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Anaphylaxis: diagnosis and management
Simon G A Brown1, Raymond J Mullins, Michael S Gold
1University of Western Australia, Fremantle Hospital, Fremantle, WA, Australia. simon.brown@uwa.edu.au
Insights
Anaphylaxis is a severe allergic reaction requiring immediate treatment with intramuscular adrenaline. Prompt recognition and management are crucial for preventing life-threatening complications like airway obstruction and hypotension.
Area of Science:
- Allergy and Immunology
- Emergency Medicine
- Pediatrics
Background:
- Anaphylaxis is a severe, rapid-onset allergic reaction with potential for fatality.
- Life-threatening symptoms include airway obstruction, bronchospasm, and hypotension.
- Food allergies are common causes in children, while venom and drug reactions are more frequent in adults.
Purpose of the Study:
- To outline the critical aspects of anaphylaxis diagnosis and management.
- To emphasize the importance of prompt recognition and intervention.
- To provide guidance on initial and subsequent treatment strategies.
Main Methods:
- Review of anaphylaxis characteristics, triggers, and diagnostic challenges.
- Description of initial management protocols including patient positioning, intramuscular adrenaline, and fluid resuscitation.
- Guidance on escalation of care with intravenous adrenaline and vasopressors if needed.
Main Results:
- Diagnosis can be challenging, with skin manifestations absent in up to 20% of cases.
- Initial management focuses on airway support, oxygen, adrenaline, and fluid resuscitation.
- Intravenous adrenaline and vasopressors are indicated for persistent hypotension.
Conclusions:
- Anaphylaxis must be considered in acute respiratory distress, bronchospasm, hypotension, or cardiac arrest.
- Timely administration of intramuscular adrenaline is the cornerstone of initial management.
- Post-resolution observation, specialist referral, and patient education are vital for long-term care and prevention.
Abstract:
Anaphylaxis is a serious, rapid-onset, allergic reaction that may cause death. Severe anaphylaxis is characterised by life-threatening upper airway obstruction, bronchospasm and/or hypotension. Anaphylaxis in children is most often caused by food. Bronchospasm is a common symptom, and there is usually a background of atopy and asthma. Venom- and drug-induced anaphylaxis are more common in adults, in whom hypotension is more likely to occur. Diagnosis can be difficult, with skin features being absent in up to 20% of people. Anaphylaxis must be considered as a differential diagnosis for any acute-onset respiratory distress, bronchospasm, hypotension or cardiac arrest. The cornerstones of initial management are putting the patient in the supine position, administering intramuscular adrenaline into the lateral thigh, resuscitation with intravenous fluid, support of the airway and ventilation, and giving supplementary oxygen. If the response to initial management is inadequate, intravenous infusion of adrenaline should be commenced. Use of vasopressors should be considered if hypotension persists. The patient should be observed for at least 4 hours after symptom resolution and referred to an allergist to assist with diagnosis, allergen avoidance measures, risk assessment, preparation of an action plan and education on the use of self-injectable adrenaline. Provision of a MedicAlert bracelet should also be arranged.
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