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==Overview==
==Overview==
There is no treatment for [disease name]; the mainstay of therapy is supportive care.
[[Anaphylaxis]] is a [[medical emergency]] and requires prompt treatment as it can progress to fatal [[anaphylactic shock]]. Because it has variable [[diagnostic criteria]] that can carry an unpredictable course, the most important point of treatment is not to delay. Intramuscular [[epinephrine]] is the medication of choice and should be used promptly. Long-term management includes avoidance of triggers after confirmation for the cause from an allergist. Patients should be advised to carry self-injectable [[epinephrine]] in case of recurrent episodes. <ref name="pmid29238519">{{cite journal| author=Alvarez-Perea A, Tanno LK, Baeza ML| title=How to manage anaphylaxis in primary care. | journal=Clin Transl Allergy | year= 2017 | volume= 7 | issue=  | pages= 45 | pmid=29238519 | doi=10.1186/s13601-017-0182-7 | pmc=5724339 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29238519  }} </ref>
 
OR
 
Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].
 
OR
 
The majority of cases of [disease name] are self-limited and require only supportive care.
 
OR
 
[Disease name] is a medical emergency and requires prompt treatment.
 
OR
 
The mainstay of treatment for [disease name] is [therapy].
 
OR
 
The optimal therapy for [malignancy name] depends on the stage at diagnosis.
 
OR
 
[Therapy] is recommended among all patients who develop [disease name].
 
OR
 
Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
 
OR
 
Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
 
OR
 
Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
 
OR
 
Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
 


==Medical Therapy==
==Medical Therapy==
===Emergency Treatment===
Anaphylaxis is a life-threatening [[medical emergency]] because of rapid constriction of the [[airway]], often within minutes of onset, which can lead to [[respiratory failure]] and [[respiratory arrest]]. Brain and organ damage rapidly occurs if the patient cannot breathe.  Due to the severe nature of the emergency, patients experiencing or about to experience anaphylaxis require the [[call for help|help]] of advanced medical personnel.  [[First aid]] measures for anaphylaxis include rescue breathing (part of [[Cardiopulmonary resuscitation|CPR]]).  Rescue breathing may be hindered by the constricted airways, but if the victim stops breathing on his or her own, it is the only way to get oxygen to him or her until professional help is available.


Another treatment for anaphylaxis is administration of [[epinephrine]] (adrenaline).  Epinephrine prevents worsening of the airway constriction, stimulates the heart to continue beating, and may be life-saving.  Epinephrine acts on [[Beta-2 adrenergic receptor]]s in the lung as a powerful [[bronchodilator]] (i.e. it opens the airways), relieving allergic or [[histamine]]-induced acute [[asthma]]tic attack or anaphylaxis.  If the patient has previously been diagnosed with anaphylaxis, they may be carrying an [[EpiPen]] (or TWINJECT TM) for immediate administration of epinephrine.  However, use of an EpiPen or similar device only provides temporary and limited relief of symptoms.
[[Anaphylaxis]] is a life-threatening [[medical emergency]] because of rapid constriction of the [[airway]], and can lead to [[respiratory failure]]. The first step is to remove the patient from exposure to the potential [[allergen]]. The patient should then be evaluated for [[airway]], [[breathing]] and [[cardiovascular]] compromise. <ref name="pmid24251536">{{cite journal| author=Dhami S, Panesar SS, Roberts G, Muraro A, Worm M, Bilò MB | display-authors=etal| title=Management of anaphylaxis: a systematic review. | journal=Allergy | year= 2014 | volume= 69 | issue= 2 | pages= 168-75 | pmid=24251536 | doi=10.1111/all.12318 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24251536 }} </ref> <ref name="pmid26525001">{{cite journal| author=Simons FE, Ebisawa M, Sanchez-Borges M, Thong BY, Worm M, Tanno LK | display-authors=etal| title=2015 update of the evidence base: World Allergy Organization anaphylaxis guidelines. | journal=World Allergy Organ J | year= 2015 | volume= 8 | issue= 1 | pages= 32 | pmid=26525001 | doi=10.1186/s40413-015-0080-1 | pmc=4625730 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26525001  }} </ref> <ref name="pmid20176258">{{cite journal| author=Simons FE| title=Anaphylaxis. | journal=J Allergy Clin Immunol | year= 2010 | volume= 125 | issue= 2 Suppl 2 | pages= S161-81 | pmid=20176258 | doi=10.1016/j.jaci.2009.12.981 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20176258  }} </ref> <ref name="pmid28546858">{{cite journal| author=Dhami S, Sheikh A, Muraro A, Roberts G, Halken S, Fernandez Rivas M | display-authors=etal| title=Quality indicators for the acute and long-term management of anaphylaxis: a systematic review. | journal=Clin Transl Allergy | year= 2017 | volume= 7 | issue= | pages= 15 | pmid=28546858 | doi=10.1186/s13601-017-0151-1 | pmc=5442671 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28546858  }} </ref>


