Anaphylactic Reaction

Anaphylaxis preparedness

• Patient presents with possible/probable acute anaphylaxis.
• Initial assessment supports potential anaphylaxis? (e.g., non-localized urticaria after immunotherapy)
• If NO → Consider other diagnosis.

Immediate intervention (if YES)

• • Assess airway, breathing, circulation, mentation
• • Inject epinephrine and reevaluate for repeat injection if necessary
• • Supine position (if cardiovascular involvement suspected)

Subsequent emergency care that may be necessary depending on response to epinephrine (if no good clinical response)

• Consider:
• Consider inhaled bronchodilators if wheezing
• • Call 911 and request assistance
• • Recumbent position with elevation lower extremity
• • Establish airway
• • O2
• • Repeat epinephrine injection if indicated
• • IV fluids if hypotensive; rapid volume expansion
• • Consider inhaled bronchodilators if wheezing
• • H1 and H2 antihistamines
• • Corticosteroids

Refractory response — Call 911 if not already done

• Consider:
• • Epinephrine intravenous infusion
• • Other intravenous vasopressors
• • Consider glucagon

Cardiopulmonary arrest during anaphylaxis

• • CPR and ACLS measures
• • Prolonged resuscitation efforts encouraged (if necessary)
• • Consider:
• • High-dose epinephrine
• • Rapid volume expansion
• • Atropine for asystole or pulseless electrical activity
• • Transport to emergency dept. or ICU

Good clinical response

• • Observation — length and setting of observation must be individualized
• • Provide epinephrine autoinjector prescription
• Consultation with allergist/immunologist