NAP 6 Perioperative Anaphylaxis Investigations The NAP 6
![NAP 6: Perioperative Anaphylaxis Investigations: The NAP 6 Data Prof. William Egner Consultant Immunologist NAP 6: Perioperative Anaphylaxis Investigations: The NAP 6 Data Prof. William Egner Consultant Immunologist](https://slidetodoc.com/presentation_image/5b18bebc24c2d4b4d8c223d2c1a1a986/image-1.jpg)
![NAP 6: Perioperative Anaphylaxis Guidelines used NICE CG 183 • N 1 written information NAP 6: Perioperative Anaphylaxis Guidelines used NICE CG 183 • N 1 written information](https://slidetodoc.com/presentation_image/5b18bebc24c2d4b4d8c223d2c1a1a986/image-2.jpg)
![NAP 6: Perioperative Anaphylaxis Tryptase: take it early At least three MCT samples available NAP 6: Perioperative Anaphylaxis Tryptase: take it early At least three MCT samples available](https://slidetodoc.com/presentation_image/5b18bebc24c2d4b4d8c223d2c1a1a986/image-3.jpg)
![Tryptase Vs. Trigger NAP 6: Perioperative Anaphylaxis Tryptase Vs. Trigger NAP 6: Perioperative Anaphylaxis](https://slidetodoc.com/presentation_image/5b18bebc24c2d4b4d8c223d2c1a1a986/image-4.jpg)
![NAP 6: Perioperative Anaphylaxis Some triggers slower onset/lower tryptases NAP 6: Perioperative Anaphylaxis Some triggers slower onset/lower tryptases](https://slidetodoc.com/presentation_image/5b18bebc24c2d4b4d8c223d2c1a1a986/image-5.jpg)
![NAP 6: Perioperative Anaphylaxis Use dynamic tryptase! NAP 6: Perioperative Anaphylaxis Use dynamic tryptase!](https://slidetodoc.com/presentation_image/5b18bebc24c2d4b4d8c223d2c1a1a986/image-6.jpg)
![NAP 6: Perioperative Anaphylaxis Presence of s. Ig. E is found in most cases NAP 6: Perioperative Anaphylaxis Presence of s. Ig. E is found in most cases](https://slidetodoc.com/presentation_image/5b18bebc24c2d4b4d8c223d2c1a1a986/image-7.jpg)
![NAP 6: Perioperative Anaphylaxis Communication Could do (much) better NAP 6: Perioperative Anaphylaxis Communication Could do (much) better](https://slidetodoc.com/presentation_image/5b18bebc24c2d4b4d8c223d2c1a1a986/image-8.jpg)
![NAP 6: Perioperative Anaphylaxis Delay in clinic assessments A bit worse than predicted by NAP 6: Perioperative Anaphylaxis Delay in clinic assessments A bit worse than predicted by](https://slidetodoc.com/presentation_image/5b18bebc24c2d4b4d8c223d2c1a1a986/image-9.jpg)
![NAP 6: Perioperative Anaphylaxis Testing Baseline correct = confirmed to be suboptimal NAP 6: Perioperative Anaphylaxis Testing Baseline correct = confirmed to be suboptimal](https://slidetodoc.com/presentation_image/5b18bebc24c2d4b4d8c223d2c1a1a986/image-10.jpg)
![NAP 6: Perioperative Anaphylaxis Quality – room for improvement NAP 6: Perioperative Anaphylaxis Quality – room for improvement](https://slidetodoc.com/presentation_image/5b18bebc24c2d4b4d8c223d2c1a1a986/image-11.jpg)
![NAP 6: Perioperative Anaphylaxis Key findings • Earlier samples gave higher MCT levels which NAP 6: Perioperative Anaphylaxis Key findings • Earlier samples gave higher MCT levels which](https://slidetodoc.com/presentation_image/5b18bebc24c2d4b4d8c223d2c1a1a986/image-12.jpg)
![NAP 6: Perioperative Anaphylaxis Key findings • • Improved access/timeliness of assessments; ideal of NAP 6: Perioperative Anaphylaxis Key findings • • Improved access/timeliness of assessments; ideal of](https://slidetodoc.com/presentation_image/5b18bebc24c2d4b4d8c223d2c1a1a986/image-13.jpg)
![NAP 6: Perioperative Anaphylaxis What did clinics do well? • • Timely assessment Comprehensive NAP 6: Perioperative Anaphylaxis What did clinics do well? • • Timely assessment Comprehensive](https://slidetodoc.com/presentation_image/5b18bebc24c2d4b4d8c223d2c1a1a986/image-14.jpg)
