• My Dashboard My Education Find an Ophthalmologist
  • Home
  • For Ophthalmologists
    • Meetings
      • AAO 2021
        • Meeting Information
          • Past and Future Meetings
          • Contact Information
          • Virtual Meeting Guide
          • Policies and Disclaimers
        • Program
          • Program Search
          • Program Highlights
          • Program Committees
          • CME
          • Meeting Archives
        • Expo
        • Registration
        • Hotels & Travel
          • Hotel Reservation Information
          • New Orleans
          • International Attendees
          • Hotel Meeting Space
        • Presenter Central
          • Presenter Central
          • Abstract Selection Process
          • Submission Policies
          • Subject Classification/Topics
          • Instruction Courses and Skills Transfer Labs
          • Papers and Posters
          • Videos
          • Grand Rounds Symposium
          • Program Participant and Faculty Guidelines
          • Faculty Development Program
        • Exhibitors
          • Exhibitor Central
          • Exhibitor Portal Information
          • New Exhibiting Companies
          • Exhibitor Resources
      • Mid-Year Forum
        • Registration and Travel
        • Congressional Advocacy Day
        • Advocacy Ambassador Program
        • Program
        • Schedule
        • Sponsored Attendees
        • News
      • Ophthalmology Business Summit
      • Codequest
        • Codequest Instructors
        • Claim Codequest CME or CEU Credit
      • Eyecelerator
    • Clinical Education
      • COVID-19
      • Education
        • Browse All Education
        • Courses
        • Cases
        • Learning Plans
        • Interactive
        • Focal Points
        • Wills Eye Manual
        • Disease Reviews
        • Clinical Webinars
        • Diagnose This
        • Self-Assessments
        • Educational Centers
          • Glaucoma Education Center
          • Pediatric Ophthalmology Education Center
          • Laser Surgery Education Center
          • Myopia Resources
          • Oculofacial Plastic Surgery Center
          • Redmond Ethics Center
      • Journals
      • Guidelines
        • Browse All Practice Guidelines
        • Preferred Practice Patterns
        • Clinical Statements
        • Compendium Guidelines
        • Complementary Therapy Assessments
        • Medical Information Technology
        • Ophthalmic Technology Assessments
        • Patient Safety Statements
        • Choosing Wisely
        • Low Vision
        • Eye Care for Older Adults
        • Eye Disease Statistics
        • About the Hoskins Center
      • Multimedia Library
        • Browse All Videos and Audio
        • Clinical and Surgical Videos
        • Presentations and Lectures
        • 1-Minute Videos
        • Master Class Videos
        • Basic Skills Videos
        • Interviews
        • Audio and Podcasts
        • Images
        • Submit an Image
        • Submit a Video
      • News
        • Browse All Clinical News
        • Editors' Choice
        • Headlines
        • Current Insight
      • CME Central
        • Browse All CME Activities
        • Claim CME Credit and View Transcript
        • CME Planning Resources
        • Complete Your Financial Disclosure
        • Joint Sponsorship Portal
        • LEO Continuing Education Recognition Award
        • Safe ER/LA Opioid Prescribing
        • Check Your Industry Payment Records
      • MOC
      • Resident Education
        • All Resident Education
        • OKAP and Board Exam Resources
          • OKAP Exam
          • Board Prep Resources
          • OKAP and Board Review Presentations
          • Study Flashcards
        • Resident Courses
        • Resident Videos
        • Cataract Master
        • Simulation in Resident Education
        • Pediatric Ophthalmology Education Center
        • News and Advice from YO Info
    • Membership
      • Join
      • Renew
      • Current Member
      • Volunteer
      • Physician Wellness
      • Member Directory
      • Member Obituaries
      • AAOE Membership
    • Advocacy
      • Advocacy News
      • Get Involved
        • Ways to Give
        • How to Get Involved
        • Congressional Advocacy
        • Support the Academy's Agenda
        • Research Legislation
        • Find Your Legislators
        • I Am an Advocate
        • Advocacy at Home
        • Advocate Tools
        • Best Practices for Advocating at Home
        • Social Media Toolkit
        • Letter to Editor
        • Town Hall Guide
        • Guide to Engaging With New Lawmakers
        • Resources
        • Attending a Political Fundraiser
      • OPHTHPAC
        • About Us
        • Join OPHTHPAC
        • OPHTHPAC Blog
      • Surgical Scope Fund
        • Support Surgery By Surgeons
        • Surgery By Surgeons Blog
    • Publications
      • EyeNet Magazine
        • Latest Issue
        • Archive
        • Subscribe
        • Advertise
        • Write For Us
        • Corporate Lunches
        • Contact
        • MIPS 2019
