Anaphylaxis - Revision history

Danbot: Strip excess bold text - keep only critical safety emphasis

2026-03-22T09:23:00Z

Strip excess bold text - keep only critical safety emphasis

← Older revision		Revision as of 09:23, 22 March 2026
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	*IgE-mediated (type I hypersensitivity) in most cases; can also be non-IgE mediated (anaphylactoid)		*IgE-mediated (type I hypersensitivity) in most cases; can also be non-IgE mediated (anaphylactoid)
	*'''Biphasic reaction''' occurs in '''5-20%''' of cases (recurrence 1-72 hours after initial reaction, usually within 8-10 hours)<ref>Lee S, et al. Biphasic anaphylaxis: review of incidence, clinical predictors, and observation recommendations. ''Immunol Allergy Clin North Am''. 2015;35(2):313-326. PMID 25841553</ref>		*'''Biphasic reaction''' occurs in '''5-20%''' of cases (recurrence 1-72 hours after initial reaction, usually within 8-10 hours)<ref>Lee S, et al. Biphasic anaphylaxis: review of incidence, clinical predictors, and observation recommendations. ''Immunol Allergy Clin North Am''. 2015;35(2):313-326. PMID 25841553</ref>
	*~~'''~~Epinephrine is the ONLY first-line treatment~~'''~~ — delays in administration increase mortality		*Epinephrine is the ONLY first-line treatment — delays in administration increase mortality

	===Common Triggers===		===Common Triggers===
	*~~'''~~Foods~~'''~~ (most common overall): peanuts, tree nuts, shellfish, fish, milk, eggs, wheat, soy		*Foods (most common overall): peanuts, tree nuts, shellfish, fish, milk, eggs, wheat, soy
	*~~'''~~Medications~~'''~~: antibiotics (penicillin, cephalosporins), NSAIDs, neuromuscular blocking agents		*Medications: antibiotics (penicillin, cephalosporins), NSAIDs, neuromuscular blocking agents
	*~~'''~~Insect stings~~'''~~: Hymenoptera (bees, wasps, hornets, fire ants)		*Insect stings: Hymenoptera (bees, wasps, hornets, fire ants)
	*~~'''~~Latex~~'''~~		*Latex
	*'''Exercise-induced anaphylaxis''' (sometimes food-dependent)		*'''Exercise-induced anaphylaxis''' (sometimes food-dependent)
	*~~'''~~Idiopathic~~'''~~ (~20% — no identifiable trigger)		*Idiopathic (~20% — no identifiable trigger)

	==Clinical Features==		==Clinical Features==
	*Onset: ~~'''~~minutes to hours~~'''~~ after exposure (usually within 30 minutes)		*Onset: minutes to hours after exposure (usually within 30 minutes)
	*~~'''~~Skin/mucosal~~'''~~ (90%): urticaria, flushing, angioedema, pruritus		*Skin/mucosal (90%): urticaria, flushing, angioedema, pruritus
	*~~'''~~Respiratory~~'''~~ (70%): ~~'''~~laryngeal edema~~'''~~, stridor, bronchospasm, wheezing, dyspnea		*Respiratory (70%): laryngeal edema, stridor, bronchospasm, wheezing, dyspnea
	*~~'''~~Cardiovascular~~'''~~ (45%): [[hypotension]], [[tachycardia]], distributive [[shock]], syncope, ~~'''~~cardiac arrest~~'''~~		*Cardiovascular (45%): [[hypotension]], [[tachycardia]], distributive [[shock]], syncope, cardiac arrest
	*~~'''~~GI~~'''~~ (45%): nausea, vomiting, abdominal cramps, diarrhea		*GI (45%): nausea, vomiting, abdominal cramps, diarrhea
	*'''Neurologic''': anxiety, dizziness, altered mental status		*'''Neurologic''': anxiety, dizziness, altered mental status
	*'''Anaphylaxis can occur WITHOUT skin findings''' (~10-20% of cases)		*'''Anaphylaxis can occur WITHOUT skin findings''' (~10-20% of cases)

	===Diagnostic Criteria (Any ONE of Three)===		===Diagnostic Criteria (Any ONE of Three)===
	*~~'''~~Criterion 1~~'''~~: Acute onset with skin/mucosal involvement AND respiratory compromise OR hypotension		*Criterion 1: Acute onset with skin/mucosal involvement AND respiratory compromise OR hypotension
	*~~'''~~Criterion 2~~'''~~: Two or more systems involved rapidly after likely allergen: skin, respiratory, cardiovascular, GI		*Criterion 2: Two or more systems involved rapidly after likely allergen: skin, respiratory, cardiovascular, GI
	*~~'''~~Criterion 3~~'''~~: Hypotension after exposure to known allergen (SBP <90 or >30% decrease from baseline)		*Criterion 3: Hypotension after exposure to known allergen (SBP <90 or >30% decrease from baseline)