![NAP 6 Letter Template NAP 6: Perioperative Anaphylaxis NAP 6 Letter Template NAP 6: Perioperative Anaphylaxis](https://slidetodoc.com/presentation_image/5b18bebc24c2d4b4d8c223d2c1a1a986/image-15.jpg)
![NAP 6: Perioperative Anaphylaxis Thank you NAP 6: Perioperative Anaphylaxis Thank you](https://slidetodoc.com/presentation_image/5b18bebc24c2d4b4d8c223d2c1a1a986/image-16.jpg)
- Slides: 16
![NAP 6 Perioperative Anaphylaxis Investigations The NAP 6 Data Prof William Egner Consultant Immunologist NAP 6: Perioperative Anaphylaxis Investigations: The NAP 6 Data Prof. William Egner Consultant Immunologist](https://slidetodoc.com/presentation_image/5b18bebc24c2d4b4d8c223d2c1a1a986/image-1.jpg)
NAP 6: Perioperative Anaphylaxis Investigations: The NAP 6 Data Prof. William Egner Consultant Immunologist
![NAP 6 Perioperative Anaphylaxis Guidelines used NICE CG 183 N 1 written information NAP 6: Perioperative Anaphylaxis Guidelines used NICE CG 183 • N 1 written information](https://slidetodoc.com/presentation_image/5b18bebc24c2d4b4d8c223d2c1a1a986/image-2.jpg)
NAP 6: Perioperative Anaphylaxis Guidelines used NICE CG 183 • N 1 written information • • • N 1. 1 Allergic or non-allergic reaction N 1. 2 Drug name and a description of their reaction N 1. 3 Investigations used N 1. 4 Drugs or drug classes to avoid in future N 1. 5 Safe alternative drugs to use N 2. 1 structured written info. to patient AAGBI • MHRA reporting BSACI • • • • B 1 Drug allergy centre with expertise/high throughput B 2 Able to investigate all potential causes B 3 Dedicated drug allergy clinic B 4. 1 Skin testing B 4. 1 Drug challenge where necessary B 5 Identify the cause and recommend safe future use. B 6 Detailed report to referrer+GP; short report to patient B 7 Anaesthetist— report to MHRA B 8. 1 Identify the cause of the reaction B 8. 2 Identify drugs likely to be safe for future anaesthesia B 8. 3 Written report to referring consultant, GP and surgeon B 8. 4 Provide patient with a brief “to whom it may concern” letter B 8. 5 Provide patient with an “alert” and specific wording B 8. 6 Report to MHRA B 9 Clinic nurse with specialist allergy experience
![NAP 6 Perioperative Anaphylaxis Tryptase take it early At least three MCT samples available NAP 6: Perioperative Anaphylaxis Tryptase: take it early At least three MCT samples available](https://slidetodoc.com/presentation_image/5b18bebc24c2d4b4d8c223d2c1a1a986/image-3.jpg)
NAP 6: Perioperative Anaphylaxis Tryptase: take it early At least three MCT samples available in 67%, two in 19% and one in 8%
![Tryptase Vs Trigger NAP 6 Perioperative Anaphylaxis Tryptase Vs. Trigger NAP 6: Perioperative Anaphylaxis](https://slidetodoc.com/presentation_image/5b18bebc24c2d4b4d8c223d2c1a1a986/image-4.jpg)
Tryptase Vs. Trigger NAP 6: Perioperative Anaphylaxis
![NAP 6 Perioperative Anaphylaxis Some triggers slower onsetlower tryptases NAP 6: Perioperative Anaphylaxis Some triggers slower onset/lower tryptases](https://slidetodoc.com/presentation_image/5b18bebc24c2d4b4d8c223d2c1a1a986/image-5.jpg)
NAP 6: Perioperative Anaphylaxis Some triggers slower onset/lower tryptases
![NAP 6 Perioperative Anaphylaxis Use dynamic tryptase NAP 6: Perioperative Anaphylaxis Use dynamic tryptase!](https://slidetodoc.com/presentation_image/5b18bebc24c2d4b4d8c223d2c1a1a986/image-6.jpg)
NAP 6: Perioperative Anaphylaxis Use dynamic tryptase!
