• Allergic Reaction SSOU Guideline

    Definition

    Acute onset illness (minutes to hours) with generalized urticaria, pruritus or flushing, swelling of lips and/or tongue maybe associated with hypotension, skin erythema, abdominal cramping, vomiting, mucosal or respiratory tract symptoms / bronchospasm in patients who respond to oxygen, IV fluids and adrenaline.

    SSOU is the ideal environment to provide the recommended 6 hours of monitoring for potential rebound phenomenae.

    Admission Criteria

    • Allergic reaction - needing observation / treatment
    • Good response to treatment / sustained response
    • If possible cease initial stimulus

     

    Exclusion Criteria

    • Ongoing airway compromise
    • Unstable vital signs eg BP < 90 after treatment
    • Ongoing reaction despite >2 doses of adrenaline
    • Persistent pulmonary complications
    • Sa02 < 94% RA
    • Anaphylaxis with major CVS co-morbidity eg: hypotension

     

    Investigations

    None specifically required

     

    Suggested Medications

    ALL PATIENTS MUST BE ON OXYGEN AND HAVE IV FLUID RUNNING (N/Saline)
    DrugDoseFrequencyRoute
    Adrenaline 1:1000300mcg (0.3 ml)prnIMI
    Salbutamol or adrenaline For persistent respiratory symptoms5 mgprnNebulized
    Prednisolone1mg/kg to max 50 mgDaily for 3/7PO
    Glucagon1-2mgStat if not responding to
    Adrenaline
    IMI
    Ranitidine
    For persistent hives, rhinorrhoea, epigastric pain
    50mg in 100ml NaClover 30 minOnce or twice daily IV
    Phenergan
    For persistent hives, rhinorrhoea
    12.5-25mg8 hourlyIV/PO

     

    Specific Observations report immediately to medical staff any of the following

    • Stridor
    • Difficulty swallowing / oropharyngeal or lip swelling
    • Hoarse voice / voice changes
    • Recurrent erythematous rash
    • Dyspnoea

     

    Specific Management Issues

    • Notify MO if adrenaline is being used, do not delay administration for severe reaction
    • Consider Epipen prescription and education prior to discharge

     

    Discharge Criteria

    • Improvement in clinical condition including skin lesions and respiratory function
    • Follow up within 24 hours arranged with GP or Clinical Immunologist
    • Adequate social support
    • Consider Epipen on discharge after education
    • Consider antihistamines/steroids for discharge

     

    Hospital Admission Criteria

    • Delayed reaction or recurrence
    • Respiratory problems persisting
    • Inability to take oral medication
    • Unstable vital signs BP < 100 systolic and or respiratory rate > 24/min
    • Continued/recurrent oropharyngeal swelling
    • Inadequate social support