	==Differential Diagnosis==		==Differential Diagnosis==
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	==Evaluation==		==Evaluation==
	*'''Anaphylaxis is a clinical diagnosis''' — do NOT delay treatment for labs		*'''Anaphylaxis is a clinical diagnosis''' — do NOT delay treatment for labs
	*~~'''~~Serum tryptase~~'''~~: elevated supports diagnosis (draw within 1-3 hours of onset)		*Serum tryptase: elevated supports diagnosis (draw within 1-3 hours of onset)
	**Normal tryptase does NOT exclude anaphylaxis		**Normal tryptase does NOT exclude anaphylaxis
	**Useful for postmortem diagnosis and distinguishing from other causes		**Useful for postmortem diagnosis and distinguishing from other causes
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	==Management==		==Management==
	===Epinephrine (Cornerstone of Treatment)===		===Epinephrine (Cornerstone of Treatment)===
	*~~'''~~Epinephrine 0.3-0.5 mg (1:1,000) IM~~'''~~ in ~~'''~~anterolateral thigh~~'''~~ (vastus lateralis)		*Epinephrine 0.3-0.5 mg (1:1,000) IM in anterolateral thigh (vastus lateralis)
	**Pediatric: ~~'''~~0.01 mg/kg (max 0.3 mg)~~'''~~ IM		**Pediatric: 0.01 mg/kg (max 0.3 mg) IM
	**~~'''~~Repeat every 5-15 minutes~~'''~~ as needed		**Repeat every 5-15 minutes as needed
	**'''Do NOT delay''' — there are NO absolute contraindications to epinephrine in anaphylaxis		**'''Do NOT delay''' — there are NO absolute contraindications to epinephrine in anaphylaxis
	*If refractory or in shock:		*If refractory or in shock:
	**~~'''~~Epinephrine infusion~~'''~~: 0.1-0.5 mcg/kg/min IV (mix 1 mg in 250 mL NS = 4 mcg/mL)		**Epinephrine infusion: 0.1-0.5 mcg/kg/min IV (mix 1 mg in 250 mL NS = 4 mcg/mL)
	**~~'''~~IV epinephrine bolus~~'''~~ (only for cardiac arrest or refractory shock): 0.1 mg of 1:10,000 IV		**IV epinephrine bolus (only for cardiac arrest or refractory shock): 0.1 mg of 1:10,000 IV
	*~~'''~~IM > SC~~'''~~ (faster absorption; SC absorption unreliable in shock)		*IM > SC (faster absorption; SC absorption unreliable in shock)

	===Adjunctive Therapies===		===Adjunctive Therapies===
	*~~'''~~IV fluids~~'''~~: ~~'''~~aggressive NS bolus~~'''~~ (1-2L in adults; 20 mL/kg in children) — distributive shock with massive third-spacing		*IV fluids: aggressive NS bolus (1-2L in adults; 20 mL/kg in children) — distributive shock with massive third-spacing
	*~~'''~~Albuterol~~'''~~ 2.5-5 mg nebulized for bronchospasm (does not replace epinephrine)		*Albuterol 2.5-5 mg nebulized for bronchospasm (does not replace epinephrine)
	*'''H1 antihistamine''': diphenhydramine 25-50 mg IV (treats urticaria/pruritus; does NOT treat life-threatening features)		*'''H1 antihistamine''': diphenhydramine 25-50 mg IV (treats urticaria/pruritus; does NOT treat life-threatening features)
	*~~'''~~H2 antihistamine~~'''~~: famotidine 20 mg IV (adjunctive)		*H2 antihistamine: famotidine 20 mg IV (adjunctive)
	*~~'''~~Corticosteroids~~'''~~: methylprednisolone 125 mg IV or prednisone 1 mg/kg PO		*Corticosteroids: methylprednisolone 125 mg IV or prednisone 1 mg/kg PO
	**Theoretical benefit in preventing biphasic reaction (~~'''~~limited evidence~~'''~~)		**Theoretical benefit in preventing biphasic reaction (limited evidence)
	**'''Do NOT rely on steroids as primary treatment''' (slow onset: 4-6 hours)		**'''Do NOT rely on steroids as primary treatment''' (slow onset: 4-6 hours)
	*~~'''~~Glucagon~~'''~~ 1-5 mg IV for patients on ~~'''~~beta-blockers~~'''~~ (resistant to epinephrine)		*Glucagon 1-5 mg IV for patients on beta-blockers (resistant to epinephrine)

	===Refractory Anaphylaxis===		===Refractory Anaphylaxis===
	*Epinephrine infusion + aggressive volume resuscitation		*Epinephrine infusion + aggressive volume resuscitation
	*~~'''~~Vasopressin~~'''~~ 1-2 units IV bolus for refractory hypotension		*Vasopressin 1-2 units IV bolus for refractory hypotension
	*~~'''~~Glucagon~~'''~~ for beta-blocker use		*Glucagon for beta-blocker use
	*Consider ~~'''~~methylene blue~~'''~~ 1-2 mg/kg IV for refractory vasoplegia		*Consider methylene blue 1-2 mg/kg IV for refractory vasoplegia
	*Secure airway early if airway edema progressing (~~'''~~may require surgical airway~~'''~~)		*Secure airway early if airway edema progressing (may require surgical airway)

