| Medical emergencies in the dental surgery: anaphylactic and anaphylactoid reactions |
General considerations
Anaphylactic (IgE-mediated) and anaphylactoid (pseudoallergic) reactions have overlapping clinical features. Anaphylactic and anaphylactoid reactions usually appear within minutes of parenteral or mucosal exposure to a drug, and around 30 minutes to hours after drug ingestion.
Anaphylactic urticaria and angioedema begin soon after drug exposure. Other features of anaphylaxis include bronchospasm, laryngeal oedema, abdominal cramps, diarrhoea and hypotension.
Anaphylactoid urticaria and angioedema with or without hypotension and bronchospasm similarly present soon after drug administration. Itch and/or urticaria alone can occur in milder presentations, and are more often seen after oral administration; they are occasionally seen following subcutaneous or intramuscular administration.
See Box 13.29 and Appendix 4.1 for management of patients with anaphylactoid or anaphylactic reactions.
Management of anaphylactoid and anaphylactic reactions (Box 13.29) [NB1]
| A patient who is known to have an allergy should be instructed to bring their medication with them when they are presenting for dental treatment. If an anaphylactoid or anaphylactic reaction occurs: Call 000. Remove and/or cease allergen. Cease dental treatment. Give adrenaline (in doses shown in Appendix 4.1 for management of anaphylactic reaction), either autoinjector into the anterolateral thigh (through clothes if necessary), or tongue OR drawn-up solution into the anterolateral thigh, tongue or floor of mouth. Give oxygen. If patient loses consciousness: Institute basic life support—cardiopulmonary resuscitation (CPR), see Basic life support (Figure 14.3) Maintain treatment until assistance arrives. |
Comments
Post a Comment