Population: Children and adults with anaphylaxis.
Organizations
NICE 2011, EACCI 2014
Recommendations
–Obtain blood samples for mast cell tryptase testing at onset and after 1–2 h.
–Administer epinephrine (1:1000) 0.01 mg/kg (maximum 0.5 mg) SC; repeat as necessary IM every 15 min.
–If circulatory instability, place patient supine with lower extremities raised and give intravenous saline 20 mL/kg bolus.
–Give inhaled beta-2-agonists and glucocorticoids for wheezing or signs of bronchoconstriction.
–Consider H1- and H2-blockers for cutaneous signs of anaphylaxis.
–Monitor after the reaction resolves. If ≥16 y, monitor at least 6–12 h. If <16 y, admit for observation.
–Refer all patients treated for an anaphylactic reaction to an allergy specialist.
–Prescribe an epinephrine injector (eg, EpiPen).
Practice Pearl
• Anaphylaxis is a severe, life-threatening, generalized hypersensitivity reaction. It is characterized by the rapid development of:
- Airway edema.
- Bronchospasm.
- Circulatory dysfunction.
Sources
–http://www.nice.org.uk/nicemedia/live/13626/57474/57474.pdf