ANAPHYLAXIS

Assess :Airway, Breathing,Circulation, Disability,Exposure

Suspect anaphylaxis if :-
 Acute onset
 Life threatening A,B or C problems
 With skin/ mucosa and/or severe
gastrointestinal problems
Give IM adrenaline (1;1000 dilution)
Children <30kg ; 0.01mg/kg IM
Children >30kg,/adults: 0.3-0.5mg IM
Site – Anterolateral thigh
Symptoms and signs :-
 Airway or breathing;- dysphagia, hoarseness,
stridor, dyspnea, tachypnea, wheeze, cyanosis
 Circulation :-tachycardia, hypotension,
dizziness, fainting , confusion
 Skin/ mucosa / GIT :- generalised pruritis,
flushing, urticaria, angioedema, vomiting,
abdominal pain
• Call for help, remove potential trigger
• Optimise posture depending on
presentation-
Respiratory distress – Propped up position
Hypotension – supine with limb elevation

 High flow oxygen at 10-15 L/min with a reservoir bag to keep Spo2>90 %
 If circulatory/severe respiratory symptoms: IV fluids – crystalloids – bolus
Children <30kg: 10-20 ml/kg (max 500ml per bolus and repeat as needed
Adults /children >30kg : 1-2 L bolus and repeat as needed
 If stridor : nebulised adrenaline as supplement to IM adrenaline
Children and adults 1mg in 4ml 0.9% NS (repeat as needed)
 If wheeze : beta 2 agonist nebulised or MDI + spacer (eg ;salbuatmol)
Children <10kg- 1.25mg , 10-20kg -2.5 mg, > 20kg – 5mg in 3ml NS nebulisation or 4-6
puffs from MDI with holding chamber – can be repeated every 20 min
Adults : 2.5-5mg nebulised or 4-6 puffs from MDI with spacer – can be repeated every
20 min

If no improvement in 5-10 min : repeat IM adrenaline and give IV fluids

Circulatory or respiratory compromise despite IM adrenaline x2

doses and IV fluids Monitor
 Consider IV adrenaline :100mcg over 5-10 min followed by  Airway patency
1mcg/min infusion (Pediatrics -0.1-0.3mcg/kg/min )  Respiratory rate , Spo2
 Pulse rate, BP, ECG
 Consider early definitive airway In severe anaphylaxis
 Conscious level
 Cardiac arrest : CPR as per ACLS protocol  Urine output

Consider additional treatment : Antihistamines – 

H1 Blockers – eg :Diphenhydramine 1mg/kg (max 50mg )
H2 blockers – eg: Ranitidine 0.5mg/kg over 5 min (max 50mg)
Corticosteroids
Hydrocortisone 5-10mg/kg (max 250-500mg)
Methylprednsolone 1-2mg/kg (max 125mg), Prednisone 1-2 mg/kg in BID /OD
Ipratropium bromide (Child 125-250mcg and adult 250-500mcg nebulisation)
Magnesium sulfate ( Child- 25-50mg/kg and Adult- 2gm IV over 20 min)
Glucagon – 50mcg/kg (max 1mg) iv every 5 min followed by infusion at 5-15mcg/min