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File 28.1 mild moderate allergic reaction
Mild and moderate allergic reaction
Recommend
 People with diagnosed allergies, e.g. nuts, bees, medication, should avoid trigger
agents and have a readily accessible action plan and medical alert device [1]
Background
 Mild allergic reaction – involves the skin and subcutaneous tissues [2]
 Acute urticaria – can last from a few minutes to 24 hours. If it lasts longer than 6
weeks it is considered chronic urticaria [3]
 Moderate allergic reaction – features suggesting respiratory, cardiovascular, or
gastrointestinal involvement [2]
Related topics:
DRABC resuscitation / the collapsed patient, page 35
Oxygen delivery systems, page 39
 Anaphylaxis and severe allergic reaction, page 60
Acute upper airway obstruction and choking, page 57
1.




May present with:

Mild allergic reaction [2]
–
generalised erythema
–
urticaria (hives)
–
periorbital oedema (swelling around the eyes)
–
angioedema - large, itchy red patches on the skin, mucous membranes

Moderate allergic reaction [2]

dyspnoea

stridor

wheeze

nausea

vomiting
dizziness
sweating
chest or throat tightness
abdominal pain
File 28.1 mild moderate allergic reaction
2.
Immediate management:

If moderate and indicated, give oxygen. See O2 Delivery systems to maintain O2 saturation >94%. If
>94% not maintained consult MO
3.
Clinical assessment:

Obtain complete patient history

known allergies? bees? foods? medications?

previous episodes? treatment used? was it effective?

contact with irritant – such as nickel, detergents, cosmetics, rubber, topical medication,
shampoo, hair dye, clothing?

contact with plants – stinging tree?

contact with animals? caterpillars? bird lice? bees?

recent intake of foods? seafood? peanuts?

time of potential contact with irritant?

geographical location of potential irritant?

current medications

Perform standard clinical observations + O2 saturation. Note any tachycardia or respiratory
problems

Perform physical examination

inspect face and eyes for any swelling

inspect skin surface for urticaria – describe lesions – red? swollen? flat? linear pattern?
diffuse? itchy? painful?

is the patient sweating?

inspect mucous membranes of mouth and throat for any swelling

does the patient have difficult breathing?

auscultate the chest for air entry and wheezes
4.
Management:

Consult MO if suspected irritant is medication, before recommending to cease

Mild allergic reaction (only if indicated)

topical applications can be used to relieve itch / skin irritation

oral promethazine (phenergan) or non sedating antihistamine [4]
DTP
IHW / NP / IPAP
Authorised Indigenous Health Workers and Isolated Practice Area Paramedic must consult MO
Nurse Practitioners may proceed
Route of
Duration
Form
Strength
Recommended Dosage
Administration
Tablet
10mg
Oral
Adult: 25mg TDS
While symptoms last
25mg
Children 6-12 years:
10mg BD or TDS
Children 2-5 years:
5mg BD or TDS
Suspension
5mg/5mL
Oral
Children 6-12 years:
While symptoms last
10mL BD or TDS
Children 2-5 years:
5mL BD or TDS
Provide Consumer Medicine Information if available:
Management of Associated Emergency: As for severe allergic reactions, see Anaphylaxis
Schedule


3
Promethazine
Moderate allergic reaction

Consult MO

give promethazine (phenergan) IV slowly or IM stat (0.5 mg/kg/dose, max 25 mg)

adrenaline may be required see anaphylaxis and severe allergic reaction for dose

MO may order if indicated
o salbutamol nebulised with oxygen
o hydrocortisone IV stat (2-4 mg/kg, max 200 mg)
Monitor patient response, promethazine may make patient drowsy
File 28.1 mild moderate allergic reaction
Promethazine
DTP
Injection
RIN / NP / IHW / IPAP
Authorised Indigenous Health Workers and Isolated Practice Area Paramedic must consult MO
Rural and Isolated Practice Endorsed Registered Nurses may proceed
Nurse Practitioners may proceed
Form
Strength
Route of Administration
Recommended Dosage
Ampoule
25mg/mL
IMI
Adult –up to 25mgs IV slowly
or
or 25mg IMI
IV slowly
Child – (0.5 mg/kg/dose, max 25 mg)
Give stat
Schedule
4
Provide Consumer Medicine Information if available:
Management of Associated Emergency:
[4]
5.
Follow up:
 Mild allergic reaction - review the next day and if no symptoms or findings review at next MO clinic
 Moderate allergic reaction – monitor response, discharge in consultation with MO
 Document in medical record “Allergic to…”
 If the adverse event follows an immunisation / medication notify the Adverse Drug Reaction Advisory
Committee (ADRAC) by completing the ADRAC form or by telephone.
 It may be appropriate to talk about ID bracelets (eg. Medicalert) that carry medical information such
as allergies on them
 Arrange Medical Officer follow-up
6.
Referral / Consultation:
 Consult MO for moderate allergic reaction