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Paediatrics: Anaphylaxis
2021-03-10 12:00 AM
Anaphylaxis is a life-threatening allergic event. It is the extreme clinical example of an immediate hypersensitivity reaction.
Anaphylaxis
Anaphylaxis is a life-threatening allergic event. It is the extreme clinical example of an immediate hypersensitivity reaction.
Symptoms
The reaction includes the involvement of:
- Skin: urticaria and angioedema.
- Respiratory: acute airway obstruction with laryngeal oedema and bronchospasm.
- Gastrointestinal: severe abdominal cramping and diarrhoea.
- Systemic: hypotension and shock.
Aetiology
The symptoms of anaphylaxis are abrupt, often within minutes of exposure to an antigen. The causes are:
- Drugs: penicillin, aspirin.
- Injections: radiographic contrast dyes.
- Stings: bites and envenomations.
- Foods: shellfish, nuts, peanuts, eggs.
Diagnosis
Take a careful history and aim to determine the time between the onset of symptoms and exposure to the potential precipitating cause.
Initial treatment
Follow a standard protocol
- ABC.
- Epinephrine (adrenaline): give SC 0.01mL/kg (1:1000, maximum dose0.5mL). Repeat every 15min if required.
- Hypotension: put the patient head-down at 30° (Trendelenburgposition) and give IV normal saline (20mL/kg bolus). IV epinephrine may be given over 2–5min (0.1mL/kg, 1:10,000), while an infusion is being prepared.
- Salbutamol: give nebulized salbutamol 0.05–0.15mg/kg in 3mL normalsaline. Approximately 2.5mg for child <30kg and 5mg for child >30kg, every 15min if required.
- Antihistamine.
- Steroid: give IV bolus methylprednisolone (2mg/kg). This dose should be followed by IV methylprednisolone 2mg/kg/day (divided every 6hr), or oral prednisolone 2mg/kg (bolus once a day).