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Anaphylaxis: Critical Treatment Pearls


Anaphylaxis is a life threatening condition, typically with extremely acute onset.  Luckily, the treatment is simple… isn’t it?  Here is a quick review to help you make the right decisions when treating this critical condition.

Since it is difficult to define anaphylaxis, we can sum it up as: A severe allergic reaction that will probably cause death if left untreated.  The onset can take anywhere from minutes to hours, and the most common causes are:

Symptoms of anaphylaxis include but are not limited to:

Signs of Anaphylaxis Include But Are Not Limited To:

*Remember that hypotension in children is identified as a Systolic BP < (70 mmHg + (Age in years x 2))


  1. If insults to the patients Airway, Breathing, or Circulation are identified intramuscular (IM) epinephrine must be given IMMEDIATELY!  DO NOT DELAY THIS INTERVENTION! There are NO contraindications to IM epinephrine in the presence of a life threatening allergic reaction.
  2. IV fluid bolus
  3. Histamine 1 antagonist (i.e. diphenhydramine)
  4. Histamine 2 antagonist (i.e. ranitidine)
  5. Glucocorticoids* (i.e. methylprednisolone)
  6. Nebulized Albuterol

*While corticosteroids like methylprednisolone are not particularly fast acting, they may help prevent or decrease the severity of a biphasic reaction, which is basically a re-occurrence of the allergic reaction after the patient has been removed from the source of the reaction, and the initial treatments have worn off.

Key Thoughts


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Lin M. Paucis Verbis: Anaphylaxis. ALiEM. 2016 [accessed 2016 Dec 27].

Mustafa S. Anaphylaxis. Anaphylaxis: Practice Essentials, Background, Pathophysiology. [accessed 2016 Dec 27].




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