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AMH SUMMARY
CHAPTER 1: ALLERGY & ANAPHYLAXIS
A. ANAPHYLACTIC REACTIONS
GENERAL
• Severe reactions which can be life threatening
• Involves symptoms such as urticaria, angioedema, hypotension
• Fatalities often occur from respiratory obstruction due to upper airway oedema or
bronchospasm
• Triggers include foods, drugs, stings, blood products
• Appearance of symptoms can come in minutes to several hours of exposure
TREATMENT
• Adrenaline is used for first suspicion of anaphylaxis, usually injected into the thigh when
anaphylaxis occurs
• IV fluids restore blood pressure in combination with adrenaline
• Bronchodilators such as beta2 agonists may help in relieving bronchospasm
• Glucagon may help in persistent hypotension in patients on beta blockers
• Corticosteroids have a delayed effect and are used to reduce duration of reaction and
prevent relapse
ANTIHISTAMINES
• Sedating (cyproheptadine, dexchlorpeniramine, dimenhydrinate, doxylamine, pheniramine,
promethazine, trimeprazine)
• Non sedating (cetirizine, desloratidine, fexofenadine, loratidine)
• Antagonists of histamine at H1 receptors, reducing vasodilation and capillary permeability
• Patient response to specific antihistamines varies, trialling a few antihistamines may be
required to determine the most effective agent
• Used for chronic urticaria and angioedema
• Also reduces itch, number, size and duration of urticarial lesions
• Adverse effects include drowsiness, more pronounced in sedating antihistamines such as
doxylamine and promethazine
• Other effects include dizziness, tinnitus
• Less sedating antihistamines can cause drowsiness, but not as much as sedating ones
• Cetirizine more likely to cause sedation in comparison to less sedating antihistamines
Reference
Australian Medicines Handbook. Adelaide: Australian Medicines Handbook Pty Ltd; 2011
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