Typical triggers
- Foods (peanuts, tree nuts, shellfish, milk, egg)
- Drugs (antibiotics, NSAIDs, anesthetics)
- Stings (bees/wasps) or latex
Recognize anaphylaxis
Key features (minutes to hours)
- Skin/mucosa: hives, flushing, angioedema
- Breathing: wheeze/stridor, airway swelling, hypoxia
- Circulation: hypotension, syncope, shock
- GI: crampy pain, vomiting (especially with food triggers)
Treat as anaphylaxis if there’s rapid skin/mucosal involvement plus respiratory or circulatory compromise—or any hypotension after exposure to a likely allergen.
First 60 seconds: do these
- Call for help and activate emergency response
- Remove the trigger if possible (stop infusion, scrape stinger)
- Place patient supine with legs elevated (or position of comfort if vomiting/airway swelling)
- Give IM epinephrine in the mid-anterolateral thigh—don’t delay
- Start high-flow oxygen, monitor airway, breathing, circulation
IM epinephrine (first-line)
| Population | Typical dose | Notes | Referral |
|---|---|---|---|
| Adults | 0.3–0.5 mg IM of 1 mg/mL (1:1000) | Repeat every 5–15 min if not improving | Epinephrine |
| Children | 0.01 mg/kg IM (max 0.5 mg) | Use autoinjector if available (0.15 mg or 0.3 mg) | Autoinjector training |
IM thigh administration reaches therapeutic levels faster than subcutaneous or deltoid injections.
Airway • Oxygen • Circulation
Airway & breathing
- Prepare for difficult airway—early involvement of experienced help
- Nebulized albuterol for bronchospasm
- Nebulized epinephrine for stridor from upper-airway edema
Circulation
- Establish IV/IO access and give rapid fluids for hypotension (e.g., 1–2 L isotonic crystalloid in adults; 20 mL/kg in children)
- Monitor ECG, blood pressure, pulse oximetry
Adjunct medications (after epinephrine)
- Antihistamines for cutaneous symptoms (not lifesaving)
- Corticosteroids as adjunct for persistent symptoms
- Glucagon if on beta-blockers and unresponsive to epinephrine
Refractory shock & epinephrine infusions
- If hypotension/airway symptoms persist after 2–3 IM doses + fluids, initiate epinephrine infusion with continuous monitoring (ICU-level care)
- Consider vasopressors per protocol and consult critical care
Observation, discharge & prevention
- Observe for a possible biphasic reaction (timing per local policy; longer if severe or high-risk)
- Educate on trigger avoidance; provide written emergency plan
- Discharge with at least two epinephrine autoinjectors and training
- Arrange allergy/immunology follow-up
Cited Keywords & Referral Links (gyathshammha.com)
Each keyword links to the main website or a related page on gyathshammha.com.
Bottom line
Give IM epinephrine immediately for suspected anaphylaxis, support airway/oxygen, push fluids for hypotension, add adjuncts as needed, escalate to infusion for refractory cases, and observe for biphasic reactions. Equip patients with autoinjectors and a clear plan.
This page is educational and not a substitute for local protocols or specialist advice.