![NAP 6 Perioperative Anaphylaxis Presence of s Ig E is found in most cases NAP 6: Perioperative Anaphylaxis Presence of s. Ig. E is found in most cases](https://slidetodoc.com/presentation_image/5b18bebc24c2d4b4d8c223d2c1a1a986/image-7.jpg)
NAP 6: Perioperative Anaphylaxis Presence of s. Ig. E is found in most cases But negative tests do not make a reaction “nonallergic”
![NAP 6 Perioperative Anaphylaxis Communication Could do much better NAP 6: Perioperative Anaphylaxis Communication Could do (much) better](https://slidetodoc.com/presentation_image/5b18bebc24c2d4b4d8c223d2c1a1a986/image-8.jpg)
NAP 6: Perioperative Anaphylaxis Communication Could do (much) better
![NAP 6 Perioperative Anaphylaxis Delay in clinic assessments A bit worse than predicted by NAP 6: Perioperative Anaphylaxis Delay in clinic assessments A bit worse than predicted by](https://slidetodoc.com/presentation_image/5b18bebc24c2d4b4d8c223d2c1a1a986/image-9.jpg)
NAP 6: Perioperative Anaphylaxis Delay in clinic assessments A bit worse than predicted by baseline survey Not good
![NAP 6 Perioperative Anaphylaxis Testing Baseline correct confirmed to be suboptimal NAP 6: Perioperative Anaphylaxis Testing Baseline correct = confirmed to be suboptimal](https://slidetodoc.com/presentation_image/5b18bebc24c2d4b4d8c223d2c1a1a986/image-10.jpg)
NAP 6: Perioperative Anaphylaxis Testing Baseline correct = confirmed to be suboptimal
![NAP 6 Perioperative Anaphylaxis Quality room for improvement NAP 6: Perioperative Anaphylaxis Quality – room for improvement](https://slidetodoc.com/presentation_image/5b18bebc24c2d4b4d8c223d2c1a1a986/image-11.jpg)
NAP 6: Perioperative Anaphylaxis Quality – room for improvement
![NAP 6 Perioperative Anaphylaxis Key findings Earlier samples gave higher MCT levels which NAP 6: Perioperative Anaphylaxis Key findings • Earlier samples gave higher MCT levels which](https://slidetodoc.com/presentation_image/5b18bebc24c2d4b4d8c223d2c1a1a986/image-12.jpg)
NAP 6: Perioperative Anaphylaxis Key findings • Earlier samples gave higher MCT levels which rapidly fell within 30 minutes • Median first MCT levels rose with reaction grade - MCT level did not correlate with severity of clinical features individually • The dynamic-tryptase algorithm [(baseline tryptase x 1. 2) +2 mcg/L] increased yield by 16%. • Clinic investigations adhered fully to AAGBI guidance in 32% and to BSACI guidance in 17% – most non-adherence was through • failing to test for all potential culprit agents • poor communication • More data on the predictive values of different modes of testing using standardised methods are required for all triggers
![NAP 6 Perioperative Anaphylaxis Key findings Improved accesstimeliness of assessments ideal of NAP 6: Perioperative Anaphylaxis Key findings • • Improved access/timeliness of assessments; ideal of](https://slidetodoc.com/presentation_image/5b18bebc24c2d4b4d8c223d2c1a1a986/image-13.jpg)
NAP 6: Perioperative Anaphylaxis Key findings • • Improved access/timeliness of assessments; ideal of 6– 8 weeks post-reaction Improved communication of diagnosis and clear safe instructions for future safe anaesthesia anaesthetists in clinic to achieve this All potential culprits tested by all relevant test modalities (SPT, IDT, s. Ig. E and where appropriate challenge testing • Better standardised clinic reports should be developed, to include – – – drugs identified type of reaction drugs to avoid safe alternatives tests used communication of results: to anaesthetists, general practitioners and patients
![NAP 6 Perioperative Anaphylaxis What did clinics do well Timely assessment Comprehensive NAP 6: Perioperative Anaphylaxis What did clinics do well? • • Timely assessment Comprehensive](https://slidetodoc.com/presentation_image/5b18bebc24c2d4b4d8c223d2c1a1a986/image-14.jpg)
NAP 6: Perioperative Anaphylaxis What did clinics do well? • • Timely assessment Comprehensive assessments Achieving Diagnosis Communication with health care professionals Avoidance advice Early access for urgent cases MHRA reporting
![NAP 6 Letter Template NAP 6 Perioperative Anaphylaxis NAP 6 Letter Template NAP 6: Perioperative Anaphylaxis](https://slidetodoc.com/presentation_image/5b18bebc24c2d4b4d8c223d2c1a1a986/image-15.jpg)
NAP 6 Letter Template NAP 6: Perioperative Anaphylaxis
![NAP 6 Perioperative Anaphylaxis Thank you NAP 6: Perioperative Anaphylaxis Thank you](https://slidetodoc.com/presentation_image/5b18bebc24c2d4b4d8c223d2c1a1a986/image-16.jpg)
NAP 6: Perioperative Anaphylaxis Thank you
Nap 6 summary
Anaphylaxis grade
Anaphylaxis images
Anaphylaxis photos
Biphasic anaphylaxis
Anaphylaxis treatment
Erythroblastosis
Brighton collaboration levels
Anaphylaxis ig
Anaphylaxis classification
Anaphylaxis treatment
Anaphylaxis onset
Anaphylaxis photos
Interprofessional care for anaphylaxis
Causes of anaphylactic reaction
Anaphylaxis
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