[[Tachycardia]] (rapid heartbeat) results from stimulation of Beta-1 adrenergic receptors of the heart increasing contractility (positive inotropic effect) and frequency (chronotropic effect) and thus cardiac output. Repetitive administration of epinephrine can cause tachycardia and occasionally [[ventricular tachycardia]] with heart rates potentially reaching 240 beats per minute, which itself can be fatal. Extra doses of epinephrine can sometimes cause [[cardiac arrest]]. This is why some protocols advise ''intramuscular'' injection of only 0.3–0.5mL of a 1:1,000 dilution.
Another treatment for [[anaphylaxis]] is the administration of [[epinephrine]] (adrenaline).  This is the treatment of choice. [[Epinephrine]] acts on [[Beta-2 adrenergic receptor]]s in the lung as a powerful [[bronchodilator]]. [[Tachycardia]] can result from stimulation of [[Beta-1 adrenergic receptor|Beta-1 adrenergic]] receptors. <ref name="pmid17620060">{{cite journal| author=Sheikh A, Ten Broek V, Brown SG, Simons FE| title=H1-antihistamines for the treatment of anaphylaxis: Cochrane systematic review. | journal=Allergy | year= 2007 | volume= 62 | issue= 8 | pages= 830-7 | pmid=17620060 | doi=10.1111/j.1398-9995.2007.01435.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17620060  }} </ref> <ref name="pmid18691308">{{cite journal| author=Kemp SF, Lockey RF, Simons FE, World Allergy Organization ad hoc Committee on Epinephrine in Anaphylaxis| title=Epinephrine: the drug of choice for anaphylaxis. A statement of the World Allergy Organization. | journal=Allergy | year= 2008 | volume= 63 | issue= 8 | pages= 1061-70 | pmid=18691308 | doi=10.1111/j.1398-9995.2008.01733.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18691308  }} </ref> <ref name="pmid14656845">{{cite journal| author=McLean-Tooke AP, Bethune CA, Fay AC, Spickett GP| title=Adrenaline in the treatment of anaphylaxis: what is the evidence? | journal=BMJ | year= 2003 | volume= 327 | issue= 7427 | pages= 1332-5 | pmid=14656845 | doi=10.1136/bmj.327.7427.1332 | pmc=286326 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14656845  }} </ref> <ref name="pmid25577622">{{cite journal| author=Campbell RL, Bellolio MF, Knutson BD, Bellamkonda VR, Fedko MG, Nestler DM | display-authors=etal| title=Epinephrine in anaphylaxis: higher risk of cardiovascular complications and overdose after administration of intravenous bolus epinephrine compared with intramuscular epinephrine. | journal=J Allergy Clin Immunol Pract | year= 2015 | volume= 3 | issue= 1 | pages= 76-80 | pmid=25577622 | doi=10.1016/j.jaip.2014.06.007 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25577622  }} </ref>  After administration of [[epinephrine]], the patient should be placed [[supine]] and their [[vital signs]] should be monitored. If supplemental [[oxygen]] and [[intravenous fluid]] are indicated they should be administered. <ref name="pmid24909803">{{cite journal| author=Muraro A, Roberts G, Worm M, Bilò MB, Brockow K, Fernández Rivas M | display-authors=etal| title=Anaphylaxis: guidelines from the European Academy of Allergy and Clinical Immunology. | journal=Allergy | year= 2014 | volume= 69 | issue= 8 | pages= 1026-45 | pmid=24909803 | doi=10.1111/all.12437 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24909803  }} </ref> <ref name="pmid20031267">{{cite journal| author=Kanwar M, Irvin CB, Frank JJ, Weber K, Rosman H| title=Confusion about epinephrine dosing leading to iatrogenic overdose: a life-threatening problem with a potential solution. | journal=Ann Emerg Med | year= 2010 | volume= 55 | issue= 4 | pages= 341-4 | pmid=20031267 | doi=10.1016/j.annemergmed.2009.11.008 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20031267  }} </ref>


