Module 4: Allergic Reaction

Allergic Reaction Objectives

 The student will understand the
pathophysiology of Allergic Reactions
Module 4: Medical/Behavioral Emergencies
 The student will recognize and
Institute for Emergency Medical Education appropriately treat allergic reactions

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Anatomy & Physiology of the

Overview
Immune System
 Definitions
 A & P of the Immune – Allergic Reaction - response of the body’s
System immune system when challenged by a
 Pathophysiology of foreign substance
allergic reaction – Anaphylactic Reaction - a severe allergic
 Assessment and reaction in which the bodies response
causes a life threatening condition
Interventions
– Antigen - foreign material that enters the
body

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Anatomy & Physiology of the Anatomy & Physiology of the

Immune System Immune System
 Definitions  Definitions
– Antibodies - protective proteins that – Made up of the liver, spleen, bone marrow,
circulate throughout the body white blood cells (5 types) and antibodies
– Uticaria - medical term for allergy induced – The body produces a specific antibody for
rash every antigen that it comes in contact with
 Immune System – The antibodies are produced by
– Purpose is to protect the body from any lymphocytes (1 type of WBC)
and all foreign materials

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Module 4: Allergic Reaction

Anatomy & Physiology of the Types of Allergic or Immune

Immune System Reactions
 Definitions  Type 1 or Immediate Hypersensitivity
– When the antibody encounters it’s antigen, – Most common type that requires transport
it binds to or covers it, which in turn
stimulates WBC to destroy it – Most common antigens causing this
reaction
– Other WBC stimulated to release
• Insect venom
Histamine,
• Antibiotics
– Histamine
• causes tissue edema, bronchiole constriction • Nuts, Shell fish and strawberries
and other effects

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Pathophysiology
 White Blood Cells release histamine which is a
potent vasodilator which can cause the blood
vessels to leak causing edema
 The vasodilatation within the skin causes
redness and a rash (hives) or Uticaria
 If tissue swelling occurs in the upper airways, it
can cause an airway obstruction and respiratory
distress (causing Stridor)
Pathophysiology
 Histamine is also a bronchoconstrictor which
can cause wheezing and difficulties breathing
 Histamine release can also cause itchy/watery
eyes and runny nose
 General vasodilitation may cause hypotension
and shock
 The most extreme example of this reaction is
Anaphylaxis

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Types of Allergic or Immune Initial Assessment

Reactions  Assessment  Intervention
– General Impression/AVPU
 Local Reaction or Type II – Call for ALS
– Airway
– mechanism remains unchanged but the • Complaints of difficulty
swallowing, swelling in lips, – Open, clear and insert
histamine release and it’s associated mouth, throat, or tongue are
serious adjunct
symptoms stay in the immediate area of
– Breathing – High Flow Oxygen,
the exposure • Oxygen Saturation Ventilate if needed
• Check upper airways for
Stridor, crowing sounds or – Treat for Shock
high pitched whistling sounds
– Circulation
– Vital Signs
• Monitor for signs of shock

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Remember! Peal of Wisdom

 Initial Assessment  By latex allergies is  When assessing a
patient, if they state
– 75% of the patients who die from not a primary they are having an
anaphylaxis die from respiratory problems, concern to EMS allergic reaction, but
the remaining 25% die from shock providers since all have no observable
our equipment is signs or complaints of
– Therefore, the initial assessment should dyspnea or difficulty
ensure that the airway is patent and that now required to be swallowing, consider
breathing and circulation is adequate latex free going to the focused
performing appropriate initial interventions – Note the allergy and assessment prior to
if appropriate initiating oxygen
document it
therapy

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Rapid/Focused History & Rapid/Focused History &

Physical Exam
 Assessment  Intervention
– Check skin for hives
(uticaria), swelling,
redness
– Patient may complain of
ABD cramps, vomiting or
itchiness
– Does the patient have a
prescription for
epinephrine?
– Take a SAMPLE History
– History of allergies or
allergic reactions
Physical Exam
 Assessment (continued)
– Place patient on
– Substance in which the patient was exposed
Oxygen (if not
– Mode of exposure (ingestion, injection, etc.)
already done in the
initial) – Symptoms/effects
– Progression of effects and time period (the
– Administer more rapid the progression the more serious)
Epinephrine auto- • Any interventions performed (antihistamines or
injector epinephrine already taken)

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Focused History: Intervention -Rapid/Focused

Don’t forget SAMPLE/OPQRST
 S = signs (findings)
and/or symptoms
 A = allergies
 M = medications
 P = past medical history
 L = last oral intake
 E = Event, what
happened to the patient
History
 O = Onset of symptoms – Goal: reducing further histamine release and
(when did it start?) managing those problems that are already
 P = provocation (what makes present
it worse?)
 Q = quality – Drug Therapy
 R = radiation • Antihistamines are used for mild reactions but are
 S = severity not currently authorized for EMT-Basics
– Have patient rate pain on 1– • In severe cases of allergic reactions
10 scale
(anaphylaxis), epinephrine (adrenaline) is
 T = time (how long does it indicated and may be life saving
last?)

