Rapid ABCDE treating life threatening problems as they are found

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

Record the time of onset of the reaction and record the circumstances immediately before the onset of symptoms.

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 should be present in all clinical areas, at Kings these are in the TOP drawer of cardiac arrest trollies. Familiarise yourself with where they are kept in your area.

In adults give adrenaline 500 micrograms Intramuscularly IM (0.5mls of 1mg/ml (1:1000) concentration). 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)

• Give 500 – 1000ml Crystalloid for an adult

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

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

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