	==Disposition==		==Disposition==
	*~~'''~~Observe minimum 4-6 hours~~'''~~ after last dose of epinephrine (biphasic reaction monitoring)		*Observe minimum 4-6 hours after last dose of epinephrine (biphasic reaction monitoring)
	*~~'''~~Extended observation (8-24 hours)~~'''~~ if:		*Extended observation (8-24 hours) if:
	**Severe initial reaction (hypotension, intubation)		**Severe initial reaction (hypotension, intubation)
	**History of biphasic reactions		**History of biphasic reactions
	**Delayed presentation		**Delayed presentation
	**Poor access to medical care		**Poor access to medical care
	*~~'''~~Discharge with~~'''~~:		*Discharge with:
	**~~'''~~Epinephrine auto-injector prescription~~'''~~ (EpiPen or equivalent) — prescribe ~~'''~~2 devices~~'''~~		**Epinephrine auto-injector prescription (EpiPen or equivalent) — prescribe 2 devices
	**Antihistamine (diphenhydramine or cetirizine) for 3 days		**Antihistamine (diphenhydramine or cetirizine) for 3 days
	**Prednisone 40-60 mg PO daily × 3-5 days		**Prednisone 40-60 mg PO daily × 3-5 days
	**~~'''~~Allergist referral~~'''~~		**Allergist referral
	**'''Written anaphylaxis action plan'''		**'''Written anaphylaxis action plan'''
	**~~'''~~Strict avoidance of trigger~~'''~~		**Strict avoidance of trigger
	**'''Return precautions''': return immediately if symptoms recur		**'''Return precautions''': return immediately if symptoms recur

Danbot: Major update: epinephrine IM dosing/frequency, biphasic reaction monitoring, diagnostic criteria, glucagon for beta-blocker patients, methylene blue, EpiPen prescription, discharge plan, references with PMIDs

2026-03-21T19:56:10Z

Major update: epinephrine IM dosing/frequency, biphasic reaction monitoring, diagnostic criteria, glucagon for beta-blocker patients, methylene blue, EpiPen prescription, discharge plan, references with PMIDs

Show changes

Danbot: Replace ranitidine with famotidine (ranitidine withdrawn from market 2020 due to NDMA contamination); add pediatric famotidine dose

2026-03-20T22:06:56Z

Replace ranitidine with famotidine (ranitidine withdrawn from market 2020 due to NDMA contamination); add pediatric famotidine dose

← Older revision		Revision as of 22:06, 20 March 2026
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	**[[Antihistamines]] (for symptom control AFTER hemodynamically stable)		**[[Antihistamines]] (for symptom control AFTER hemodynamically stable)
	***{{MedicationDose\|drug=Diphenhydramine\|dose=25-50 mg (1 mg/kg in children)\|route=IV\|context=H1 antihistamine\|indication=Anaphylaxis\|population=Adult}}		***{{MedicationDose\|drug=Diphenhydramine\|dose=25-50 mg (1 mg/kg in children)\|route=IV\|context=H1 antihistamine\|indication=Anaphylaxis\|population=Adult}}
	***{{MedicationDose\|drug=~~Ranitidine~~\|dose=50 mg (0.5 mg/kg ~~in children~~)\|route=IV\|context=H2 antihistamine\|indication=Anaphylaxis\|population=~~Adult~~}} (has been found to improve urticaria but not angioedema at 2 hours<ref>Lin, RY et al. Improved Outcomes in Patients With Acute Allergic Syndromes Who Are Treated With Combined H1 and H2 Antagonists. Annals of Emergency Medicine. 36:5 NOVEMBER 2000.</ref>)		***{{MedicationDose\|drug=Famotidine\|dose=20 mg\|route=IV\|context=H2 antihistamine\|indication=Anaphylaxis\|population=Adult}}
			***{{MedicationDose\|drug=Famotidine\|dose=0.25 mg/kg (max 20 mg)\|route=IV\|context=H2 antihistamine\|indication=Anaphylaxis\|population=Pediatric}}
	***{{MedicationDose\|drug=Cetirizine\|dose=10 mg (peds: 5-10 mg 6-11y, 2.5 mg 6mo-5y)\|route=IV\|context=H1 antihistamine\|indication=Anaphylaxis\|population=Adult}}		***{{MedicationDose\|drug=Cetirizine\|dose=10 mg (peds: 5-10 mg 6-11y, 2.5 mg 6mo-5y)\|route=IV\|context=H1 antihistamine\|indication=Anaphylaxis\|population=Adult}}
	***AVOID promethazine as this can worsen hypotension		***AVOID promethazine as this can worsen hypotension

