptoms

Cardiac Increased heart rate

Low blood pressure

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)

Shock - HYPOPERFUSION

• Why does the body go into shock?

5 Gallons5 Gallons

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

Epinephrine Auto-InjectorsEpinephrine Auto-Injectors

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)

1. Check medication name, expiration date, clarity of solution

2. Remove safety cap.

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.

4. Properly dispose of auto-injector, and record

time.

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?

Case Presentation #3Case Presentation #3

So, what is your complete treatment plan for this patient?

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.