        • MIPS 2020
      • Focal Points
      • Ophthalmology
      • Ophthalmology Glaucoma
      • Ophthalmology Retina
      • YO Info
      • Scope
    • Subspecialties
      • Cataract/Anterior Segment
      • Comprehensive Ophthalmology
      • Cornea/External Disease
      • Glaucoma
      • Neuro-Ophthalmology/Orbit
      • Ocular Pathology/Oncology
      • Oculoplastics/Orbit
      • Pediatric Ophthalmology/Strabismus
      • Refractive Management/Intervention
      • Retina/Vitreous
      • Uveitis
    • IRIS Registry
      • About
      • Using the Registry
        • User Guide
        • Medicare Reporting
        • Maintenance of Certification
        • Non-EHR Reporting
      • Sign Up
        • Application Process
        • Why Participate
        • Once You've Applied: Getting Started
        • What Practices Are Saying About the Registry
      • Requirements
        • EHR Systems
        • Data & Technical Needs
      • Research
      • Registry Dashboard
      • News
    • Medicare Information
  • For Practice Management
    • Coding
      • Codequest
      • Ask the Coding Experts
      • Coding Updates and Resources
      • Coding for Injectable Drugs
      • ICD-10-CM
        • News and Advice
      • Ophthalmic Coding Specialist (OCS) Exam
    • Regulatory
      • Medicare Participation Options
      • Audits
      • Medicare Advantage Plans
        • Termination Appeal Letter
      • New Medicare Card
      • Provider Enrollment, Chain and Ownership System (PECOS)
      • HIPAA Resources
    • Practice Operations
      • Practice Management Advice
      • Lean Management
      • Cybersecurity
      • Private Equity
      • EHRs
        • Overview
        • Planning and Preparation
        • Vendor Selection
        • Implementation and Evaluation
        • Patient Portals
        • Resources
        • Ratings
    • Events
      • Annual Meeting
      • Business Summit
      • Codequest Courses
    • Leadership
      • AAOE Board of Directors
      • Leadership Program (OPAL)
    • Listservs
    • Resources
      • Practice Management Resource Library
      • Coronavirus Resources
      • Patient Education
      • Practice Forms Library
        • Practice Forms Library - Examination
        • Practice Forms Library - Financial
        • Practice Forms Library - HIPAA
        • Practice Forms Library - Human Resources
        • Practice Forms Library - Job Descriptions
        • Practice Forms Library - Patient Forms
        • Practice Forms Library - Protocols
        • Practice Forms Library - Surgery
      • Practice Analytics
        • Benchmarking Tool
        • Salary Survey
      • Consultant Directory
      • Ophthalmology Job Center
      • Practice Management for Retina
      • Reopening and Recovery
    • Get Involved
    • Medicare
      • Quality
        • Overview
        • Reporting
        • Measures
      • Promoting Interoperability
        • Overview
        • Measures
        • Attestation
        • Hardships and Exceptions
        • Audits
        • News and Advice
      • Improvement Activities
        • Overview
        • List of Improvement Activities
        • Attestation
        • Audits
      • Cost
      • Avoid a Penalty
      • Resources
        • 2019 to 2020 MIPS Changes
        • MIPS Solo and Small Practice Survival Guide
        • MIPS Glossary
        • MIPS Resources on EyeNet
        • MIPS Extreme Hardship Exceptions
        • Solo and Small-Practice Roadmap
        • MIPS Manual
        • MIPS Large Practice Roadmap
        • IRIS Registry User Guide
        • CMS Websites
        • 2020 MIPS Payments: Understanding Remittance Advice Codes
        • Final Checklist for EHR/Non-EHR 2019 MIPS Reporting
        • MIPS Tips
        • MIPS Archive
    • Membership
  • For Public & Patients
    • Eye Health A-Z
    • Symptoms
    • Glasses & Contacts
    • Tips & Prevention
    • News
    • Ask an Ophthalmologist
    • Patient Stories
    • No Cost Eye Exams
    • Español
      • A - Z de Salud Ocular
      • Síntomas
      • Anteojos y Lentes de Contacto
      • Consejos y Prevención
      • Noticias
      • Relatos de Pacientes
      • Exámenes de la vista sin costo
      • English
  • AAO 2021
    • Meeting Information
      • Past and Future Meetings
      • Contact Information
      • Virtual Meeting Help
      • Virtual Meeting Guide
      • Policies and Disclaimers
    • Program
      • Program Search
      • Program Highlights
      • Program Committees
      • CME
      • Meeting Archives
    • Expo
    • Registration
    • Hotels & Travel
      • Hotel Reservation Information
      • New Orleans
      • International Attendees
      • Hotel Meeting Space
    • Presenter Central
      • Presenter Central
      • Abstract Selection Process
      • Submission Policies
      • Subject Classification/Topics
      • Instruction Courses and Skills Transfer Labs
      • Papers and Posters
      • Videos
      • Grand Rounds Symposium
      • Program Participant and Faculty Guidelines
      • Faculty Development Program
    • Exhibitors
