Treatment of Anaphylaxis

                      Anaphylaxis is a serious allergic reaction that is rapid in onset and may cause death. Anaphylaxis a severe, life-threatening, generalised or systemic Hypersensitivity Reaction which is likely when both of the following criteria are met :
- Sudden onset and rapid progression of symptoms.
- Life-threatening airway and/or breathing and/or circulation problems.

Causes 
1. Foods
✎ Peanuts
✎ Pulses
✎ Tree nuts (eg, brazil nut, almond, hazelnut)
✎ Fish and shellfish
✎ Eggs
✎ Milk
2. Venom
✎ Bee stings
✎ Wasp stings
3. Drugs
Antibiotics
✎ Opioids
✎ Non-steroidal anti-inflammatory drugs (NSAIDs)
✎ Intravenous (IV) contrast media
✎ Muscle relaxants
✎ Other anaesthetic drugs

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Emergency Treatment 
1. Rapid assessment :
- Airway
- Breathing
- Circulation: colour, pulse and BP.
- Disability: assess whether responding or unconscious.
- Exposure: assess skin with adequate exposure, but avoid excess heat loss.
2. Consider Anaphylaxis when there is compatible history of rapid-onset severe allergic-type reaction with respiratory difficulty and/or hypotension, especially if there are skin changes present.
3. Give high-flow oxygen - using a mask with an oxygen reservoir (greater than 10 litres min-1 to prevent reservoir collapse).
4. Lay the patient flat:
- Raise the legs (with care, as this may worsen any breathing problems).
- In pregnant patients, use a left lateral tilt of at least 15° (to avoid caval compression).
5. Adrenaline (Epinephrine) intramuscularly (IM) in the anterolateral aspect of the middle third of the thigh (safe, easy, effective) :
- Adult IM dose 0.5 mg IM (= 500 micrograms = 0.5 mL of 1:1000) adrenaline (epinephrine).
6. IV fluids
7. Chlorphenamine 
>12 years and adults: 10 mg IM or IV slowly.
>6-12 years: 5 mg IM or IV slowly.
>6 months-6 years: 2.5 mg IM or IV slowly.
<6 months: 250 micrograms/kg IM or IV slowly.
8. Hydrocortisone 
>12 years and adults: 200 mg IM or IV slowly.
>6-12 years: 100 mg IM or IV slowly.
>6 months-6 years: 50 mg IM or IV slowly.
<6 months: 25 mg IM or IV slowly.
9. Continuing Respiratory deterioration requires further treatment with a bronchodilator, such as salbutamol (inhaled or IV), ipratropium (inhaled), aminophylline (IV) or magnesium sulfate (IV - unlicensed indication).
10. If there are symptoms and signs of cardiac failure (shortness of breath, increased heart rate, raised JVP, a third heart sound, and inspiratory crackles in the lungs on auscultation) : Decrease or stop the fluid infusion.

Reference 
1. Patient.co.uk : http://www.patient.co.uk/doctor/anaphylaxis-and-its-treatment

Related Article :
-  Hypersensitivity Reaction
-  Adrenaline (Epinephrine)

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