Allergy is an adverse response of the immune system. The symptoms can affect one organ or be multi-system.

Signs and symptoms of allergy:

• Itching
• Angioedema
• Urticaria
• Rhinitis
• Cough
• Itchy eyes, watery eyes
• Wheeze
• Diarrhoea
• Vomiting
• Anaphylaxis

At least 2 organ systems are usually involved. May be triggered by cofactors such as: exercise, medication, (antacids) infection.

Anaphylaxis is defined as a “severe life-threatening, generalised or systemic hypersensitivity reaction.”

Anaphylaxis is characterised by: rapidly developing, life threatening, airway and/or breathing and/or circulation problem, usually with skin and/or mucosal changes.

Suspected drug allergy is any reaction caused by a drug with clinical features compatible with immunological mechanism. All drugs have the potential to cause adverse drug reactions, but not all of these are allergic in nature.

Common drugs causing allergic reactions:

• Antibiotics such as penicillins, cephalosporins
• Sulphonamides, aspirin, NSAIDs
• Neuro-muscular blocking agents (atricurium, vecuronium, pancuronium)
• Chlorhexidine
• Latex

If anaphylaxis is suspected:

• Secure the airway
• Lay patient flat with legs raised and Call for help
• Give intramuscular adrenaline immediately (most nursing homes doesn’t have adrenaline in stock for such intervention; but patient if is known with allergy may have prescribed EpiPen)

Regulation 238 of the Human Medicine Regulation, 2012 allows for certain prescription only medicines to be administered by anyone for the purpose of saving life in an emergency. These medicines include:

• Adrenaline 1:1000 up to 1 mg for intramuscular use in anaphylaxis
• Chlorphenamine injection
• Hydrocortisone injection

To avoid any Allergy incidents:

• Always ask patient if they have any allergies
• Patient allergies should be recorded on all medical record including: medical profile, clinical notes, Mar sheet, allergy prevention care plan
• If food allergy present the kitchen must be informed as well as all staff on duty; for the new staff they must be informed in the first day of their induction.

Anaphylaxis algorithm