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Grading system for generalised hypersensitivity /
anaphylais
( Brown SGA . Clinical features and severity grading 0f anaphylaxis
J. Allergy Clin Iunol !00"# $$"(!% & '$)* %
!"#ild (involveent of the s+in)ucosal tissues% $
generalised erythea # urtica# perior,ital edea or
angioedea
%"#oderate (involvent of -espiratory# Cardiovascular# GI syst% & SB# Stridor# whee/ing# nausea# voiting# di//iness
(presyncope%#diaphoresis# chest throat tightness# a,d. pain
a,d. crap
&"Severe (hypoxia# hypotention# neurological coproise% & cyanosis(Sp! 1!2%# hypotention(adults 3SB4 5
10 6g%# confusion# collapse# 7C 7oss of
Consciousness#
incontinence.($ 8 acute hypersensitivity reaction% (! 9 ' 8 anaphylaxis%
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#anagement a'(te hypersensitivity / anaphylais
Acute hypersensitivity reaction
(involveent of the s+in# ucosal
tissues# or ,oth only%
Anaphylaxis reaction
(involveent of ! or ore syste
organ%
:ipenhydraine in; ($0)!0 g% I< <anageent of anaphylaxis
,servation for ")* hours
Good
-esponse
(no clinical
anifestation%
worsening=o -esponse=o -esponse
(,e worsen%(,e worsen%
>xplore the
prognostic factors
Another treatent
(due to the
pro,le%
Good -esponse=o -esponse
(,e worsen%
,servation
A,ulatory
ralantihistaine for ' days
=o
response
In patient
I?@:
A6$ in; i.
A6! in; i.v
Steroid in;
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#ANAGE#ENT )F ANA*+,LA-IS
History of severe allergic reaction with respiratory difficulty or
hypotension, especially if skin changes present
Oxygen high flow
Adrenalin / epinephrine (1 : 1000 0,! " 0,# $l %& (0,01 $g/kg '
)epeat in #*1# $inutes if no clinical i$prove$ent
Antihista$ine 10*+0 $g %& or slowly %ntravenously
%n addition• ive 1*+ l of fluid intravenously if clinical $anifestation of shock do not respond
to drug treat$ent• -orticosteroid for all severe or recurrent reactions . patients with asth$a
-ðyl prednisolone 1+#*+#0 $g %
- exa$ethasone +0 $g %- Hydrocortisone 100*#00 $g % slowly
continue 2y $aintenance dose• %nhaled short acting *+ agonist $ay used if 2ronchospas$ severe• asopressor (dopa$ine, do2uta$ine with titration dose
O2servation for + * ! x +3 horus, for $ild case 4ust need 5 hours
ive -orticosteroid and antihista$ine orally for ! x +3 horus6lderly ( ≥50 yo, - adrenalin dose 0,1*0,+cc %& with interval #*10 $nt
7top ad$inistration of precipitant
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FA T)RS ASS) IATE. IT+
SE0ERIT, REA TI)NS
• Age
• Allergen
• Atopy
• C?: (Cardiovascular :isease%
• C4: (Chronic ,structive 4ulonary :isease%
• Astha Bronchiale
• Acid ,ase and electrolyte in,alance
•
:rugs ( eg# ,eta),loc+er# AC>)inhi,itor%• Interval of epinephrine in;ection after exposure