Danbot: Convert medications to MedicationDose template with SMW; dosing verified

2026-03-20T15:55:04Z

Convert medications to MedicationDose template with SMW; dosing verified

← Older revision		Revision as of 15:55, 20 March 2026
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	==Management==		==Management==
	*'''[[Epinephrine]]'''		*'''[[Epinephrine]]'''
	**~~1:1000 '''IM'''~~ 0.3 - 0.~~5mg~~ (~~0.3~~ - 0.~~5mL) every~~ 5 ~~- 15 minutes~~ <ref>Dhami S. et al. Management of anaphylaxis: a systematic review. Allergy. 69 (2014) 168–175. http://onlinelibrary.wiley.com/store/10.1111/all.12318/asset/all12318.pdf?v=1&t=hrspdbpk&s=8067bfd5903c7ffebf4a274f062a71633ebe0507</ref> <ref>Sheikh A, Shehata YA, Brown SGA, Simons FER. '''Adrenaline (epinephrine) for the treatment of anaphylaxis with and without shock.''' ''Cochrane Database of Systematic Reviews'' 2008, Issue 4. Art. No.: CD006312. DOI:10.1002/14651858.CD006312.pub2</ref>		**{{MedicationDose\|drug=Epinephrine\|dose=0.3-0.5 mg (1:1,000) q5-15 min\|route=IM\|context=1st line anaphylaxis\|indication=Anaphylaxis\|population=Adult\|notes=Thigh preferred; 0.5 mg for >50 kg}} <ref>Dhami S. et al. Management of anaphylaxis: a systematic review. Allergy. 69 (2014) 168–175. http://onlinelibrary.wiley.com/store/10.1111/all.12318/asset/all12318.pdf?v=1&t=hrspdbpk&s=8067bfd5903c7ffebf4a274f062a71633ebe0507</ref> <ref>Sheikh A, Shehata YA, Brown SGA, Simons FER. '''Adrenaline (epinephrine) for the treatment of anaphylaxis with and without shock.''' ''Cochrane Database of Systematic Reviews'' 2008, Issue 4. Art. No.: CD006312. DOI:10.1002/14651858.CD006312.pub2</ref>
	***0.5mg for adults >50kg is strongly associated with a reduction in escalation of care <ref>Retrospective comparison between 0.3 mg and 0.5 mg dosing of intramuscular epinephrine for anaphylaxis. Am J Emerg Med. 2025 Oct 10;99:270-275. doi: 10.1016/j.ajem.2025.10.020. </ref>		***0.5mg for adults >50kg is strongly associated with a reduction in escalation of care <ref>Retrospective comparison between 0.3 mg and 0.5 mg dosing of intramuscular epinephrine for anaphylaxis. Am J Emerg Med. 2025 Oct 10;99:270-275. doi: 10.1016/j.ajem.2025.10.020. </ref>
	**Intramuscular injection of epinephrine into the thigh as the preferred route and site of injection <ref>Simons FER, Gu X, Simons KJ. '''[[Epinephrine]]absorption in adults: Intramuscular versus subcutaneous injection,''' ''J Allergy Clin Immunol'' 2001;108:871-3 </ref> <ref>Epinephrine absorption in adults: Intramuscular versus subcutaneous injection. Simons, F.Estelle R. et al. Journal of Allergy and Clinical Immunology, Volume 108, Issue 5, 871 - 873 </ref>		**Intramuscular injection of epinephrine into the thigh as the preferred route and site of injection <ref>Simons FER, Gu X, Simons KJ. '''[[Epinephrine]]absorption in adults: Intramuscular versus subcutaneous injection,''' ''J Allergy Clin Immunol'' 2001;108:871-3 </ref> <ref>Epinephrine absorption in adults: Intramuscular versus subcutaneous injection. Simons, F.Estelle R. et al. Journal of Allergy and Clinical Immunology, Volume 108, Issue 5, 871 - 873 </ref>
	**If response to IM is inadequate: ~~give epinephrine infusion~~ 1:10,000 ~~2 - 10 µg/min~~		**If response to IM is inadequate: {{MedicationDose\|drug=Epinephrine\|dose=2-10 mcg/min (1:10,000)\|route=IV drip\|context=Anaphylaxis drip\|indication=Anaphylaxis\|population=Adult\|link=no}}
	**'''How to make a quick epinephrine drip:''' ''Take your code-cart epinephrine (it does not matter if it is 1:1,000 or 1:10,000) and inject 1mg into a liter bag of NS. Final concentration is 1mcg/ml. Run at 1cc/min and titrate to effect''.		**'''How to make a quick epinephrine drip:''' ''Take your code-cart epinephrine (it does not matter if it is 1:1,000 or 1:10,000) and inject 1mg into a liter bag of NS. Final concentration is 1mcg/ml. Run at 1cc/min and titrate to effect''.
	*'''[[Corticosteroids]]'''		*'''[[Corticosteroids]]'''
	**[[Methylprednisolone~~]]: 125mg IV~~ (~~2mg~~/kg in children)		**{{MedicationDose\|drug=Methylprednisolone\|dose=125 mg (2 mg/kg in children)\|route=IV\|context=Anaphylaxis steroid\|indication=Anaphylaxis\|population=Adult}}
