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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_2669_Библиотеки_им_академика_М_И_Перельмана
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ANAPHYLAXIS: Clinical Criteria for diagnosis
Kim & Fischer AACI 2011, 7(Suppl 1):S6
Anaphylaxis is
highly likely when ANY ONE of the following 3 criteria is fulfilled following exposure to an allergen:
1.
Acute onset of an illness (min to several hours) with
q Skin or mucosal tissue involvement (or both)
• Generalized hives, itch/flushing, swelling of lips/tongue/uvula
AND at least
ONE of the following:
q Respiratory compromise
• Dyspnoea, wheeze, bronchospasm, stridor, reduced PEF, hypoxemia
q Hypotension or associated symptoms of end-organ dysfunction
• Hypotonia, syncope, incontinence
2.
TWO or more of the following that occur rapidly (min to several hours) after exposure to a likely allergen for
that patient
q Skin or mucosal tissue involvement
• Generalized hives, itch/flushing, swelling of lips/tongue/uvula
q Respiratory compromise
• Dyspnoea, wheeze, bronchospasm, stridor, reduced PEF, hypoxemia
q Hypotension or associated symptoms of end-organ dysfunction
• Hypotonia, syncope, incontinence
q Persistent GI symptoms
• Painful abdominal cramps, vomiting
3.
Hypotension after exposure to a known allergen for that patient (min to several hours)
q Adults: sBP <90 mmHg or >30% decrease from patient’s baseline
1. Possible
allergen +
Skin/mucosa
+ ≥ 1 of
Resp
HoTN/EOF
2. Likely Allergen +
≥ 2 of
Skin/mucosa
Resp
HoTN/EOF
GI
3. Known
Allergen +
HoTN
ANAPHYLAXIS =
one of:
PEARL: As a general rule, any time you have more than one system involved, you should suspect anaphylaxis!
https://t.me/medicina_free
!-*#/#@@#*'<@@-"=&
Approach:
– IgE-Mediated: pruritus, urticaria, angioedema, etc.
– Non-IgE-Mediated: SJS-TENS (blistering, desquamation, conjunctivitis), DRESS (eosinophilia, fever, end-organ
involvement), serum sickness (arthritis, fever)
Management: IgE-mediated Reactions
– Allergy referral for Penicillin Skin Testing + Oral Challenge
• ~90% “PCN allergic” patients will test negative – can safely receive beta-lactam and cephalosporin antibiotics
• Positive skin test – AVOID penicillin, higher likelihood of reacting to 1
st
gen cephalosporins
– Drug Desensitization (under close observation, OK to do even in Pregnant patient (eg) with syphilis))
• If penicillin is required acutely and no time for skin testing, or skin test positive
• Note: this is a temporary induction of ‘tolerance’, and does NOT rule out allergy
• Note: this is only used in cases of IgE-mediated drug reactions (NOT if any suspicion of serum sickness, SJS-TENS,
DRESS, etc.)
– Note: Aztreonam (monobactam) – generally tolerated in penicillin allergic patients
• exception: if they have reacted to ceftazidime!
Patient history not very reliable (JAMA 2001):
PCN allergy history positive: LR+ 1.9 for +ve skin test
PCN allergy history negative: LR- 0.5 for +ve skin test
https://t.me/medicina_free
CA%$>@-'D)-B3#+*
A 30-year-old woman presents with a second pneumonia in the last
six months. She has a past medical history of recurrent pneumonias
and sinusitis. Investigations show: WBC 6, Neutrophils 3,
Lymphocytes 2, Monocytes 1.
What is most likely diagnosis?
1. Complement deficiency
2. Common variable immunodeficiency
3. HIV
4. Chronic granulomatous disease
https://t.me/medicina_free
<*B5-"
A 30-year-old woman presents with a second pneumonia in the last
six months. She has a past medical history of recurrent pneumonias
and sinusitis. Investigations show: WBC 6, Neutrophils 3,
Lymphocytes 2, Monocytes 1.
What is most likely diagnosis?
1. Complement deficiency
2. Common variable immunodeficiency
3. HIV
4. Chronic granulomatous disease
https://t.me/medicina_free
CA%$>@-'D)-BE+*
A middle-aged female presents with a 6 month history of urticaria. She
has never had any episodes of swelling. The urticaria resolve within 12hr,
with no residual bruising or scarring. She reports that she has been eating
out at restaurants more recently. She is otherwise well. Initial bloodwork
is normal including a CBC, creatinine and liver profile. What is the most
likely cause of this patient’s symptoms?
1. Chronic Idiopathic Urticaria
2. Food allergy
3. C1 esterase deficiency
4. Autoimmune Disease
https://t.me/medicina_free
<*B5-"
A middle-aged female presents with a 6 month history of urticaria. She
has never had any episodes of swelling. The urticaria resolve within 12hr,
with no residual bruising or scarring. She reports that she has been eating
out at restaurants more recently. She is otherwise well. Initial bloodwork
is normal including a CBC, creatinine and liver profile. What is the most
likely cause of this patient’s symptoms?
1. Chronic Idiopathic Urticaria
2. Food allergy
3. C1 esterase deficiency
4. Autoimmune Disease
https://t.me/medicina_free
CA%$>@-'D)-B3#+*
A pregnant patient with a history of asthma states she is allergic to
penicillin. She developed wheeze the last time she took it, while
admitted for an upper respiratory tract infection. She was referred
for penicillin skin testing, which was negative.
Penicillin is now indicated for a pregnancy acquired syphilis infection.
Which drug would you use?
1. Penicillin
2. Second-Generation Cephalosporin
3. Doxycycline
https://t.me/medicina_free
<*B5-"
A pregnant patient with a history of asthma states she is allergic to
penicillin. She developed wheeze the last time she took it, while
admitted for an upper respiratory tract infection. She was referred
for penicillin skin testing, which was negative.
Penicillin is now indicated for a pregnancy acquired syphilis infection.
Which drug would you use?
1. Penicillin
2. Second-Generation Cephalosporin
3. Doxycycline
https://t.me/medicina_free
CA%$>@-'D)-BE+*
A young man presents with occasional angioedema of his lips and
hands. Which of the following features make it least consistent with
C1 esterase deficiency?
1. Occasional GI symptoms
2. Triggered by dental procedure
3. Presence of urticaria
4. Laryngeal involvement
https://t.me/medicina_free
<*B5-"
A young man presents with occasional angioedema of his lips and
hands. Which of the following features make it least consistent with
C1 esterase deficiency?
1. Occasional GI symptoms
2. Triggered by dental procedure
3. Presence of urticaria
4. Laryngeal involvement
https://t.me/medicina_free
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