      • Exhibitor Central
      • Exhibitor Portal Information
      • New Exhibiting Companies
      • Exhibitor Resources
  • About
    • Who We Are
      • What We Do
      • About Ophthalmology
      • The Eye Care Team
      • Ethics and the Academy
      • History
      • Museum of Vision
      • Values
    • Governance
      • Council
      • Board of Trustees
      • Committees
      • Academy Past Presidents
      • Secretariats
      • Elections
      • Academy Blog
      • Academy Staff Leadership
    • Leadership Development
    • Awards
      • Laureate Recognition Award
      • Outstanding Advocate Award
      • Outstanding Humanitarian Service Award
      • International Blindness Prevention Award
      • Distinguished Service Award
      • Guests of Honor
      • Secretariat Award
      • Straatsma Award
      • Achievement Award Program
      • Artemis Award
      • EnergEYES Award
      • International Education Award
      • International Scholar Award
      • Commitment to Advocacy Award
      • Visionary Society Award
    • Financial Relationships
    • Policy Statements
    • Related Organizations
      • Subspecialty/Specialized Interest Society Directory
      • State Society Directory
      • Subspecialty/Specialized Interest Society Meetings
      • State Society Meetings
      • Resources for Societies
    • Year in Review
      • 2019 Year in Review
  • Foundation
    • About
      • Funding Allocations and Sources
      • 2019-2020 Annual Report
      • Annual Report Archives
      • News From the Chair
      • Foundation Staff
    • Our Impact
      • Partners for Sight
      • Donor Spotlights
      • Global Ophthalmic Community
      • Sponsorships
      • Patients and the Public
    • Giving Options
      • Our Supporters
      • Estate and Planned Giving
      • Ophthalmic Business Council
    • Orbital Gala
      • Why Attend
      • Photo Recap
      • Corporate Support Opportunities
      • Tribute Gifts
      • Silent Auction
      • Corporate Sponsors
    • Donate
    • Museum of the Eye Campaign
      • Museum Supporters
  • Museum of the Eye
    • Visit
    • Events
    • Explore
      • Research and Resources
      • Collection Search
      • Previous Exhibits
      • Oral Histories
      • Biographies
    • Volunteer
    • Mailing List
    • Donate
    • About the Museum
      • Museum Blog
  • Young Ophthalmologists
    • YO Info
    • Learn to Bill
    • Engage with the Academy
  • Senior Ophthalmologists
    • Scope
    • Practice Transitions
  • International Ophthalmologists
    • Global Programs and Resources for National Societies
    • Awards
    • Global Outreach
  • Residents
  • Medical Students
×
Log In Create an Account
  • For Ophthalmologists
  • For Practice Management
  • For Public & Patients
  • About
  • Foundation
  • Museum of the Eye
  • COVID-19
  • Journals
  • Education
    • Education
    • Courses
    • Cases
    • Learning Plans
    • Interactive
    • Focal Points
    • Wills Eye Manual
    • Disease Reviews
    • Clinical Webinars
    • Diagnose This
    • Self-Assessments
    • Education Centers
      • Glaucoma Education Center
      • Pediatric Ophthalmology Education Center
      • Laser Surgery Education Center
      • Oculofacial Plastic Surgery Center
      • Redmond Ethics Center
      • Myopia Resources
  • Guidelines
    • Practice Guidelines
    • Preferred Practice Patterns
    • Clinical Statements
    • Ophthalmic Technology Assessments
    • Patient Safety Statements
    • Complementary Therapy Assessments
    • Compendium Guidelines
    • Medical Information Technology
    • Low Vision
    • Choosing Wisely
    • Eye Care for Older Adults
    • Eye Disease Statistics
    • About the Hoskins Center
    • Artificial Intelligence
    • Premium IOLs
  • Multimedia
    • Multimedia Library
    • Video
      • 1-Minute Videos
      • Presentations and Lectures
      • Master Class Videos
      • Basic Skills Videos
      • Clinical and Surgical Videos
      • Interviews
      • Resident Lectures
      • Submit a Video
    • Audio and Podcasts
    • Images
      • Submit an Image
  • News
    • Clinical News
    • Editors' Choice
    • Headlines
    • Current Insight
  • CME
    • CME Central
    • Claim CME Credit and View Transcript
    • CME Planning Resources
    • Complete Your Financial Disclosure
    • Joint Sponsorship Portal
    • LEO Continuing Education Recognition Award
    • Safe ER/LA Opioid Prescribing
    • Check Your Industry Payment Records
  • MOC
  • Residents
    • Resident Education
    • OKAP and Board Exam Resources
      • OKAP Exam
      • Board Prep Resources
      • OKAP and Board Review Presentations
      • Study Flashcards
    • Resident Courses
    • Resident Videos
    • Cataract Master
    • Simulation in Resident Education
    • Diversity and Inclusion Education
    • Pediatric Ophthalmology Education Center
    • News and Advice from YO Info
    • Clinical Education /
    • Book Excerpts /
    • Basic and Clinical Science Course - Excerpt
  • 2020–2021 BCSC Basic and Clinical Science Course™