	**[[Dexamethasone~~]]: 10mg IV or PO~~ (0.~~6mg~~/kg in children)		**{{MedicationDose\|drug=Dexamethasone\|dose=10 mg (0.6 mg/kg in children)\|route=IV or PO\|context=Anaphylaxis steroid\|indication=Anaphylaxis\|population=Adult}}
	**Evidence:		**Evidence:
	***May start having effect within 5-30 minutes<ref>Liyanage CK, et al. Corticosteroids in management of anaphylaxis; a systematic review of evidence. Eur Ann AllErgy Clin immunol. 2017. 49(5): 196-207. 10.23822/EurAnnACI.1764-1489.15.</ref>		***May start having effect within 5-30 minutes<ref>Liyanage CK, et al. Corticosteroids in management of anaphylaxis; a systematic review of evidence. Eur Ann AllErgy Clin immunol. 2017. 49(5): 196-207. 10.23822/EurAnnACI.1764-1489.15.</ref>
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	**[[Albuterol]] for bronchospasm resistant to IM epinephrine		**[[Albuterol]] for bronchospasm resistant to IM epinephrine
	**[[Antihistamines]] (for symptom control AFTER hemodynamically stable)		**[[Antihistamines]] (for symptom control AFTER hemodynamically stable)
	***[[Diphenhydramine~~]]:~~ 25 ~~to 50mg IV~~ (~~1mg~~/kg in children)		***{{MedicationDose\|drug=Diphenhydramine\|dose=25-50 mg (1 mg/kg in children)\|route=IV\|context=H1 antihistamine\|indication=Anaphylaxis\|population=Adult}}
	***[[Ranitidine~~]]: 50mg IV~~ (0.~~5mg~~/kg in children) (has been found to improve urticaria but not angioedema at 2 hours<ref>Lin, RY et al. Improved Outcomes in Patients With Acute Allergic Syndromes Who Are Treated With Combined H1 and H2 Antagonists. Annals of Emergency Medicine. 36:5 NOVEMBER 2000.</ref>)		***{{MedicationDose\|drug=Ranitidine\|dose=50 mg (0.5 mg/kg in children)\|route=IV\|context=H2 antihistamine\|indication=Anaphylaxis\|population=Adult}} (has been found to improve urticaria but not angioedema at 2 hours<ref>Lin, RY et al. Improved Outcomes in Patients With Acute Allergic Syndromes Who Are Treated With Combined H1 and H2 Antagonists. Annals of Emergency Medicine. 36:5 NOVEMBER 2000.</ref>)
	***[[Cetirizine~~]] 10mg IV~~ (~~6-11 years old~~: 5-10 mg ~~IV;~~ 6 mo - ~~5 years:~~ 2.5 mg IV)		***{{MedicationDose\|drug=Cetirizine\|dose=10 mg (peds: 5-10 mg 6-11y, 2.5 mg 6mo-5y)\|route=IV\|context=H1 antihistamine\|indication=Anaphylaxis\|population=Adult}}
	***AVOID promethazine as this can worsen hypotension		***AVOID promethazine as this can worsen hypotension
	**[[Glucagon]]		**[[Glucagon]]
	***1 - ~~5mg IV~~ over 5 ~~minutes followed by infusion of~~ 5 - 15 µg/min<ref>Campbell RL, et al. Emergency department diagnosis and treatment of anaphylaxis: a practice parameter. Ann Allergy Asthma Immunol. 2014; 113:599e608.</ref>		***{{MedicationDose\|drug=Glucagon\|dose=1-5 mg over 5 min, then 5-15 mcg/min drip\|route=IV\|context=Beta-blocker refractory anaphylaxis\|indication=Anaphylaxis\|population=Adult\|link=no}}<ref>Campbell RL, et al. Emergency department diagnosis and treatment of anaphylaxis: a practice parameter. Ann Allergy Asthma Immunol. 2014; 113:599e608.</ref>
	***If taking beta-blocker AND unresponsive to [[Epi\|epinephrine]]		***If taking beta-blocker AND unresponsive to [[Epi\|epinephrine]]
	**Consider adding additional pressor support if persistent hypotension present		**Consider adding additional pressor support if persistent hypotension present
	***For example: '''[[vasopressin]]''' 2-8 units for persistent refractory shock (case series only)<ref>Schummer et al. The Pivotal Role of Vasopressin in Refractory Anaphylactic Shock. Anesthesia & Analgesia: August 2008 - Volume 107 - Issue 2 - pp 620-624.</ref><ref>Dünser et al. Treatment of Anaphylactic Shock: Where Is the Evidence? Anesthesia & Analgesia: August 2008 - Volume 107 - Issue 2 - pp 359-361</ref>		***For example: '''[[vasopressin]]''' 2-8 units for persistent refractory shock (case series only)<ref>Schummer et al. The Pivotal Role of Vasopressin in Refractory Anaphylactic Shock. Anesthesia & Analgesia: August 2008 - Volume 107 - Issue 2 - pp 620-624.</ref><ref>Dünser et al. Treatment of Anaphylactic Shock: Where Is the Evidence? Anesthesia & Analgesia: August 2008 - Volume 107 - Issue 2 - pp 359-361</ref>
	***[[Norepinephrine]] 0.05 to 0.5 mcg/kg ~~per minute~~		***{{MedicationDose\|drug=Norepinephrine\|dose=0.05-0.5 mcg/kg/min\|route=IV drip\|context=Refractory anaphylactic shock\|indication=Anaphylaxis\|population=Adult}}

