Transcript Insect Sting Deaths in USA for 10-year Period of 1982-1991

2001 DEY B9-508-00 7/01
Definition of Anaphylaxis
• Systemic allergic reaction
– Affects body as a whole
– Multiple organ systems may be involved
• Onset generally acute
• Manifestations vary from mild to fatal
– Recurrence up to 8 hours later
– Protracted
– Hours to days
Signs and Symptoms of Anaphylaxis
• Skin: Flushing, Itching, swelling, hives
• Lower respiratory: Bronchospasm, throat or
chest tightness, hoarseness, wheezing,
shortness of breath, cough
• Gastrointestinal tract:
– Oral itching
– Cramps, nausea, vomiting, diarrhea
• Cardiovascular system:
– Increased ht rate then lower heart rrate,
hypotension/shock, arrhythmias, ischemia,
chest pain
Clinical Manifestations of Anaphylaxis
Signs/symptoms
Urticaria and angioedema
Upper airway edema*
Dyspnea and wheezing
Flush*
Dizziness, syncope, and hypotension
Gastrointestinal symptoms
Rhinitis*
Headache*
Substernal pain*
Itch without rash*
Seizure*
*Symptom or sign not reported in all four series
Incidence (%)
88
56
47
46
33
30
16
15
6
4.5
1.5
Anaphylaxis Fatalities
• Estimated 500–1000 deaths annually
• 1% risk
• Risk factors:
– Failure to administer epinephrine
immediately
– Beta blocker, ?ACEI therapy
– Asthma
– Cardiac disease
– Rapid IV allergen
Food-induced Anaphylaxis:
Common Triggers
• Children and adults (usually not outgrown):
– Peanuts
– Tree nuts
– Shellfish
– Fish
• Additional triggers in children (commonly outgrown):
– Milk
– Egg
– Soy
– Wheat
Latex-induced Anaphylaxis:
Triggers
• Proteins in natural rubber latex
• Component of ~40,000 commonly used items
– Rubber bands
– Elastic (undergarments)
– Hospital and dental equipment
• Latex-dipped products are biggest culprits
– Balloons, gloves, bandages, hot water bottles
Venom-induced Anaphylaxis:
Common Culprits
• Hymenoptera
– Bees
– Wasps
– Yellow jackets
– Hornets
– Fire ants
• Geographical
– Honeybees, yellow jackets most common in
East, Midwest, and West regions of US
– Wasps, fire ants most common in Southwest
and Gulf Coast
Other Causes of Anaphylactic
and Anaphylactoid Reactions
• Drugs
– Antibiotics
– Chemotherapeutic agents
– Aspirin, NSAIDs
– Biologicals (vaccines, monoclonal antibodies)
• Radiocontrast media
• Exercise
• Idiopathic
Myth: If you have been stung by a bee or eaten a peanut and
have not reacted to it then you do not have Anaphylaxis
• IgE-mediated (Type I hypersensitivity)
• Sensitization stage
• Subsequent anaphylactic response
Myth: Anaphylaxis Is Rare
REALITY:
• Anaphylaxis is underreported
• Incidence seems to be increasing
• Up to 41 million Americans at risk
(Neugut AI et al, 2001)
• 63,000 new cases per year
(Yocum MW et al, 1999)
• 5% of adults may have a history of
anaphylaxis (various surveys)
Myth: The Cause of Anaphylaxis is
Always Obvious
REALITY:
• Idiopathic anaphylaxis is common
• Triggers may be hidden
• Patient may not recall details of
exposure, clinical course
Myth: Prior Episodes
Predict Future Reactions
REALITY:
• No predictable pattern
• Severity depends on:
– Sensitivity of the individual
– Dose of the allergen
Myth: Anaphylaxis is Easy to Avoid If
You Know What You are Allergic To
REALITY:
• Most cases of anaphylaxis are due to
accidental exposures
Treatment of Anaphylaxis
• Immediate treatment with epinephrine
imperative
– No contraindications in anaphylaxis
– Failure or delay associated with fatalities
– IM may produce more rapid, higher peak
levels vs SC
– Must be available at all times
• Antihistamine (oral or parenteral; if oral, use
liquid or chewable tablet)
• Call 911; proceed to Emergency Room
Myth:
Epinephrine is Dangerous
REALITY:
• Risks of anaphylaxis far outweigh risks
of epinephrine administration
• Minimal cardiovascular effects in children
(Simons et al, 1998)
• Caution when administering epinephrine in
elderly patients or those with known cardiac
disease
EpiPen® 2-Pak
Call for help (911); transport patient to
emergency care facility
Stay calm;
Keep patient warm
How to use an epipen.
Risk Management for Anaphylaxis
• Be aware of the problem and keep your “index
of suspicion” high.
•
The school nurse will
– EDUCATE: the student
– Draft an Emergency Plan
– In form staff of KNOWN anaphylactic
students and STAFF