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Lindsey Creech


  • Sudden onset of signs and symptoms, usually in more than one body system, within minutes to a few hours of exposure to a trigger
  • Most common s/s are cutaneous (e.g., sudden onset of generalized urticaria, angioedema, flushing, pruritus) [Note: 10 to 20% of patients have no skin findings]
  • Danger signs – Rapid progression of symptoms, respiratory distress (e.g., stridor, wheezing, dyspnea, increased work of breathing, persistent cough, cyanosis), vomiting, abdominal pain, hypotension, dysrhythmia, chest pain, collapse
  • Treatment
    • ABCs with removal of inciting event (stop inciting medication)
    • IM epinephrine (0.3mg) autoinjector into the mid-outer aspect of the thigh may be repeated at 5- to 15-minute intervals if there is no response or an inadequate response or even sooner if clinically indicated
    • Placement in supine position with BLE elevated, unless CI (airway swelling/vomiting)
    • Supplemental oxygen
    • Volume resuscitation with IV fluids with 2 large bore IVs
    • Labs: tryptase

Seasonal allergies

  • Symptoms: runny nose, itchy/watery eyes, congestion, raised wheals (hives), eczematous rash
  • Treatment:
    • Daily PO antihistamine (loratadine, fexofenadine, cetirizine) or daily nasal antihistamine (Astelin)
    • Daily nasal fluticasone (Flonase) or Triamcinolone (Nasacort) one spray each nostril daily (increase up to BID)
    • Antihistamine Eye Drops (Panatol) for conjunctivitis
  • Refractory to medical therapy: Referral to Allergy and Immunology for allergen immunotherapy

Food allergy

  • Combinations of the following symptoms: pruritus; urticaria; flushing; swelling of the lips, face, or throat; nausea; vomiting; cramping; diarrhea; wheezing; lightheadedness; syncope; or hypotension
  • Treatment: Patients should avoid the suspected food until further evaluation by an allergist. Prescribe Epinephrine autoinjector PRN (educate patient on use).
  • Education: If the patient experiences prompt, complete, and durable response to one dose of epinephrine and has access to additional epinephrine autoinjectors, the patient does not have to present to the ER. Situations that would warrant EMS activation include severe anaphylaxis, symptoms that do not resolve promptly, completely or nearly completely, or symptoms that return or worsen.

Drug allergy

  • High risk reaction: Severe anaphylactic symptoms withing 1-6 hours of medication within the last 5 years, SJS, TEN, Serum sickness, Mouth/eye ulcerations
  • Low risk reaction: Greater than 5 years since last reaction, Urticaria only, GI symptoms only, Remote childhood reaction with limited details, FH of drug allergy, Known tolerance of drug since original reaction
  • Treatment: