Common Allergic Reactions

Anaphylactic shock

Anaphylactic shock occurs rapidly and is life-threatening.

a systemic, type I hypersensitivity reaction that often has fatal consequences.

Anaphylaxis causes the immune system to release a flood of chemicals that can cause
a person to go into shock.

 Causes

 Food allergies

The most common anaphylaxis triggers in children are food allergies, such as to
peanuts, and tree nuts, fish, shellfish and milk.

 Medication allergies

Certain medications, including antibiotics, aspirin and other over-the-counter pain

relievers, and the intravenous (IV) contrast used in some imaging tests.

 Insect allergies

Stings from bees, yellow jackets, wasps, hornets and fire ants.

 Latex allergy

Latex allergy develops after many previous exposures to latex.

 Signs & Symptoms

 Itching
 Wheezing/Shortness of breath
 Hives
 Unconsciousness
 Low blood pressure
 Pale skin color
 Weakness
 Confusion

 RISK FACTORS:

• People with ASTHMA ,ECZMA ,or ALLERGIC RHINITIS

 Complications of Anaphylactic Shock:

This can contribute to potential complications such as:

 brain damage
 kidney failure
 cardiogenic shock, a condition that causes your heart to not pump enough blood
to your body
 arrhythmias, a heartbeat that is either too fast or too slow
 heart attacks
 death

 PREVENTION

 Parents should be aware of any food allergies their child may have and take
appropriate precautions to avoid exposure to those allergens.
 If a child is at risk for anaphylaxis, the pediatrician may recommend keeping an
epinephrine auto-injector, such as an EpiPen, on hand.
 Parents should be aware of the signs and symptoms of anaphylactic shock so that
they can recognize them quickly and seek medical attention if necessary.

 TREATMENT

The first and most important principle is not to panic!

Remove antigen. Removing the causative antigen such as discontinuing an antibiotic

agent could stop the progression of shock.

Administer medications. Administer medications that restore vascular tone and

provide emergency support of basic life functions.

Cardiopulmonary resuscitation. If cardiac arrest and respiratory arrest are imminent

or have occurred, cardiopulmonary resuscitation is performed

Endotracheal intubation. Endotracheal intubation or tracheostomy may be necessary

to establish an airway.

 Medications used for a patient at risk or under anaphylactic shock:

 Epinephrine. Epinephrine is given for its vasoconstrictive reaction; for

emergency situations, an immediate injection of 1:1, 000 aqueous solution, 0.1 to
0.5 ml, repeated every 5 to 20 minutes is given.
 Diphenhydramine. Diphenhydramine (Benadryl) is administered to reverse the
effects of histamine, thereby reducing capillary permeability.
 Albuterol. Albuterol (Proventil) may be given to reverse histamine-induced
bronchospasm.

 Nursing Management

Nursing management for anaphylactic shock of children involves prompt recognition

of symptoms and immediate actions to prevent further complications.
The nurse should assess the child’s airway, breathing, and circulation (ABCs) as the
first priority. If the child is not breathing, the nurse should initiate cardiopulmonary
resuscitation (CPR) and call for emergency help.

The administration of epinephrine is the most critical intervention for anaphylactic

shock. The nurse should administer epinephrine immediately following the onset of
symptoms.

The nurse should also monitor the child's vital signs and oxygen saturation, and
provide supportive care such as oxygen therapy, intravenous fluids, and
antihistamines.

Close monitoring of the child's condition is crucial to prevent recurrence of symptoms

and ensure timely interventions.

The nurse should also provide education to the child and family on anaphylaxis
management and prevention, including the importance of carrying an epinephrine
auto-injector at all times.

 REFERENCES

1. Emt-P, R. B. (2022, May 12). Symptoms of Anaphylaxis. Verywell Health.

https://www.verywellhealth.com/symptoms-of-anaphylactic-shock-1298253

2. Anaphylaxis in Infants & Children. (n.d.-a). In HealthyChildren.org.

https://healthychildren.org/English/health-issues/injuries-emergencies/Pages/

Anaphylaxis.aspx

3. Александрович, П. А. (n.d.). iLive.com.ua. https://m.iliveok.com/health/how-

anaphylactic-shock-treated-children_86059i15937.html

4. UCSF Health. (2021, June 16). Treating Anaphylactic Shock.

ucsfbenioffchildrens.org.

https://www.ucsfbenioffchildrens.org/education/treating-anaphylactic-shock

Urticaria and Angioedema

Urticaria- "Hives" (anywhere on your body, including the face, lips, tongue, throat,
and ears)
Angioedema- swelling that occurs beneath the skin (eyes, lips and sometimes of the
genitals, hands, and feet)

Acute urticaria and/or angioedema (hives or swelling lasting less than 6 weeks)
Chronic urticaria and/or angioedema are hives or swelling that lasts more than 6
weeks.

 CAUSES

 Food allergies

Shellfish, fish, peanuts, tree nuts, soy, eggs and milk are frequent offenders.

 Medication allergies

Penicillins, aspirin, ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve)
and blood pressure medications.

 Airborne allergens

Pollen and other allergens that you breathe in can trigger hives, sometimes
accompanied by upper and lower respiratory tract symptoms.

 Insect bites and infections

Other causes of acute hives and angioedema are insect bites and infections.

 COMMON SIGNS & SYMPTOMS

Urticaria

 Skin-colored, reddish on white skin, or purplish on black and brown skin

 Itchy, ranging from mild to intense
 Round, oval or worm-shaped
 As small as a pea or as large as a dinner plate

Angioedema

 Welts that form in minutes to hours

 Swelling, especially around the eyes, cheeks or lips
 Mild pain and warmth in the affected areas

Seek emergency care if you think your child's hives or angioedema is caused by a
known allergy to food or medication, as symptoms may be an early sign of an
anaphylactic reaction.

 TREATMENT

 Antihistamines are best taken daily to prevent urticaria and angioedema. For
those with recurrent urticaria and angioedema, double the normal dose is needed.
 Newer non-sedating antihistamines such as cetirizine, loratadine and
fexofenadine are preferred to older types as they are more effective and do not
make children drowsy.
 Different antihistamines should be tried and restarted if the urticaria/angioedema
returns.
 Moisturisers, tepid baths and cool temperatures can help reduce itching.
 Other medications such as leukotriene receptor antagonists and prednisolone can
be used for severe attacks.
 Low histamine or salicylate diets are not suitable for children.

 COMPLICATIONS

 Anaphylaxis
 Gastrointestinal problems
 Delayed hypersensitivity reaction

 PREVENTION

 Avoidance of known triggering factors

 Parental education and recognition of Warning Signs so that they can recognize
them quickly and seek medical attention if necessary.
 Timely diagnosis and care are essential to prevent long-term health issues that
may arise

 NURSING MANAGEMENT/RESPONSIBILITIES

 Nurses need to carefully assess the child's symptoms and determine the type and
severity of the reaction.
 In mild cases, first-line treatment includes antihistamines, while in more severe
cases, epinephrine may be necessary.
 Nurses also need to educate parents and caregivers on environmental triggers and
preventive measures such as avoiding allergens and having emergency
medication available at all times.
 Close monitoring and follow-up care are essential to ensure the child's symptoms
are managed appropriately and prevent complications.

 REFERENCES

1. Hives (Urticaria) & Angioedema Symptoms, Diagnosis & Treatment. (n.d.).

https://www.aaaai.org/Tools-for-the-Public/Conditions-Library/Allergies/

Hives-(Urticaria)-and-Angioedema-Overview
2. Hives, Urticaria, and Angioedema. (2005, April 1). WebMD.

https://www.webmd.com/allergies/hives-urticaria-angioedema

3. Ensina, L. F., Brandão, L. S., Neto, H. J. C., & Ben-Shoshan, M. (2022). Urticaria

and angioedema in children and adolescents: diagnostic challenge.

