The first ED rounds of 2016 were well aligned. Dr Chris Vaillancourt presented an update from his recent attendance to the American College of Allergy and Immunology Conference in Texas, and Dr Todd Way presented an interactive session on ED Dermatology.
ALLERGY UPDATE
The take home messages from Dr Vaillancourt’s presentation were:
- Peanut introduction should be recommended between 4-11 months for high risk infants. See the LEAP study.
- Ace Inhibitor induced Angioedema is mediated by Bradykinin (not Histamine) so Antihistamines / Steroids are unlikely to be effective.
- Consider nebulised (aerosol) epinephrine for symptomatic tongue swelling (see ref).
- Consider Icatibant in cases where intubation may be required. A small study in the NEJM has provided some evidence of efficacy, although the control was questionable and the cost of the drug is very high.
- Patients who present with anaphylaxis from a known food allergen are less likely to have a biphasic reaction, whereas those who present with either more widespread systemic reaction or the allergen is unknown may have a biphasic reaction and this reaction may occur later than previous guidelines suggest. A recent meta-analysis looked at the Time of Onset and Predictors of Biphasic Anaphylactic Reactions. The median time to biphasic reaction was 11 hours (0.2-72 hours).
Dr Vaillancourt’s full presentation can be seen here
