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Concerns

Anaphylactic drug reaction

Cause

Mechanism

Signs and symptoms

Differential diagnosis

Action

Anaphylactic drug reaction

Life threatening hypersensitive drug reaction, which develops within seconds to minutes of exposure to a drug.

Cause

Type I allergy from exposure to an allergen/drug. Mediated by IgE antibodies.

Mechanism

Histamine-inflammatory mediators released upon exposure to an allergen, which affects all systems adversely, particularly skin, gastro-intestinal, pulmonary, cardio-vascular, and central nervous systems.

Signs and symptoms

  • Skin – erythema, intense pruritis, wheals, perspiration.
  • Head/Neck/Oral – difficult phonation, angioedema of lips, tongue and throat. Conjunctivitis, vasomotor rhinitis, “hair on end” phenomena.
  • Pulmonary – dyspnea, exaggerated rapid breathing with use of accessory muscles, high pitched crowing sounds (stridor) or no sounds from the patient, wheezing, peripheral cyanosis.
  • CNS – increased anxiety, loss of consciousness.
  • Cardio-Vascularchest pain, tachycardia, hypotension, arrhythmias, cardiac arrest.
  • Gastro-Intestinal – nausea/vomiting, fecal/urinary incontinence.

Differential diagnosis

Action

  • Stop dental treatment.
  • Remove any loose items from the oral cavity.
  • Alert emergency medical services (EMS).
  • Position chair at 45 degree angle.
  • Check, assess and record vital signs.
  • Deliver O2 with a full face mask.
  • Administer a bronchodilator, such as an β2-agonist inhaler (albuterol)  x  2 puffs.
  • If available, provide “wide open” IV fluids (normal saline or D5/1/2 [Dextrose 5% in 1/2 normal saline].
  • Administer epinephrine (0.3 ml of 1:1,000 IV, IM, Sub Cut., or consider an “epi-pen”), injectable steroid (Solu-Medrol 125 mg IV, IM, Sub Cut.), histamine blocker (diphenhydramine 50 mg IM, Sub Cut.).
  • Initiate BLS/ACLS ( if qualified).
  • Perform a crico-thyroidotomy, if necessary and if qualified.

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