    Go to Academy Store Learn more and Purchase.

    1 Update on General Medicine

    Chapter 16: Medical Emergencies and Ocular Adverse Effects of Systemic Medications

    Shock

    Anaphylaxis

    Anaphylaxis is an acute allergic reaction following antigen exposure in a previously sensitized person; it requires immediate and specific therapy. It is usually mediated by immunoglobulin E antibodies and involves release of chemical mediators from mast cells and basophils. Anaphylactoid reactions, which are more common and less severe, are triggered by nonantigenic agents and are the result of direct release of these chemical mediators. Anaphylaxis or anaphylactoid reactions may occur after exposure to pollen, drugs, foreign serum, insect stings, diagnostic agents such as iodinated contrast materials or fluorescein, vaccines, local anesthetics, and food products. The most important parameter for predicting such an attack is a history of a previous allergic reaction to any other drug or possible antigen. Unfortunately, a history of known sensitivity may not always be elicited. Studies indicate that the prevalence of anaphylaxis has been increasing steadily since 2008.

    Anaphylaxis is particularly important to the ophthalmologist, in view of the increasing number of surgical procedures and fluorescein angiograms performed in the office setting. It is estimated that allergic reactions to fluorescein (including urticaria) occur in up to 1% of all angiograms. In 1 survey, the overall risk of a severe reaction was 1 in 1900 patients, including a risk of respiratory compromise in 1 in 3800 subjects. If diaphoresis, apprehension, pallor, a rapid and weak pulse, or any combination thereof develops in a patient after administration of a drug, the patient should be considered to have an allergic reaction until proven otherwise. The diagnosis is confirmed if the patient experiences associated generalized itching, urticaria, angioedema of the skin, dyspnea, wheezing, or arrhythmia. Anaphylaxis may rapidly lead to loss of consciousness, shock, cardiac arrest, coma, or death.

    Once an acute allergic reaction is suspected, prompt treatment is indicated:

    • Oxygen should be administered to patients in respiratory distress.

    • Epinephrine (0.3 mL of a 1:1000 solution) injected intramuscularly in a limb opposite to the antigenic agent exposure site is usually effective for the maintenance of circulation and blood pressure.

    • IV volume expansion may be necessary to restore and maintain tissue perfusion. Methylprednisolone should be administered for serious or prolonged reactions. When given early, corticosteroids help control possible long-term sequelae.

    • Antihistamines are helpful in slowing or halting the ongoing allergic response but are of limited value in acute anaphylaxis.

    • Tracheotomy or cricothyrotomy is indicated when laryngeal edema is unresponsive to the previous methods or when oral intubation cannot be performed.