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Module 4: Allergic Reaction

State Wide Treatment Protocol:

Detailed & On Going Asses. ALLERGIC REACTION / ANAPHYLAXIS 3.2
Amended 8/5/04

 Detailed Exam  On Going Assessment  ASSESSMENT / TREATMENT

– Assess for more
subtle signs or
changes in patient
condition
– Perform an in-depth
SAMPLE history
– Remember that the
patient may suddenly
progress quickly, so
be alert for changes
– Reassess findings of the
initial assessment & vital PRIORITIES
signs – Determine if patient is in mild or severe distress:
– Remember to reassess • Mild Distress: itching, isolated urticaria, nausea, no
vital signs
respiratory distress.
• Stable: 15 minutes
• Severe Distress: stridor, bronchospasm, severe
• Unstable: 5 minutes
abdominal pain, respiratory distress, tachycardia,
– Assess interventions for
shock (systolic BLOOD PRESSURE <90), observe for
effectiveness
edema of lips, tongue or face and generalized
urticaria. Monitor and record ECG and vital signs.

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State Wide Treatment Protocol:

ALLERGIC REACTION / ANAPHYLAXIS 3.2
 BASIC PROCEDURES
– Ensure scene safety and maintain
appropriate body substance isolation
precautions.
– Maintain an open airway. This may
include repositioning of the airway,
suctioning, or use of airway adjuncts
(oropharyngeal airway/
nasopharyngeal airway) as indicated.
Assist ventilations as needed.
– Administer oxygen using appropriate
oxygen delivery device, as clinically – If patient’s BLOOD PRESSURE drops
indicated.
– Activate ALS intercept, if deemed
necessary and if available.
– Initiate transport as soon as possible
with or without ALS.
Amended 8/5/04
Medication Name & Class
– BLS STANDING ORDERS
• If patient presents in Severe Distress, as
defined in Assessment Priorities, and if
patient age is between 5 and 65 years:  Epinephrine auto-  Generic Name
administer epinephrine by auto-injection.
• A second injection may be administered, if
injector (Epi-Pen, Ana- – Epinephrine
available, in 5 minutes if necessary. NOTE: Kit)
Adult EPI-PENs® should be used on
patients greater than 30 kg (66 lbs).
Pediatric EPI-PENs® (EPI-PEN JR. ®)
 Class
should be used on patients less than 30 kg – Natural occurring  Trade Name
(66 lbs). NOTE: EMTs must contact
Medical Control prior to administration of Catacolamine within the – Adrenaline
epinephrine by auto-injector when patient is
under age 5 or over age 65. body and is a potent
vasoconstrictor and
bronchodilator that
below 100 systolic: treat for shock.
– Monitor and record vital signs every 5 counteracts the effects of
minutes at a minimum if unstable, or histamine
every 15 minutes if stable.

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Contraindications / Forms
Indications
 Must meet all of the following three  No contraindications when used in a life
criteria threatening situation
– Emergency medical care for the treatment
of the patient exhibiting the assessment
findings of an allergic reaction  Medication form - liquid administered
– Medication is prescribed for this patient by via an automatically injectable needle
a physician and syringe system
– Medical direction authorizes use for this
patient

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Actions / Dosage/ Side Effects Administration

 Actions  Side Effects  Obtain order from medical direction either on-
– Dilates the bronchiole – Increases heart rate line or off-line
– Constricts blood vessels – Pallor
 Obtain patient's prescribed auto injector.
 Dosage – Dizziness
– Adult- one adult auto- – Chest pain  Ensure
injector (0.3 mg) – Prescription is written for the patient experiencing
– Headache
– Infant and child - one the allergic reactions
infant/child auto-injector – Nausea
(0.15 mg) – Vomiting – Medication is not discolored
– Excitability,  Remove safety cap from the auto-injector
anxiousness

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Administration Re-assessment strategies

 Place tip of auto-injector against patient's thigh  Continue focused assessment of
– Lateral portion of the thigh, midway between the waist airway, breathing and circulatory status
and the knee
 Patient condition continues to worsen
 Push the injector firmly against the thigh to
activate the injector – Decreasing mental status
 Hold the injector in place until the medication is – Increasing breathing difficulty
injected – Decreasing blood pressure
 Record activity and time & Dispose of injector in  Obtain medical direction
biohazard container – Additional dose of epinephrine

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Re-assessment strategies Summary

 It is important to treat all allergic reactions
 Treat for shock (hypoperfusion) aggressively
 Prepare to initiate Basic Cardiac Life  Any patient experiencing difficulty
Support measures swallowing or other evidence of airway
– CPR/AED swelling is experiencing anaphylaxis
 Document all responses to medications  In cases of anaphylaxis, epinephrine is
extremely beneficial in improving the
patients outcome

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Questions?

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