Anaphylaxis--recognition and management

Anaphylaxis is a rapid onset, multisystem hypersensitivity reaction. The diagnosis is usually straightforward, but may be difficult when skin signs are absent.

This article describes the recognition, assessment and evidence based management of anaphylaxis in the general practice setting.

Published guidelines on the management of anaphylaxis are broadly consistent and emphasise the early use of intramuscular adrenaline, supine position, airway support and intravenous fluid resuscitation. Intravenous bolus doses of adrenaline should be avoided unless cardiac arrest occurs. Steroids and antihistamines have no proven role and are not recommended as first line management. As protracted or biphasic reactions can occur, patients should be observed in the emergency department setting for at least 6 hours after an acute event. Follow up aims to provide accurate identification of likely cause(s) to help prevent further exposure, immunotherapy if available and an action plan and adrenaline auto-injector where further accidental exposures are likely.