Anaphylaxis Seminar

NU2303
S22
 Learning objectives
• By the end of this session and with further self-directed study you
should be able to:
• Discuss the epidemiology and aetiology of allergy and anaphylaxis
• Describe the pathophysiology of anaphylaxis and related signs/symptoms
• Outline the emergency treatment of anaphylaxis

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 Atopy
• Atopy refers to a genetic predisposition for individuals to produce an
exaggerated immunoglobulin E (IgE) immune response to otherwise
harmless allergens.
• Examples of atopic conditions:
• Asthma
• Hay fever
• Allergic rhinitis
• Atopic eczema / dermatitis
• Allergies to foods / animals / medications etc.

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 Epidemiology
• The UK has some of the highest prevalence of atopic conditions in the
world with 44% of British adults suffering from at least one allergy.
• Almost half of sufferers have more than one allergy (approx. 10
million people).
• Allergies currently affect an estimated 30% of children in Scotland.
• Have a preexisting atopic condition significantly increases your risk of
developing anaphylaxis.
• 1 in 300 people in Europe will experience anaphylaxis at some point
during their lifetime

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 Anaphylaxis
• Anaphylaxis is a severe, life-
threatening, generalised or
systemic hypersensitivity reaction.
It is characterised by rapidly
developing, life-threatening
problems involving: the airway
(pharyngeal or laryngeal oedema)
and/or breathing (bronchospasm
with tachypnoea) and/or
circulation (hypotension and/or
tachycardia) (NICE 2021).

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 Common causes of anaphylaxis
Food Drugs
• Nuts (peanuts, tree nuts) • Antibiotics (penicillin)
• Fish (shellfish) • General anaesthesia
(neuromuscular blockers,
• Milk
anaesthetic agents)
• Egg • Aspirin
• Fruit (strawberries) • NSAID’s
• Wheat • ACE-inhibitors
• Soy • IV radiocontrast media
• Sesame
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 Common causes of anaphylaxis
• Insect stings / bites

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 Other causes
• Exercise induced anaphylaxis (EIA) – a rare disorder in which exercise
can trigger anaphylaxis during or after physical activity.
• Idiopathic – no cause can be identified.

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 Thomas: the man, the myth, the legend
• Type 1 hypersensitivity
• All nuts (peanuts / tree nuts)
• Sesame
• Pollen
• Comorbidities
• Asthma
• Eczema
• Hay fever

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 Pathophysiology
Immunologically Mediated
• Sensitisation process to allergen
• Primed mast cells in the tissues of the
body
• Subsequent exposure = mast cell (and
circulating basophil) degranulation
• Cytokines = recruit additional
WBC’s
• Inflammatory mediators including
histamine and prostaglandins

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 Histamine

Bronchoconstriction: Vasodilation:
Narrowing of the bronchioles Hypotension
Reduced air entry and gas exchange Reduced tissue perfusion
Cyanosis / hypoxia Ischemia

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 Histamine
Increased vascular permeability:
• Fluid leaves circulation and
enters surrounding tissues
• Oedema
• Angioedema
• Hypovolemia

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 Angioedema

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 Pathophysiology
• Non-immunologically Mediated
• Essentially the same process except it doesn’t involve IgE
• The allergen directly stimulates the mast cells to degranulate without having
to involve IgE antibodies
• Many drugs can trigger non-immunological anaphylaxis ( for example:
opioids, vancomycin).

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 Signs/symptoms
Airway

• Airway swelling e.g. trachea,

tongue
• Difficulty breathing and/or
swallowing
• Sensation of ‘throat closing up’
• Hoarse voice
• Stridor

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 Signs/symptoms
Breathing

• Shortness of breath / increased

work of breathing
• Use of accessory muscles of
breathing
• Tachypnoea
• Respiratory arrest
• Lethargy / exhaustion /
confusion
• Cyanosis
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 Signs/symptoms
Circulation

• Hypotension
• Tachycardia
• Decreased conscious level
• Myocardial ischemia / angina
• Cardiac arrest

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 Signs/symptoms
Disability
• Sense of impending doom
• Anxiety / panic
• Decreased conscious level

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 Signs/symptoms
Exposure

• Erythema (patchy or generalised red

rash)
• Urticaria (aka hives, weals, welts)
• Angioedema (deep tissue swelling –
eyelids, lips, mouth, throat).

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 Management
• ABCDE assessment
• Diagnosis – looking for acute onset of Airway and/or Breathing and/or
circulatory problems +/- skin changes
• Call for help (2222 or 999)
• Remove trigger (if possible)
• Lie patient flat (sitting position may support breathing)

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 Management
• Administer IM adrenaline (epinephrine)
• Establish airway
• Give high flow O2
• Apply monitoring: pulse oximetry, ECG, blood pressure
• If no response – repeat IM adrenaline after 5 mins & IV fluid bolus

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 References
• ANAPHYLAXIS UK, 2023. Allergy factsheets. [online]. Farnborough: Anaphylaxis
UK. Available from: https://www.anaphylaxis.org.uk/factsheets/ [Accessed 01
December 2023].
• HUETHER, S. and MCCANCE, K., 2019. Pathophysiology. The biological basis for
disease in adults and children. 8th ed. Maryland Heights, MO: Mosby.
• NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE (NICE), 2021.
Anaphylaxis. Assessment to confirm an anaphylactic episode and the decision to
refer after emergency treatment for a suspected anaphylactic episode. London:
NICE.
• RESUSCITATION COUNCIL UK, 2021. Emergency treatment of anaphylaxis:
Guidelines for healthcare providers. London: Resuscitation Council UK.

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