Tim Gieseke MD CMD TimothyGiesekegmailcom What We Know 2 cases of Anaphylaxis in the UK United Kingdom in persons who had known prior anaphylaxis carried Epipens and did well 2 cases of anaphylaxis in USA with one in someone who did not have prior anaphylaxis history Both did well ID: 934651
Download Presentation The PPT/PDF document "COVID-19 MRNA VACCINES – caution re An..." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
COVID-19 MRNA VACCINES – caution re Anaphylaxis
Tim Gieseke MD, CMD
TimothyGieseke@gmail.com
Slide2What We Know
2 cases of Anaphylaxis in the UK (United Kingdom) in persons who had known prior anaphylaxis, carried Epipens, and did well
2 cases of anaphylaxis in USA with one in someone who did not have prior anaphylaxis history. Both did well
CDC now recommends against the mRNA vaccines if a prior history of anaphylaxis to an injectable.
C
aution
if
history of food
, drug, or insect sting allergy.
Cause of
anaphylaxis
isn’t known, but
mRNA component unlikely to trigger anaphylaxis
Multiple carrier ingredients are part of vaccine and some may trigger an allergic reaction
These ingredients are identified on each vaccine’s fact sheets, which should be reviewed prior to vaccine administration.
Slide3Early recognition is key
A
potentially life-threatening multisystem syndrome caused by the sudden release of mast cell mediators into the systemic
circulation triggered by IGE
mediated allergy to specific foods, drugs, or insect stings
Life time prevalence in USA = 1.6%
An acute illness evolving over minutes to hours that may involve the
skin or mucous membranes
(hives,
pruritis
, swollen lips, tongue, uvula) and
at least one
of following:
Respiratory compromise
(dyspnea, wheezing, stridor, reduced peak flow, hypoxemia)
Reduced tissue perfusion
(hypotension,
hypotonia
, syncope, incontinence). Hypotension = SBP<90 or 30 mmHg < usual SBP
GI ischemia symptoms
(nausea, vomiting, abdominal colic)
Slide4Other Characteristics
Usually occurs within seconds to minutes of a defined exposure with quickest onset and progression when an IV exposure.
Time from onset to death in IV exposures may be 5 minutes.
Early presentation may be subtle
Only weakness and malaise.
Mental dullness with patient not recognizing or reporting they could be seriously ill.
Cutaneous manifestations ~ 90% of
time
CDC
recommends observe patients for 30 minutes
after
vaccine given.
Slide5Treatment
If anaphylaxis suspected,
dial 911
Stat epinephrine
by
auto injector
IM lateral proximal
thigh
Reverse Trendelenburg and monitor vital signs
Position on Left side if vomiting, especially if pregnant.
O2
by non-rebreathing mask at 15 LPM & monitor O2 sats
Only administer antihistamines (optional) after Epi given.
Consider bronchodilators if severe bronchospasm
Transfer to ER ASAP
. Paramedics generally:
S
tart large bore (14-16 gauge) IV for NS infusion
Consider IV epinephrine (1 mg/ml) – slow infusion
Telemetry
Intubate if airway compromised
Consider IV Solumedrol