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Tryptase
Tryptase greater than 1.2 times baseline level plus 2 suggestive of anaphylaxis. Baseline tryptase x 1.2 plus 2 - if the level drawn during an acute episode is higher than that-highly likely to be anaphylaxis. Comparing reaction tryptase to baseline tryptase useful in diagnosing anaphylaxis. Tryptase lasts up to 6 hours.
Anaphylaxis remains a clinical diagnosis. Tryptase supportive but retrospective.
No practical lab test available to measure platelet activating factor (PAF) but this is elevated in anaphylaxis.
Study by Dr. Simmons in US: prevalence of anaphylaxis in general population is at least 1.6% and probably higher. Prevalence of anaphylaxis in gen pop 1.6% and likely higher, fortunately rarely results in death.
Epinephrine
In the management of anaphylaxis, the ABC's have an extra "A" for adrenaline - and it comes first! Epinephrine is the only appropriate treatment for ANAPHYLAXIS (but of course, not all allergic reactions are anaphylaxis...)
Dr Moshe Ben-Shoshan from McGill presented on the Cross Canada Anaphylaxis Registry (C-CARE).
The older the patient, the less likely to use epinephrine. Dr Ben-Shoshan: In Montreal hospitals severe anaphylactic reactions were treated with Epi 100% of the time in kids, 50% in adults. Dr Ben-Shoshan: There was a direct link between increasing age in adults & decreasing likelihood of treatment with Epi for anaphylaxis.
Higher use of epinephrine for severe anaphylaxis in children compared to adults - 100% vs 50% in C-CARE study.
Dr Ben-Shoshan: Parents may hear the statement "If you use Epi, you have to go to ER" and think..."Well, I better not give Epi then.."
Food allergy is the main trigger for anaphylaxis
Food allergy is the main trigger for anaphylaxis in Montreal Children's Hospital ER.
Dr Ben Shoshan: food is about 80% of anaphylaxis in kids in Montreal. Food allergy is the main trigger for anaphylaxis in Montreal Children's Hospital ER.
Dr Ben-Shoshan: Montreal Children's hospital study showed that 0.3% of ER visits were from anaphylaxis. Higher than other countries. The rate of anaphylaxis in Canada is higher than in other countries.
In Montreal adults, similar rates of anaphylaxis in ER, most commonly to shellfish (peanuts, tree nuts, eggs, milk in children).
Rate of anaphylaxis as a presenting problem to the ED is about 0.3% at both BC children's hospital and Montreal children's hospital.
Shellfish most common food in adult anaphylaxis, peanuts in kids.