Anaphylaxis

Anaphylaxis

Written by – Dr Andrew Lam

Anaphylactic vs. Anaphylactoid Reactions

Management of Anaphylaxis

Immediate

• IM Adrenaline (0.3-0.5mg to the lateral thigh. If symptoms persist, can consider repeating dose every 5-15 minutes. However, if symptoms are refractory, prepare for an adrenaline infusion)
• If signs of bronchospasm present and refractory to adrenaline, consider 5mg of salbutamol through a nebuliser
• Deliver O2, up to 15L via a non-rebreather mask as required to maintain adequate SPO2
• Adequate fluid resuscitation with 20ml/kg of normal saline if the patient is shocked, and repeat as necessary
• Place the patient in the supine position, ideally with lower limbs elevated to support perfusion to vital organs
• Hydrocortisone 200mg IV for management of delayed immune reaction secondary to anaphylaxis

If Refractory

• Adrenaline infusion commencing at 1mcg/kg/min, titrating according to vital signs and clinical response of the patient
• Vasopressor support (in addition to adrenaline) for patients with for maintenance of blood pressure and prevention of shock
• Glucagon for a patient with beta-blocker therapy who may not respond to adrenaline, given as a bolus followed by infusion.  

References:

Campbell, R.L., Kelso, J.M. (2021). Anaphylaxis: Emergency Treatment. UpToDate. Retrieved May 16, from https://www.uptodate.com.acs.hcn.com.au/contents/anaphylaxis-emergency-treatment