Anaphylaxis Management

Expansion

Recognition requires sudden onset, rapid progression, and life threatening Airway, Breathing or Circulation problems:

• Airway - swelling, hoarseness, stridor
• Breathing - tachypnoea, wheeze, fatigue, cyanosis, confusion
• Circulation - pale, clammy, hypotension, faintness, reduced consciousness

Skin and mucosal changes are present in about 80 per cent, but their absence does not exclude anaphylaxis, and skin changes alone are not anaphylaxis.

Immediate treatment

1. Remove the trigger, call for help
2. Lie the patient flat with legs raised. Sitting or standing a hypotensive patient up has caused deaths
3. Adrenaline 500 micrograms IM (0.5 ml of 1 in 1000) into the anterolateral thigh, repeated after 5 minutes if no improvement
4. High flow oxygen and an intravenous fluid bolus
5. If refractory after two doses, an adrenaline infusion by someone experienced

Doses by age: over 12 years 500 micrograms, 6 to 12 years 300, under 6 years 150.

Steroids and antihistamines are no longer part of initial management and must not delay adrenaline.

Afterwards: mast cell tryptase as soon as possible, at 1 to 2 hours and at 24 hours; observe for a biphasic reaction; prescribe two adrenaline autoinjectors with training; and refer to allergy services.