Anaphylaxis Management

    • Rapid ABCDE treating life threatening problems as they are found

    • Again remember – skin changes without ABC problems do not signify anaphylaxis

  • Call for help early, this will also help to confirm diagnosis if not obvious

    • Intramuscular (IM) Adrenaline - Make sure to use 1:1000 adrenaline.

    • Remember: Anaphylaxis kits are commonly available in cardiac arrest trollies, familiarise yourself with where they are kept in your area.

    • Adrenaline 500 micrograms Intramuscularly IM (0.5mls of 1:1000). Give as soon as Anaphylaxis is suspected.

    • The best IM injection site is the anterolateral aspect of the middle thigh. Ensure needle is long enough as this needs to be intramuscular

    • Repeat IM adrenaline if no improvement (5 minutes after 1st dose)

injection site

  • If requiring repeated doses escalate to critical care/ intensive care

  • IV adrenaline should only be given by experienced specialists

  • IV Fluid Challenge

    • Give 500 – 1000ml Crystalloid for an adult

    • Stop any IV colloid as this may be the cause of anaphylaxis

  • Antihistamines

    Non-sedating anti-histamines, in preference to chlorphenamine, can be given following initial stabilisation in patients with persisting skin symptoms.

  • Steroids

    Corticosteroids may be used as a third line intervention to treat underlying bronchospasm or shock

Anaphylaxis algorithm

Refractory anaphylaxis