Acute Anaphylaxis

Clinical features

 

Life threats

Initial Management

SEVERITY OF REACTION CLINICAL EXAMPLE INITIAL MANAGEMENT
Mild Urticaria only Promethazine (1mg/kg) 25mg PO or IM
Moderate Angioedema without stridor

Mild/Moderate bronchospasm

Adrenaline 6mg/6ml neb
+/- 
Adrenaline (0.01 mg/kg) 0.5mg IM
Severe Angioedema with stridor

Severe bronchospasm

Hypotension

Adrenaline (0.01 mg/kg) 0.5mg IM
(if impeding or complete airway obstruction consider sublingual injection)
+/-
Saline/Gelofusin 500ml IV stat (if shocked)

Special cases -  C1 esterase deficiency - FFP 2 units

* note that ACE-I induced angioedema often poorly responsive to conventional measures

Ongoing Management

Adrenaline

For moderate to severe cases which are not responding

Otherwise

Fluids

Anti-histamines

Promethazine 25mg PO or IV/IM

Ranitidine 50mg 8/24 IV

Steroids

All moderate to severe cases receive steroids on arrival and for 3 days (minimum)

Disposal

Observe all moderate/severe cases for 6 hrs.  If stable then discharge with referral to Allergist/Immunologist ELSE admit.

Consider discharge with self-administered adrenaline pen (and instructions on use)

SEVERITY TREATMENT
Mild Promethazine 10mg qid PO (3 days)
Moderate/Severe as above + prednisolone 50mg daily PO (3 days)