Emergency Management of AnaphylaXIS A L L S A

ALLERGY SOCIETY OF
SOUTH AFRICA

(Adult and Child)

2015/16
ACUTE RESPIRATORY DIFFICULTY
(Progressive Swelling, Stridor, Wheezing, Distress)
and/or
SIGNS OF SHOCK/HYPOTENSION
(especially if skin or mucosal changes are present)

Early (first line) treatment

ADRENALINE
1mg/ml (1:1000) - 0.01mg/kg IM (Maximum - 0,5ml IM)
or
Auto-Injector
> 6 yrs - 0,3 ml IM
< 6 yrs - 0,15 ml IM
Repeat every 5 - 15 minutes if no improvement

OXYGEN – MONITORS – IV ACCESS

• High flow oxygen
• Maintain patent airway (Intubate/Cricothyrotomy if
necessary)
• BP, Sats, ECG monitoring
• Lie patient supine with legs elevated if hypotensive
• High flow IV line

Adjunctive treatment

CRYSTALLOID NEBULISED BRONCHODILATORS

H1 ANTIHISTAMINE (e.g. Ringers/Balsol) (if severe bronchospasm, and especially if
on beta blockers)
Promethazine Rapid infusion of 1 - 2 litres (20 ml/kg for children)
if no response to adrenaline Salbutamol
> 12 yrs - 25 mg IM or slow IV
6 - 12 yrs - 12,5 mg IM or slow IV > 6 yrs - 5 mg every 15 - 20 mins
Repeat IV infusion as necessary, as large amounts
< 6 yrs - 2,5 mg every 15 - 20 mins
2 - 6 yrs - 6,25 mg IM or slow IV may be required
WITH Ipratropium
(Avoid if < 2 yrs old and low BP) Adrenaline infusion (0,1 - 1 ug/kg/min) ONLY if
> 6 yrs - 0,5 mg every 15 - 20 mins
unresponsive to IM adrenaline and fluids
< 6 yrs - 0,25 mg every 15 - 20 mins

H2 RECEPTOR ANTAGONIST
Ranitidine
Adult - 50 mg IM or slow IV (diluted in 20 ml GLUCAGON
CORTICOSTEROIDS
over 2 min) Adult – 1 - 2 mg IM or slow IV every 5 mins if
unresponsive to adrenaline, and especially Hydrocortisone
Child – 1 mg/kg (Max - 50 mg) > 12 yrs - 200 mg IM or slow IV
if on beta blockers
OR 6 - 12 yrs - 100 mg IM or slow IV
Child – 20 ug/kg (Max - 1 mg)
1 - 6 yrs - 50 mg IM or slow IV
Cimetidine
< 1 yr - 25 mg IM or slow IV
Adult – 300 mg IM or slow IV (diluted in 20 ml (Look out for vomiting and hyperglycaemia)
over 2 min)
Child – 5 mg/kg (Max - 300 mg)

Important Information

Q When is it appropriate to initiate treatment for

Anaphylaxis?
for observation for 4 - 6 hours or longer based
on the severity of the reaction due to the risk of Q Why are Antihistamines considered adjunctive
treatment?
biphasic reaction. 2
A ANY SYMPTOMS SHOULD BE TREATED
A H1-antihistamines may relieve itching and uticaria
IMMEDIATELY. Do not wait for symptoms to
progress. 1
Q What is the discharge protocol for patients leaving
the hospital?
but do not prevent or relieve life threatening
symptoms of anaphylaxis. 2

Q What should happen once a patient is A Ensure patients leave with: 2

1. A referral to a specialist
The use of antihistamines alone is the most
common reason reported for not using adrenaline
resuscitated?
2. An Anaphylaxis Emergency Action Plan and may place a patient at significantly increased
A Patients must be transferred to a medical facility 3. An Adrenaline Auto-Injector risk for progression towards a life-threatening
reaction.

For more information visit www.resuscitationcouncil.co.za

EPIPEN EPIPENJr
® ®

(Adrenaline) Auto-Injectors 0,3/0,15 mg

References: 1. Simons FER, Ardusso LRF, Biló MB, El-Gamal YM, Ledford DK, Ring J, et al. World Allergy Organization guidelines for the assessment and management of anaphylaxis. Proudly sponsored by:
WAOJ. 2011. 2. Boyce JA, Assa’ad A, Burks AW, et al. Guidelines for the Diagnosis and Management of Food Allergy in the United States: Report of the NIAID-Sponsored Expert Panel.
J Allergy Clin Immunol. 2010;126,6:S1-S58.

EPIPEN® (Auto-injector). Reg. No.: 27/5.1/0063. Adrenaline 0,3 mg / 0,3 ml. EPIPEN Junior® (Auto-injector). Reg. No.: 38/5.1/0278. Adrenaline 0,15 mg / 0,3 mg.
For full prescribing information refer to the package insert approved by the medicines regulatory authority.