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EM Gurus > Learning Resources > Guidelines Central > Anaphylaxis
What is it?
What is it?
Anaphylaxis is a severe, potentially life-threatening allergic reaction that develops rapidly, usually over minutes to hours.
Anaphylaxis is a severe, potentially life-threatening allergic reaction that develops rapidly, usually over minutes to hours.
WHAT ARE THE CRITERIA??
WHAT ARE THE CRITERIA??
Skin/Mucosal Symptoms + Systemic Compromise:
Skin/Mucosal Symptoms + Systemic Compromise:
- Urticaria, generalized itching/flushing, or edema of lips, tongue, uvula, or skin.
- AND one of the following:
- Respiratory distress or hypoxia.
- Hypotension or cardiovascular collapse.
- Associated symptoms of organ dysfunction (e.g., hypotonia, syncope, incontinence).
Two or More of the Following:
Two or More of the Following:
- Skin/mucosal involvement.
- Respiratory compromise.
- Hypotension or associated symptoms.
- Persistent gastrointestinal symptoms (e.g., cramps, vomiting).
Exposure to Known Allergen:
Exposure to Known Allergen:
- If the patient is exposed to a known allergen AND develops hypotension.
Note: If none of the above criteria are met, it is likely an allergic reaction and can be treated with simple antihistamines.
Note: If none of the above criteria are met, it is likely an allergic reaction and can be treated with simple antihistamines.
Note: If none of the above criteria are met, it is likely an allergic reaction and can be treated with simple antihistamines.
HOW TO TREAT??
HOW TO TREAT??
If Peri-Arrest (Impending Cardiac Arrest or Profoundly Hypotensive/Bradycardic):
If Peri-Arrest (Impending Cardiac Arrest or Profoundly Hypotensive/Bradycardic):
- IV Epinephrine:
- Adult: 50 micrograms (0.05 ml of 1 mg/ml epinephrine vial) as a bolus.
- Pediatrics: 1 mg.
- Simultaneous ABC Management:
- Airway, Breathing, Circulation.
- Epinephrine Infusion:
- Start at 1 microgram/min (0.1–0.3 microgram/kg/min for pediatrics; max 1.5 microgram/kg/min).
- Titrate to achieve resolution.
IF NOT PERI- ARREST
IF NOT PERI- ARREST
- IM Epinephrine:
- Adult: 0.3–0.5 mg (0.01 mg/kg for pediatrics).
- Repeat every 5 minutes (up to 3 doses if needed).
- If No Improvement (After IM Epinephrine):
- IV Epinephrine: 100 micrograms (0.1 ml of 1 mg/ml epinephrine vial diluted in 100 ml N/S over 5–10 minutes).
- Pediatrics: 1 microgram/kg over 10 minutes.
- Followed by Epinephrine Infusion: 1 microgram/min (0.1–0.3 microgram/kg/min for pediatrics; max 1.5 microgram/kg/min).
- IV Fluids:
- 1–2 L bolus (10–20 ml/kg for pediatrics).
- Additional Medications:
- Antihistamines: Avil (H1-antihistamine), H2-antihistamine if available.
- Steroids: Any steroid to prevent recurrence.
- Bronchodilators: Ventolin nebulization if wheeze/bronchospasm present.
- If on Beta-Blockers & Not Improving:
- Glucagon: 1–5 mg (adult).
Criteria for Discharge:
Criteria for Discharge:
A. No need for IV epinephrine.
A. No need for IV epinephrine.
B. Stable for 4–6 hours post-treatment.
B. Stable for 4–6 hours post-treatment.
- Home Medications:
- Steroids: Prednisone 1 mg/kg/day divided twice a day for 3–5 days.
- Antihistamine: H1-antihistamine (e.g., Loratadine, Cetirizine).
- H2 Blocker: Famotidine 40 mg once a day (if available).
- Calamine Lotion: For skin lesions as needed.
- Follow-Up:
- Medicine OPD follow-up in 3 days.
- Identify and counsel patient to avoid triggers.
- Explain the risk of biphasic reaction.
Reference
Reference
- EB Medicine Anaphylaxis
ContributorS
ContributorS
Author:
Author:
- Dr Faysal Subhani
Editor:
Editor:
- Dr Ayesha Saeed
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