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Anaphylaxis

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Anaphylaxis

Clinical features

Latent period between exposure and development of symptoms variable but usually occurs within 10 min if provoking agent is given parenterally

Management

  • ABC
  • oxygen by facemask
  • epinephrine for severe cases: 0.3-1 mg IM or 0.2-0.5 mg IV. Increases cAMP in WBCs and mast cells and thus inhibits further release of histamine. Norepinephrine may be required if hypotension persists in spite of epinephrine and colloids
  • fluids. Colloids probably preferable to crystalloids. Very large volumes of fluid may be required
  • bronchodilators: nebulized salbutamol ± IV aminophylline 5.6 mg/kg over 30 min
  • steroids have no proven benefit and should only be given in refractory bronchospasm (hydrocortisone 200mg)
  • antihistamines are only indicated in protracted cases or in those with angio-oedema which may recur.

Diagnosis

  • send blood for IgE
  • mast cell tryptase. ­ 1h after a reaction begins and may persist for up to 4h. Highly specific and sensitive for anaphylaxis

Further reading

Fisher MM. Anaphylaxis. In Oh TE (ed), Intensive Care Manual, 4th Ed., Butterworth Heinemann, Oxford, 1997, pp 509-11


© Charles Gomersall December 1997


©Charles Gomersall, April, 2014 unless otherwise stated. The author, editor and The Chinese University of Hong Kong take no responsibility for any adverse event resulting from the use of this webpage.
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