Some patients with severe allergies routinely carry preloaded syringes containing [[epinephrine]], [[diphenhydramine]] (Benadryl), and [[dexamethasone]] (Decadron) whenever they go to an unknown or uncontrolled environment.These three injections, taken at the beginning of anaphylaxis, can often bring it under control and avoid a trip to the emergency Room.
Repetitive administration of [[epinephrine]] can cause [[tachycardia]] which can be fatal. Therefore protocols advise ''intramuscular'' injection of only 0.3–0.5mL of a 1:1,000 dilution. Some patients with severe [[allergies]] carry preloaded syringes containing [[epinephrine]], [[diphenhydramine]], and [[dexamethasone]] which can prevent anaphylactic reactions. <ref name="pmid12897756">{{cite journal| author=Pumphrey RS| title=Fatal posture in anaphylactic shock. | journal=J Allergy Clin Immunol | year= 2003 | volume= 112 | issue= 2 | pages= 451-2 | pmid=12897756 | doi=10.1067/mai.2003.1614 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12897756  }} </ref> <ref name="pmid18358585">{{cite journal| author=Soar J, Pumphrey R, Cant A, Clarke S, Corbett A, Dawson P | display-authors=etal| title=Emergency treatment of anaphylactic reactions--guidelines for healthcare providers. | journal=Resuscitation | year= 2008 | volume= 77 | issue= 2 | pages= 157-69 | pmid=18358585 | doi=10.1016/j.resuscitation.2008.02.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18358585  }} </ref> <ref name="pmid29238519">{{cite journal| author=Alvarez-Perea A, Tanno LK, Baeza ML| title=How to manage anaphylaxis in primary care. | journal=Clin Transl Allergy | year= 2017 | volume= 7 | issue=  | pages= 45 | pmid=29238519 | doi=10.1186/s13601-017-0182-7 | pmc=5724339 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29238519  }} </ref> <ref name="pmid15131564">{{cite journal| author=Simons FE| title=First-aid treatment of anaphylaxis to food: focus on epinephrine. | journal=J Allergy Clin Immunol | year= 2004 | volume= 113 | issue= 5 | pages= 837-44 | pmid=15131564 | doi=10.1016/j.jaci.2004.01.769 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15131564  }} </ref> <ref name="pmid20543673">{{cite journal| author=Simons KJ, Simons FE| title=Epinephrine and its use in anaphylaxis: current issues. | journal=Curr Opin Allergy Clin Immunol | year= 2010 | volume= 10 | issue= 4 | pages= 354-61 | pmid=20543673 | doi=10.1097/ACI.0b013e32833bc670 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20543673  }} </ref>


===Clinical Care===
[[Paramedic]] treatment in the field includes administration of [[epinephrine]], [[Benadryl]] IM, [[Steroid|steroids]], [[IV Fluid]] administration, and [[vasopressors]] such as [[dopamine]] for hypotension, administration of [[oxygen]], and [[intubation]] during transport to advanced medical care. <ref name="pmid20543673">{{cite journal| author=Simons KJ, Simons FE| title=Epinephrine and its use in anaphylaxis: current issues. | journal=Curr Opin Allergy Clin Immunol | year= 2010 | volume= 10 | issue= 4 | pages= 354-61 | pmid=20543673 | doi=10.1097/ACI.0b013e32833bc670 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20543673  }} </ref> <ref name="pmid24468252">{{cite journal| author=Nurmatov UB, Rhatigan E, Simons FE, Sheikh A| title=H2-antihistamines for the treatment of anaphylaxis with and without shock: a systematic review. | journal=Ann Allergy Asthma Immunol | year= 2014 | volume= 112 | issue= 2 | pages= 126-31 | pmid=24468252 | doi=10.1016/j.anai.2013.11.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24468252  }} </ref> <ref name="pmid20584003">{{cite journal| author=Choo KJ, Simons E, Sheikh A| title=Glucocorticoids for the treatment of anaphylaxis: Cochrane systematic review. | journal=Allergy | year= 2010 | volume= 65 | issue= 10 | pages= 1205-11 | pmid=20584003 | doi=10.1111/j.1398-9995.2010.02424.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20584003  }} </ref>


