Anaphylaxis Formal Diagnosis
Jun 10, 2024
We do not diagnose anaphylaxis in the operating theatre, we merely suspect it based on the clinical presentation. 🧐
Searching for a trigger during the crisis may be a fruitless exercise and distract your team from the necessary management. When the patient has been stabilised, it is now time to think about the diagnostic process. 👩🔧📈
There are two main steps for formal anaphylaxis diagnosis:
1️⃣ Serum tryptase tests
👉🏻 To confirm our suspected anaphylaxis, we first need to do blood tests to detect a spike in serum tryptase. Samples should be taken immediately once the patient is stabilised, then again at 4 and 24 hours.
👉🏻 This confirmation then allows referral for skin testing, which can take place with an ANZAAG allergy clinic around 6 weeks later.
👉🏻 As a peri-anaesthesia nurse, you can remind the team to perform these tests and ensure request forms accompany the patient to their next destination.
👉🏻 A strong suspicion of anaphylaxis despite negative tryptase tests is still ground for referral for skin testing.
2️⃣ Formal skin testing
👉🏻 Most major centres have an ANZAAG allergy clinic. If the tryptase tests were suggestive of anaphylaxis, skin testing should occur 4-6 weeks after the anaphylaxis. This allows the mast cells to normalise their histamine stores allowing for an accurate challenge.
👉🏻 The ANZAAG referral form is available on the ANZAAG website and should be completed by the anaesthetist or medical officer directly involved with the case.
In the time between your patient leaving the hospital and undergoing skin testing, they will need to be informed about their risk of future reactions based on the best information available. This is especially important if the patient is to return for urgent surgery in the near term.
Build knowledge ✅
Improve safety ✅
Ref: https://media.anzaag.com/2022/09/26104018/testing-guidelines.pdf
