ANAPHYLAXIS
Anaphylaxis is a severe, rapid-onset systemic hypersensitivity reaction
CAUSES SYMPTOMS
A. Foods
Children: Peanuts, tree nuts, milk, Rapid onset: seconds to minutes after
eggs, shellfish, fish, soy, wheat exposure
Adults: Shellfish, peanuts, tree nuts Skin/mucosa: urticaria, flushing,
B. Medications angioedema
Antibiotics: Penicillins, cephalosporins Respiratory: throat tightness, stridor,
NSAIDs wheeze, dyspnea
Radiocontrast media Cardiovascular: hypotension, tachycardia,
Monoclonal antibodies (rarely) collapse
C. Insect Stings Gastrointestinal: nausea, vomiting,
Bees, wasps, hornets, fire ants diarrhea, abdominal pain
D. Other Neurological: dizziness, syncope, confusion
Latex Pediatric patients may present more
Exercise-induced anaphylaxis often with vomiting, lethargy, or pallor
Idiopathic (no identifiable cause) rather than obvious hypotension.
🩺 TREATMENT Airway - Breathing - Circulation
1. First-line Drug: Epinephrine (Adrenaline)
Route: Intramuscular (IM), anterolateral Adjunctive Medications (supportive)
thigh
Antihistamines - Relieve hives, itching, flushing
Onset: Rapid, life-saving
Repeat: Every 5–15 min if needed
🔹 Adults: Diphenhydramine 25–50 mg IV/IM
🔹 Adults: 0.3–0.5 mg IM
🔹 Children: 1 mg/kg IV/IM (max 50 mg)
🔹 Pediatrics: Optional: H2 blocker (e.g., Ranitidine 1 mg/kg
⚠️ IV epinephrine is not first-line — only in IV)
refractory shock, and then by infusion in
Corticosteroids
ICU.
🔹Adults: Hydrocortisone 200 mg IV
2. Breathing
Oxygen: High flow, 10–15 L/min by non-
🔹Children: Hydrocortisone 4–8 mg/kg IV
(max 200 mg)
rebreather mask
or Methylprednisolone 1–2 mg/kg IV
Position: Supine with legs elevated
(unless vomiting/respiratory distress)
Bronchodilators (if bronchospasm persists
Monitor: BP, HR, SpO₂, ECG
despite epinephrine)
3. IV Fluids (for hypotension/shock) Salbutamol (Albuterol) nebulization
(normal saline or Ringer’s lactate) 🔹 Adults: 2.5–5 mg nebulized every 20 min
🔹 Adults: 1–2 L rapid bolus, repeat as (as needed)
needed 🔹 Children: 2.5 mg nebulized
🔹 Children: 20 mL/kg bolus, repeat if (0.15 mg/kg if <20 kg)
necessary
Health Education Academy
Anaphylaxis is a severe, rapid-onset systemic hypersensitivity reaction
CAUSES SYMPTOMS
A. Foods
Children: Peanuts, tree nuts, milk, Rapid onset: seconds to minutes after
eggs, shellfish, fish, soy, wheat exposure
Adults: Shellfish, peanuts, tree nuts Skin/mucosa: urticaria, flushing,
B. Medications angioedema
Antibiotics: Penicillins, cephalosporins Respiratory: throat tightness, stridor,
NSAIDs wheeze, dyspnea
Radiocontrast media Cardiovascular: hypotension, tachycardia,
Monoclonal antibodies (rarely) collapse
C. Insect Stings Gastrointestinal: nausea, vomiting,
Bees, wasps, hornets, fire ants diarrhea, abdominal pain
D. Other Neurological: dizziness, syncope, confusion
Latex Pediatric patients may present more
Exercise-induced anaphylaxis often with vomiting, lethargy, or pallor
Idiopathic (no identifiable cause) rather than obvious hypotension.
🩺 TREATMENT Airway - Breathing - Circulation
1. First-line Drug: Epinephrine (Adrenaline)
Route: Intramuscular (IM), anterolateral Adjunctive Medications (supportive)
thigh
Antihistamines - Relieve hives, itching, flushing
Onset: Rapid, life-saving
Repeat: Every 5–15 min if needed
🔹 Adults: Diphenhydramine 25–50 mg IV/IM
🔹 Adults: 0.3–0.5 mg IM
🔹 Children: 1 mg/kg IV/IM (max 50 mg)
🔹 Pediatrics: Optional: H2 blocker (e.g., Ranitidine 1 mg/kg
⚠️ IV epinephrine is not first-line — only in IV)
refractory shock, and then by infusion in
Corticosteroids
ICU.
🔹Adults: Hydrocortisone 200 mg IV
2. Breathing
Oxygen: High flow, 10–15 L/min by non-
🔹Children: Hydrocortisone 4–8 mg/kg IV
(max 200 mg)
rebreather mask
or Methylprednisolone 1–2 mg/kg IV
Position: Supine with legs elevated
(unless vomiting/respiratory distress)
Bronchodilators (if bronchospasm persists
Monitor: BP, HR, SpO₂, ECG
despite epinephrine)
3. IV Fluids (for hypotension/shock) Salbutamol (Albuterol) nebulization
(normal saline or Ringer’s lactate) 🔹 Adults: 2.5–5 mg nebulized every 20 min
🔹 Adults: 1–2 L rapid bolus, repeat as (as needed)
needed 🔹 Children: 2.5 mg nebulized
🔹 Children: 20 mL/kg bolus, repeat if (0.15 mg/kg if <20 kg)
necessary
Health Education Academy
