Clinical Resources
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) Drug Dose Frequency Route Adrenaline 1:1000 300mcg (0.3 ml) prn IMI Salbutamol or adrenaline For persistent respiratory symptoms 5 mg prn Nebulized Prednisolone 1mg/kg to max 50 mg Daily for 3/7 PO Glucagon 1-2mg Stat if not responding to
AdrenalineIMI Ranitidine
For persistent hives, rhinorrhoea, epigastric pain50mg in 100ml NaClover 30 min Once or twice daily IV Phenergan
For persistent hives, rhinorrhoea12.5-25mg 8 hourly IV/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