	==Disposition==		==Disposition==

Ostermayer at 15:51, 15 January 2026

2026-01-15T15:51:43Z

← Older revision		Revision as of 15:51, 15 January 2026
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	{{~~Adult top}} [[~~Anaphylaxis (peds)~~]].''~~		{{AdultPage\|Anaphylaxis (peds)}}
	==Background==		==Background==
	*Type I [[Hypersensitivity Reaction\|hypersensitivity reaction]] that is either severe in nature or having two or more organ systems involved.		*Type I [[Hypersensitivity Reaction\|hypersensitivity reaction]] that is either severe in nature or having two or more organ systems involved.

Zbuchwald: /* Management */

2025-11-11T10:27:01Z

Management

← Older revision		Revision as of 10:27, 11 November 2025
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	==Management==		==Management==
	*'''[[Epinephrine]]'''		*'''[[Epinephrine]]'''
	**1:1000 '''IM''' 0.3 - 0.5mg (0.3 - 0.5mL) every 5 - 15 minutes~~; 0.5mg for adults >50kg is strongly associated with a reduction in escalation of care~~ <ref>Dhami S. et al. Management of anaphylaxis: a systematic review. Allergy. 69 (2014) 168–175. http://onlinelibrary.wiley.com/store/10.1111/all.12318/asset/all12318.pdf?v=1&t=hrspdbpk&s=8067bfd5903c7ffebf4a274f062a71633ebe0507</ref> <ref>Sheikh A, Shehata YA, Brown SGA, Simons FER. '''Adrenaline (epinephrine) for the treatment of anaphylaxis with and without shock.''' ''Cochrane Database of Systematic Reviews'' 2008, Issue 4. Art. No.: CD006312. DOI:10.1002/14651858.CD006312.pub2</ref> <ref>Retrospective comparison between 0.3 mg and 0.5 mg dosing of intramuscular epinephrine for anaphylaxis. Am J Emerg Med. 2025 Oct 10;99:270-275. doi: 10.1016/j.ajem.2025.10.020. </ref>		**1:1000 '''IM''' 0.3 - 0.5mg (0.3 - 0.5mL) every 5 - 15 minutes <ref>Dhami S. et al. Management of anaphylaxis: a systematic review. Allergy. 69 (2014) 168–175. http://onlinelibrary.wiley.com/store/10.1111/all.12318/asset/all12318.pdf?v=1&t=hrspdbpk&s=8067bfd5903c7ffebf4a274f062a71633ebe0507</ref> <ref>Sheikh A, Shehata YA, Brown SGA, Simons FER. '''Adrenaline (epinephrine) for the treatment of anaphylaxis with and without shock.''' ''Cochrane Database of Systematic Reviews'' 2008, Issue 4. Art. No.: CD006312. DOI:10.1002/14651858.CD006312.pub2</ref>
	**Give as soon as possible		***0.5mg for adults >50kg is strongly associated with a reduction in escalation of care <ref>Retrospective comparison between 0.3 mg and 0.5 mg dosing of intramuscular epinephrine for anaphylaxis. Am J Emerg Med. 2025 Oct 10;99:270-275. doi: 10.1016/j.ajem.2025.10.020. </ref>
	**Intramuscular injection of epinephrine into the thigh as the preferred route and site of injection <ref>Simons FER, Gu X, Simons KJ. '''[[Epinephrine]]absorption in adults: Intramuscular versus subcutaneous injection,''' ''J Allergy Clin Immunol'' 2001;108:871-3 </ref> <ref>Epinephrine absorption in adults: Intramuscular versus subcutaneous injection. Simons, F.Estelle R. et al. Journal of Allergy and Clinical Immunology, Volume 108, Issue 5, 871 - 873 </ref>		**Intramuscular injection of epinephrine into the thigh as the preferred route and site of injection <ref>Simons FER, Gu X, Simons KJ. '''[[Epinephrine]]absorption in adults: Intramuscular versus subcutaneous injection,''' ''J Allergy Clin Immunol'' 2001;108:871-3 </ref> <ref>Epinephrine absorption in adults: Intramuscular versus subcutaneous injection. Simons, F.Estelle R. et al. Journal of Allergy and Clinical Immunology, Volume 108, Issue 5, 871 - 873 </ref>
	**If response to IM is inadequate: give epinephrine infusion 1:10,000 2 - 10 µg/min		**If response to IM is inadequate: give epinephrine infusion 1:10,000 2 - 10 µg/min

