Is anyone else seeing more Angiooedema than straight anaphylaxis or is it an east coast phenomenon?
I am seeing a steady number of folk with localised deep swelling sometime affecting the pharynx.
The area itches but is deeper than urticaria and tends to ache as much as itch.
Think salicylates as a trigger, common in spices, some fruits, probably in Red Bull, seen two cases, one going to respiratory arrest whilst visiting the region with a long drive to get home, cross reactivity with NSAID and apparently more common in women with endometriosis possibly due to increased analgesia usage.
Also when the swelling settles, the skin often peels over the area. I know this because my significant other is one of our regular patients. Three times in resus with airway symtoms in the last three years plus two episodes at home.
Adrenaline followed by a few days steroids seems to be the answer to damp down the attack sequence.
Be warned, not all cases respond to antihistamines. Some must be working via prostaglandins since Pip responds to tranexamic acid and reacts to clarityn and neoclarityn.
If anyone out there has a miracle cure please contact me off list.
Andy Volans
---------- Original Message ----------------------------------
From: Ray McGlone <[log in to unmask]>
Reply-To: Accident and Emergency Academic List <[log in to unmask]>
Date: Sat, 13 Mar 2004 10:43:33 -0000
>Yes, interesting paper. I'm glad they mentioned the problem of patients who
>can get delayed reactions in anaphylaxis. I must admit I've usually veered
>on the side of caution if adrenaline has been given and admit them for a
>period of observation....... so perhaps not necessary if just a sting. What
>do others do?
>
>Regarding the iv versus im debate. Both work........ the problem occurs when
>junior / inexperienced staff are taught about both. I've had two patients
>given neat adrenaline iv as a bolus over the years and both ended up on CCU
>though survived. The human body is very robust! One doctor was an SHO and
>the other was a GP. With the former the SHO had been to the lecture on
>anaphylaxis the week before.... though was obviously half asleep.
>
>Ray McGlone
>A&E Lancaster
>
>----- Original Message -----
>From: "Rowley Cottingham" <[log in to unmask]>
>To: <[log in to unmask]>
>Sent: Saturday, March 13, 2004 10:11 AM
>Subject: Anaphylaxis study
>
>
>> I don't know if Simon Brown still reads this forum, but can I salute his
>astonishing paper on ant
>> venom anaphylaxis? It is one of the bravest pieces of medical research
>with some of the bravest
>> volunteer patients in modern times, and his addition of atropine could
>well save lives. We recently
>> had a patient die in front of one of us of anaphylaxis, and he collapsed
>within seconds.
>>
>> Emerg Med J 2004:21;149-154.
>>
>> Best wishes,
>>
>>
>> Rowley Cottingham
>>
>> [log in to unmask]
>> Visit the new and improved http://www.emergencyunit.com
>>
>
>________________________________________________________________________
>This email has been scanned using the CleanPort MEF antivirus
>system. Funded for members by the Doctors.net.uk Bulletin service
>How does this protect me? http://www.Doctors.net.uk/qualityemail
>________________________________________________________________________
>
>
>
_______________________________________________________________________
All email and attachments sent from http://www.Doctors.net.uk have been
scanned by the MessageLabs SkyScan antivirus system
_______________________________________________________________________
|