Anaphylaxis

Criteria: Acute onset (minutes to hours)

Criterion 1 (90% of cases)

- skin +/- mucosa plus respi +/- decreased BP (or symptoms: syncope/dizziness)

Criterion 2 (10-20%)

- any 2: skin/mucosa, respi, decreased BP or symptoms, persistent GI (vomit/diarrhea/cramps)

Criterion 3

- decreased BP after exposure (<90 or more than 30% from baseline)

1. Airway: O2, consider intubation if airway oedema

- consider albuterol from bronchospasm

2. Adrenaline: 0.3-0.5mL (0.3-0.5mg) 1:1,000 q 5-15 mins

+/- infusion 1:10,000 2-10mcg/min

- Peds: 0.01 mg/kg/dose IM (Max: 0.5mg)

or

>12: 0.5mg

6-12: 0.3mg

<6: 0.15

Infusion: 0.05-1 mcg/kg/min

3. Normal Saline

2L bolus (20mL/kg for peds)

4. Antihistamines: pruritus control

- AFTER hemodynamically stable; choices:

a. Chlorpheniramine IM or slow IV

>12: 10mg

6-12: 5mg

6m-6y: 2.5mg

<6m: 250mcg/kg

b. Promethazine 25 IM or slow IV

c. Diphenhydratmine 25-50mg IM or slow IV

5. Hydrocortisone IM or slow IV: may blunt biphasic reaction

>12: 200mg

6-12: 100mg

6m-6y: 50mg

<6m: 25mg

* 3 days PO (biphasic reaction always occurs within 72 hours)

or Methylprednisolone

- 125mg IV (2mg/kg in peds)