Zbuchwald: /* Management */

2025-11-11T10:26:06Z

Management

← Older revision		Revision as of 10:26, 11 November 2025
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	==Management==		==Management==
	*'''[[Epinephrine]]'''		*'''[[Epinephrine]]'''
	**1:1000 '''IM''' 0.3 - 0.5mg (0.3 - 0.5mL) every 5 - 15 minutes<ref>Dhami S. et al. Management of anaphylaxis: a systematic review. Allergy. 69 (2014) 168–175. http://onlinelibrary.wiley.com/store/10.1111/all.12318/asset/all12318.pdf?v=1&t=hrspdbpk&s=8067bfd5903c7ffebf4a274f062a71633ebe0507</ref><ref>Sheikh A, Shehata YA, Brown SGA, Simons FER. '''Adrenaline (epinephrine) for the treatment of anaphylaxis with and without shock.''' ''Cochrane Database of Systematic Reviews'' 2008, Issue 4. Art. No.: CD006312. DOI:10.1002/14651858.CD006312.pub2</ref>		**1:1000 '''IM''' 0.3 - 0.5mg (0.3 - 0.5mL) every 5 - 15 minutes; 0.5mg for adults >50kg is strongly associated with a reduction in escalation of care <ref>Dhami S. et al. Management of anaphylaxis: a systematic review. Allergy. 69 (2014) 168–175. http://onlinelibrary.wiley.com/store/10.1111/all.12318/asset/all12318.pdf?v=1&t=hrspdbpk&s=8067bfd5903c7ffebf4a274f062a71633ebe0507</ref> <ref>Sheikh A, Shehata YA, Brown SGA, Simons FER. '''Adrenaline (epinephrine) for the treatment of anaphylaxis with and without shock.''' ''Cochrane Database of Systematic Reviews'' 2008, Issue 4. Art. No.: CD006312. DOI:10.1002/14651858.CD006312.pub2</ref> <ref>Retrospective comparison between 0.3 mg and 0.5 mg dosing of intramuscular epinephrine for anaphylaxis. Am J Emerg Med. 2025 Oct 10;99:270-275. doi: 10.1016/j.ajem.2025.10.020. </ref>
	**Give as soon as possible		**Give as soon as possible
	**Intramuscular injection of epinephrine into the thigh as the preferred route and site of injection <ref>Simons FER, Gu X, Simons KJ. '''[[Epinephrine]]absorption in adults: Intramuscular versus subcutaneous injection,''' ''J Allergy Clin Immunol'' 2001;108:871-3 </ref> <ref>Epinephrine absorption in adults: Intramuscular versus subcutaneous injection. Simons, F.Estelle R. et al. Journal of Allergy and Clinical Immunology, Volume 108, Issue 5, 871 - 873 </ref>		**Intramuscular injection of epinephrine into the thigh as the preferred route and site of injection <ref>Simons FER, Gu X, Simons KJ. '''[[Epinephrine]]absorption in adults: Intramuscular versus subcutaneous injection,''' ''J Allergy Clin Immunol'' 2001;108:871-3 </ref> <ref>Epinephrine absorption in adults: Intramuscular versus subcutaneous injection. Simons, F.Estelle R. et al. Journal of Allergy and Clinical Immunology, Volume 108, Issue 5, 871 - 873 </ref>

