Symptoms are associated with hypersensitivity and anaphylaxis

Differentiation from Other Conditions or Issues:

Nurses must be adept at differentiating hypersensitivity and anaphylaxis from other conditions that may present with similar symptoms. This requires a thorough assessment, considering the following:

• Onset and Progression: Anaphylaxis typically has a rapid onset (within minutes to a few hours of exposure to the trigger) and progresses quickly. Other conditions like asthma exacerbations or vasovagal syncope may have a slower or different pattern of progression (StatPearls, 2023).  
• Trigger Identification: A detailed history of recent exposures (foods, medications, insect stings, latex, etc.) is crucial. Identifying a potential allergen strongly suggests a hypersensitivity reaction.
• Multiple System Involvement: Anaphylaxis characteristically involves multiple organ systems (e.g., respiratory, cardiovascular, skin, gastrointestinal). Isolated symptoms are less likely to be anaphylaxis.  
• Absence of Fever: Hypersensitivity reactions, including anaphylaxis, are typically not associated with fever, which may suggest an infectious etiology.
• Response to Initial Treatments: While mild hypersensitivity reactions may respond to antihistamines, anaphylaxis requires epinephrine for reversal of life-threatening symptoms. Lack of improvement with antihistamines and rapid deterioration suggest anaphylaxis.  
• Consideration of Other Conditions:
  • Asthma Exacerbation: While both can involve breathing difficulties and wheezing, anaphylaxis often presents with skin and cardiovascular symptoms that are less common in asthma alone (Allergy & Asthma Network, 2018).
  • Vasovagal Syncope: This typically involves a slower onset of dizziness and fainting, often preceded by triggers like pain or emotional stress, and lacks the prominent respiratory and skin symptoms of anaphylaxis.
  • Panic Attack: While anxiety can cause shortness of breath and a rapid heart rate, it usually lacks the objective signs of anaphylaxis like hypotension, hives, and angioedema.
  • Myocardial Infarction: Chest pain is a primary symptom, which is less typical in anaphylaxis, although cardiovascular collapse can occur in severe cases.

Steps if the Nurse Suspects Anaphylaxis:

Immediate recognition and intervention are critical in managing suspected anaphylaxis. The nurse should take the following steps (Resuscitation Council UK, 2021; National Institutes of Health, n.d.):  

1. Immediately assess the patient's airway, breathing, and circulation (ABCs).
2. Call for help immediately! Activate the emergency response system in the healthcare setting.
3. Administer epinephrine intramuscularly (IM) in the mid-outer thigh. This is the first-line treatment for anaphylaxis and should not be delayed. Repeat the dose after 5-15 minutes if there is no improvement.  
4. Position the patient appropriately. Lay the patient flat with legs elevated to help maintain blood pressure, unless there is respiratory distress, in which case they may need to sit up. Pregnant patients should lie on their left side.
5. Administer high-flow oxygen if available.
6. Monitor vital signs frequently (blood pressure, heart rate, respiratory rate, oxygen saturation).
7. Establish intravenous (IV) access for fluid resuscitation and administration of other medications as ordered.  
8. Administer adjunctive medications as prescribed, such as antihistamines (H1 and H2 blockers) and bronchodilators. Note that these are secondary to epinephrine in the acute management of anaphylaxis. Corticosteroids may be given to prevent a biphasic reaction.  
9. Continuously reassess the patient's condition and be prepared to provide advanced airway management and cardiopulmonary resuscitation (CPR) if necessary.  
10. Document the event thoroughly, including the time of onset, suspected trigger, symptoms, interventions, and the patient's response.
11. Educate the patient and family about the allergic reaction, trigger avoidance, and the proper use of an epinephrine auto-injector if the patient is discharged. Referral to an allergist for further evaluation and management is essential.  

References:

Allergy & Anaphylaxis Australia. (n.d.). Signs and symptoms of an allergic reaction. Retrieved from https://allergyfacts.org.au/signs-and-symptoms-of-an-allergic-reaction/

Allergy & Asthma Network. (2018). Ask the allergist: Anaphylaxis or asthma flare? Retrieved from https://allergyasthmanetwork.org/news/ask-the-allergist-anaphylaxis-asthma-flare/

Cleveland Clinic. (n.d.). Allergies: Types, symptoms, treatment & management. Retrieved from https://my.clevelandclinic.org/health/diseases/8610-allergies

Mayo Clinic. (2023). Anaphylaxis - Symptoms & causes. Retrieved from https://www.mayoclinic.org/diseases-conditions/anaphylaxis/symptoms-causes/syc-20351468  

National Institute of Allergy and Infectious Diseases. (2023). Anaphylaxis. Retrieved from https://www.niaid.nih.gov/health-topics/anaphylaxis

National Institutes of Health. (n.d.). Anaphylaxis. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK482124/

Resuscitation Council UK. (2021). Emergency treatment of anaphylaxis: Guidelines for healthcare providers

. Retrieved from https://www.resus.org.uk/sites/default/files/2021-05/Emergency%20Treatment%20of%20Anaphylaxis%20May%202021_0.pdf

StatPearls. (2023). Anaphylaxis. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK482124/