Allergologia Et Immunopathologia, 50(SP1), 17–29.

https://doi.org/10.15586/aei.v50isp1.538

4. Lester, M. R. (2016). Urticaria (Hives) And Angioedema: Diseases and Conditions

| Pediatric Oncall.

https://www.pediatriconcall.com/articles/immunology/urticaria-hives-and-

angioedema/urticaria-hives-and-angioedema-introduction

STINGING INSECT HYPERSENSITIVITY

allergic reaction to the venom injected by certain types of insects, such as bees,
wasps, hornets, and ants.

 Signs & Symptoms

 Redness
 Swelling
 Itching
 In severe cases, children may experience anaphylactic shock, which can be life-
threatening.
 RISK FACTORS:

 TREATMENT

Remove any stingers.

Gently wash the area with soap and water.

Apply a cloth dampened with cold water or filled with ice to the area of the bite or
sting for 10 to 20 minutes. This helps reduce pain and swelling.

If the injury is on an arm or leg, raise it.

Apply to the affected area calamine lotion, baking soda paste, or 0.5% or 1%
hydrocortisone cream. Do this several times a day until your symptoms go away.
Take an anti-itch medicine (antihistamine) by mouth to reduce itching. Options
include nonprescription cetirizine, fexofenadine (Allegra Allergy, Children's Allegra
Allergy), loratadine (Claritin).

Take a nonprescription pain reliever as needed

 Complications:

 Allergic Reaction, can cause death if the reaction is serious enough and your
child does not get medical care right away.
 Infection

 PREVENTION

 Not use perfumes, hairsprays, or other scented products

 Not wear brightly colored clothing
 Not walk or play outside barefoot
 Use an insect repellent made for children
 Stay away from areas that have hives and nests.
 Have professionals remove any nests.
 Stay calm and walk away slowly if an insect comes near

 Nursing Management

To be aware of the signs, symptoms, and treatments for this condition to ensure that
the patient is receiving the best possible care.

The nurse should be familiar with the triggers that can bring on an allergic reaction
and should provide education to the patient and family about how to avoid those
triggers.

Additionally, they should monitor the patient’s reactions and be aware of any changes
in their condition. If the patient is having an anaphylactic reaction, the nurse should be
prepared to provide appropriate medical treatment.

The nurse should also be vigilant in providing follow-up care to ensure that the patient
is responding well to treatment and that the condition is managed properly.

Finally, the nurse should also coordinate with other healthcare professionals to ensure
that the patient is receiving the best possible care for their stringing insect
hypersensitivity.

 REFERENCES

1. Insect bites and stings: First aid. (2022, March 18). Mayo Clinic.

https://www.mayoclinic.org/first-aid/first-aid-insect-bites/basics/art-
 20056593#:~:text=To%20treat%20a%20mild%20reaction%20to%20an

%20insect,an%20arm%20or%20leg%2C%20raise%20it.%20More%20items

2. Society, C. P. (n.d.). Stinging insect hypersensitivity: Evaluation and management

in children and youth | Canadian Paediatric Society.

https://cps.ca/en/documents/position/stinging-insect-hypersensitivity

3. Golden, D. M., Demain, J. G., Freeman, T. M., Graft, D. F., Tankersley, M. S.,

Tracy, J. D., Blessing-Moore, J., Bernstein, D. I., Dinakar, C., Greenhawt, M.,

Khan, D. A., Lang, D. M., Nicklas, R. A., Oppenheimer, J., Portnoy, J. M.,

Randolph, C., Schuller, D. E., & Wallace, D. (2017). Stinging insect

hypersensitivity. Annals of Allergy Asthma & Immunology, 118(1), 28–54.

https://doi.org/10.1016/j.anai.2016.10.031

4. Li, J. T., & Yunginger, J. W. (1992). Management of Insect Sting Hypersensitivity.

Mayo Clinic Proceedings, 67(2), 188–194. https://doi.org/10.1016/s0025-

6196(12)61321-4