Zbuchwald: /* Management */

2025-11-11T10:22:21Z

Management

← Older revision		Revision as of 10:22, 11 November 2025
Line 85:		Line 85:
	**1:1000 '''IM''' 0.3 - 0.5mg (0.3 - 0.5mL) every 5 - 15 minutes<ref>Dhami S. et al. Management of anaphylaxis: a systematic review. Allergy. 69 (2014) 168–175. http://onlinelibrary.wiley.com/store/10.1111/all.12318/asset/all12318.pdf?v=1&t=hrspdbpk&s=8067bfd5903c7ffebf4a274f062a71633ebe0507</ref><ref>Sheikh A, Shehata YA, Brown SGA, Simons FER. '''Adrenaline (epinephrine) for the treatment of anaphylaxis with and without shock.''' ''Cochrane Database of Systematic Reviews'' 2008, Issue 4. Art. No.: CD006312. DOI:10.1002/14651858.CD006312.pub2</ref>		**1:1000 '''IM''' 0.3 - 0.5mg (0.3 - 0.5mL) every 5 - 15 minutes<ref>Dhami S. et al. Management of anaphylaxis: a systematic review. Allergy. 69 (2014) 168–175. http://onlinelibrary.wiley.com/store/10.1111/all.12318/asset/all12318.pdf?v=1&t=hrspdbpk&s=8067bfd5903c7ffebf4a274f062a71633ebe0507</ref><ref>Sheikh A, Shehata YA, Brown SGA, Simons FER. '''Adrenaline (epinephrine) for the treatment of anaphylaxis with and without shock.''' ''Cochrane Database of Systematic Reviews'' 2008, Issue 4. Art. No.: CD006312. DOI:10.1002/14651858.CD006312.pub2</ref>
	**Give as soon as possible		**Give as soon as possible
	**~~Always IM initially~~ <ref>Simons FER, Gu X, Simons KJ. '''[[Epinephrine]]absorption in adults: Intramuscular versus subcutaneous injection,''' ''J Allergy Clin Immunol'' 2001;108:871-3 </ref>		**Intramuscular injection of epinephrine into the thigh as the preferred route and site of injection <ref>Simons FER, Gu X, Simons KJ. '''[[Epinephrine]]absorption in adults: Intramuscular versus subcutaneous injection,''' ''J Allergy Clin Immunol'' 2001;108:871-3 </ref> <ref>Epinephrine absorption in adults: Intramuscular versus subcutaneous injection. Simons, F.Estelle R. et al. Journal of Allergy and Clinical Immunology, Volume 108, Issue 5, 871 - 873 </ref>
	**If response to IM is inadequate: give epinephrine infusion 1:10,000 2 - 10 µg/min		**If response to IM is inadequate: give epinephrine infusion 1:10,000 2 - 10 µg/min
	**'''How to make a quick epinephrine drip:''' ''Take your code-cart epinephrine (it does not matter if it is 1:1,000 or 1:10,000) and inject 1mg into a liter bag of NS. Final concentration is 1mcg/ml. Run at 1cc/min and titrate to effect''.		**'''How to make a quick epinephrine drip:''' ''Take your code-cart epinephrine (it does not matter if it is 1:1,000 or 1:10,000) and inject 1mg into a liter bag of NS. Final concentration is 1mcg/ml. Run at 1cc/min and titrate to effect''.

Rossdonaldson1: /* Clinical Features */

2025-03-19T21:33:46Z

Clinical Features

← Older revision		Revision as of 21:33, 19 March 2025
Line 13:		Line 13:
	==Clinical Features==		==Clinical Features==
	[[File:Hives2010.jpg\|thumbnail\|Raised [[urticaria]]]]		[[File:Hives2010.jpg\|thumbnail\|Raised [[urticaria]]]]
			[[File:1440px-Rash on the chest of a person with anaphylaxis.jpg\|thumb\|Urticarial rash on the chest of a patient with anaphylaxis.]]
	[[File:Angioedema2013.jpg\|thumbnail\|[[Angioedema]] of tongue]]		[[File:Angioedema2013.jpg\|thumbnail\|[[Angioedema]] of tongue]]
	[[File:Angioedema2010.jpg\|thumb\|Angioedema of face.]]		[[File:Angioedema2010.jpg\|thumb\|Angioedema of face.]]

Rossdonaldson1: /* Management */

2025-03-19T21:09:22Z

Management

← Older revision		Revision as of 21:09, 19 March 2025
Line 87:		Line 87:
	**If response to IM is inadequate: give epinephrine infusion 1:10,000 2 - 10 µg/min		**If response to IM is inadequate: give epinephrine infusion 1:10,000 2 - 10 µg/min
	**'''How to make a quick epinephrine drip:''' ''Take your code-cart epinephrine (it does not matter if it is 1:1,000 or 1:10,000) and inject 1mg into a liter bag of NS. Final concentration is 1mcg/ml. Run at 1cc/min and titrate to effect''.		**'''How to make a quick epinephrine drip:''' ''Take your code-cart epinephrine (it does not matter if it is 1:1,000 or 1:10,000) and inject 1mg into a liter bag of NS. Final concentration is 1mcg/ml. Run at 1cc/min and titrate to effect''.
	*[[Corticosteroids]]		*'''[[Corticosteroids]]'''
	**[[Methylprednisolone]]: 125mg IV (2mg/kg in children)		**[[Methylprednisolone]]: 125mg IV (2mg/kg in children)
	**[[Dexamethasone]]: 10mg IV or PO (0.6mg/kg in children)		**[[Dexamethasone]]: 10mg IV or PO (0.6mg/kg in children)

← Older revision		Revision as of 21:33, 19 March 2025
Line 13:		Line 13:
	==Clinical Features==		==Clinical Features==
	[[File:Hives2010.jpg\|thumbnail\|Raised [[urticaria]]]]		[[File:Hives2010.jpg\|thumbnail\|Raised [[urticaria]]]]
			[[File:1440px-Rash on the chest of a person with anaphylaxis.jpg\|thumb\|Urticarial rash on the chest of a patient with anaphylaxis.]]
	[[File:Angioedema2013.jpg\|thumbnail\|[[Angioedema]] of tongue]]		[[File:Angioedema2013.jpg\|thumbnail\|[[Angioedema]] of tongue]]
	[[File:Angioedema2010.jpg\|thumb\|Angioedema of face.]]		[[File:Angioedema2010.jpg\|thumb\|Angioedema of face.]]