    • All patients with anaphylaxis or anaphylactoid reactions should be kept under observation for at least 6 hours.

    In cases of mild allergic reactions, the physician can administer 25–50 mg of diphenhydramine hydrochloride orally or intramuscularly and observe the patient closely to determine whether further treatment is necessary. Pretreating high-risk patients with an antihistamine, corticosteroids, or both prior to fluorescein angiography may reduce the risk of an allergic reaction. In all cases of anaphylaxis, supportive treatment should be maintained until the emergency medical team arrives.

    For patients with a known history of anaphylaxis, personal emergency kits containing epinephrine are available and can be used until medical help arrives. The kits are designed to allow self-treatment by the patient or administration by a family member or an informed bystander. One commercially available allergy kit contains a syringe and needle preloaded with 0.6 mL of 1:1000 epinephrine. The physician who prescribes this kit must give detailed instructions concerning the use of the device. Epinephrine auto-injectors are also available. Each contains a spring-loaded automatic injector, which does not permit graduated doses to be given but automatically injects 0.3 mg of epinephrine (0.15 mg in the pediatric version) when the device is triggered by pressure on the thigh. The epinephrine ampules contained in these self-treatment kits have a limited shelf life and should be replaced when the expiration date is reached or if the solution becomes discolored. Any person given epinephrine requires 4–6 hours of observation to ensure that there is no rebound effect. In recent years, there has been renewed interest in treatment of allergic reactions with sublingual immunotherapy, in which the patient is exposed to the offending antigen via the gastrointestinal system to improve tolerance.

    Excerpted from BCSC 2020-2021 series: Section 1 - Update on General Medicine. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.

  • Most Commented
    Loading, please wait...
    There are no comments available.
    Most Viewed
    Loading, please wait...
    Most Viewed content is not available.
  • The Academy Store
    2021 North Carolina Codequest (Recording)
    2021 Tennessee Codequest (Recording)
    2021 Codequest (Recording)
    2021 Michigan Codequest (Recording)
    Focal Points 2020 Complete Set
    2021 Coding Coach: Complete Ophthalmic Coding Reference 
    2021 CPT: Complete Pocket Ophthalmic Reference
    2021 Retina Coding: Complete Reference Guide
    2021 Fundamentals of Ophthalmic Coding
    2021 CPT Professional Edition 
    2021 HCPCS Level ll Professional Edition
    2021 Coding Assistant: Cataract and Anterior Segment
    2021 Coding Assistant: Cornea
    2021 Coding Assistant: Glaucoma
    2021 Coding Assistant: Oculofacial
    2021 Coding Assistant: Pediatrics/Strabismus
    2021 Coding Assistant for Subspecialties 
    Recorded Webinar: 2021 Ophthalmology Coding Update
    Webinar: 2021 Ophthalmology Coding Update
    Ophthalmology Journal
    Ophthalmology Retina Journal
    Focal Points Member Benefit
    2021 ICD-10-CM for Ophthalmology: The Complete Reference 
    Conquering New E-M Documentation Guidelines for Ophthalmology
    2020-2021 Basic and Clinical Science Course Complete Set
    2020-2021 Basic and Clinical Science Course Residency Set
    2020-2021 Basic and Clinical Science Course, Section 01: Update on General Medicine
    2020-2021 Basic and Clinical Science Course, Section 02: Fundamentals and Principles of Ophthalmology
    2020-2021 Basic and Clinical Science Course, Section 03: Clinical Optics
    2020-2021 Basic and Clinical Science Course, Section 04: Ophthalmic Pathology and Intraocular Tumors
 
  • Contact Us
  • About the Academy
  • Jobs at the Academy
  • Financial Relationships with Industry
  • Medical Disclaimer
  • Privacy Policy
  • Terms of Service
  • Help
  • For Advertisers
  • For Media
  • Ophthalmology Job Center

OUR SITES

  • EyeWiki
  • International Society of Refractive Surgery

FOLLOW THE ACADEMY

Medical Professionals

  • Facebook
  • Twitter
  • LinkedIn
  • YouTube

Public & Patients

  • Facebook
  • Twitter
  • Instagram
  • YouTube

Museum of the Eye

  • Facebook
  • Twitter
  • Instagram
  • Trip Advisor
  • Yelp
© American Academy of Ophthalmology 2021