Diagnosis of Anaphylaxis

Diagnosis of Anaphylaxis

Anaphylaxis Diagnosis may sometimes be difficult

Anaphylaxis Diagnosis

Diagnostic Criteria for Anaphylaxis

Following are the diagnostic points:

  1. Acute illness ( within minutes to hours) involving skin, mucosal tissues or both , and at least one of the following:

    • Respiratory compromise. Features of respiratory comprise include dyspnea, bronchospasm, stridor, hypoxemia etc)
    • Reduced blood pressure or associated symptoms of end-organ dysfunction. Features include hypotonia, syncope, collapse etc
  2. Two or more of the following that occur rapidly after exposure to a likely allergen:

    • Skin-mucosal tissue involvement. Signs include generalized hives, itch-flush, swollen lips-tongue-uvula.
    • Respiratory compromise. Signs include dyspnea, bronchospasm, stridor, hypoxemia.
    • Reduced blood pressure or associated symptoms of end-organ dysfunction. Sign include hypotonia, syncope, collapse.
    • Persistent gastrointestinal symptoms. Sign include painful abdominal cramps, vomiting
  3. Reduced blood pressure after exposure to a known allergen:

For Infants and children: Low systolic BP (age-specific) or greater than 30% decrease in systolic BP
For Adults: Systolic BP of less than 90mmHg or greater than 30% from that
person’s baseline

Investigations include

  • Serum tryptase level
  • in vitro IgE testing
  • Skin test
  • Challenge test
  • Basophil activation test

Treatment of Anaphylaxis

If someone has symptoms of anaphylaxis, you should:

Dose of Adrenaline / Epinephrine

10-20 kg (~1-5yrs) – 0.15mg (green labelled on autoinjector)

>20kg (~>5yrs) – 0.3mg (yellow labelled on autoinjector)

Pregnant woman- 0.3mg (yellow labelled on autoinjector)

If do not have autoinjector or in hospital settings

Give INTRAMUSCULAR (IM) injection of Adrenaline/ Epinephrine as follows:

  • 1:1000 solution of Adrenaline in IM into outer aspect of mid-thigh in right site.
  • 0.01mg per kg up to maximum of 0.5mg per dose can be used.
  • Repeat every 5 minutes as needed.
  • Call emergency number for an ambulance immediately
  • Remove any trigger if possible – for example, carefully remove any wasp or bee sting stuck in the skin
  • Lie the person down flat. The left lateral position is recommended for patients who are pregnant.
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