[[Paramedic]] treatment in the field includes administration of [[epinephrine]] IM (or IV infusion in severe cases), Benadryl IM, steroids such as Decadron, IV Fluid administration and in severe cases, pressor agents (which cause the heart to increase its contraction strength) such as Dopamine for hypotension, administration of [[oxygen]], and [[intubation]] during transport to advanced medical care.  
[[Antihistamine]] drugs such as [[Benadryl]] (which inhibit the effects of [[histamine]] at [[histamine]] receptors) are continued but are usually not sufficient in [[anaphylaxis]], and high doses of intravenous [[corticosteroid]]s such as [[Decadron]] or [[Solu-Medrol]] are often required. [[Hypotension]] is treated with [[intravenous fluid]]s and [[vasopressor]] drugs. For bronchospasm, [[bronchodilator]] drugs such as [[albuterol]] are used. Supportive care with [[mechanical ventilation]] may be required. <ref name="pmid29238519">{{cite journal| author=Alvarez-Perea A, Tanno LK, Baeza ML| title=How to manage anaphylaxis in primary care. | journal=Clin Transl Allergy | year= 2017 | volume= 7 | issue=  | pages= 45 | pmid=29238519 | doi=10.1186/s13601-017-0182-7 | pmc=5724339 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29238519  }} </ref> <ref name="pmid26120521">{{cite journal| author=Ring J, Beyer K, Biedermann T, Bircher A, Duda D, Fischer J | display-authors=etal| title=Guideline for acute therapy and management of anaphylaxis: S2 Guideline of the German Society for Allergology and Clinical Immunology (DGAKI), the Association of German Allergologists (AeDA), the Society of Pediatric Allergy and Environmental Medicine (GPA), the German Academy of Allergology and Environmental Medicine (DAAU), the German Professional Association of Pediatricians (BVKJ), the Austrian Society for Allergology and Immunology (ÖGAI), the Swiss Society for Allergy and Immunology (SGAI), the German Society of Anaesthesiology and Intensive Care Medicine (DGAI), the German Society of Pharmacology (DGP), the German Society for Psychosomatic Medicine (DGPM), the German Working Group of Anaphylaxis Training and Education (AGATE) and the patient organization German Allergy and Asthma Association (DAAB). | journal=Allergo J Int | year= 2014 | volume= 23 | issue= 3 | pages= 96-112 | pmid=26120521 | doi=10.1007/s40629-014-0009-1 | pmc=4479483 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26120521  }} </ref> <ref name="pmid29489197">{{cite journal| author=| title=StatPearls | journal= | year= 2021 | volume=  | issue=  | pages=  | pmid=29489197 | doi= | pmc= | url= }} </ref>


In severe situations with profuse laryngeal edema (swelling of the airway), [[cricothyrotomy]] or [[tracheotomy]] may be required to maintain oxygenation. In these procedures, an incision is made through the anterior portion of the neck, over the cricoid membrane, and an endotracheal tube is inserted to allow mechanical ventilation of the victim.  
The possibility of recurrence of [[anaphylaxis]] requires that patients be monitored after stabilization. <ref name="pmid19927537">{{cite journal| author=Manivannan V, Campbell RL, Bellolio MF, Stead LG, Li JT, Decker WW| title=Factors associated with repeated use of epinephrine for the treatment of anaphylaxis. | journal=Ann Allergy Asthma Immunol | year= 2009 | volume= 103 | issue= 5 | pages= 395-400 | pmid=19927537 | doi=10.1016/S1081-1206(10)60358-4 | pmc=3723113 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19927537  }} </ref> <ref name="pmid26525001">{{cite journal| author=Simons FE, Ebisawa M, Sanchez-Borges M, Thong BY, Worm M, Tanno LK | display-authors=etal| title=2015 update of the evidence base: World Allergy Organization anaphylaxis guidelines. | journal=World Allergy Organ J | year= 2015 | volume= 8 | issue= 1 | pages= 32 | pmid=26525001 | doi=10.1186/s40413-015-0080-1 | pmc=4625730 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26525001  }} </ref>


The clinical treatment of anaphylaxis by a [[physician|doctor]] and in the [[hospital]] setting aims to treat the cellular [[hypersensitivity]] reaction as well as the symptoms. [[Antihistamine]] drugs such as Benadryl (which inhibit the effects of histamine at histamine receptors) are continued but are usually not sufficient in anaphylaxis, and high doses of intravenous [[corticosteroid]]s such as Decadron or Solu-Medrol are often required. [[Hypotension]] is treated with [[intravenous fluid]]s and sometimes vasopressor drugs. For bronchospasm, [[bronchodilator]] drugs (e.g. [[Salbutamol]], known as Albuterol in the United States) are used. In severe cases, immediate treatment with epinephrine can be lifesaving.  Supportive care with [[mechanical ventilation]] may be required.
It is also possible to undergo a second reaction prior to medical attention or using an epipen. It is suggested to seek one to two days of medical care.
The possibility of biphasic reactions (recurrence of anaphylaxis) requires that patients be monitored for four hours after being transported to medical care for anaphylaxis.
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
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[[Category:Pulmonology]]
[[Category:Pulmonology]]
[[Category:Immunology]]
[[Category:Immunology]]
__NOTOC__
{{Anaphylaxis}}
{{CMG}}; {{AE}}


==References==
==References==

Latest revision as of 20:51, 14 April 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Associate Editor(s)-in-Chief: Dushka Riaz, MD

Overview

Anaphylaxis is a medical emergency and requires prompt treatment as it can progress to fatal anaphylactic shock. Because it has variable diagnostic criteria that can carry an unpredictable course, the most important point of treatment is not to delay. Intramuscular epinephrine is the medication of choice and should be used promptly. Long-term management includes avoidance of triggers after confirmation for the cause from an allergist. Patients should be advised to carry self-injectable epinephrine in case of recurrent episodes. [1]

Medical Therapy

Anaphylaxis is a life-threatening medical emergency because of rapid constriction of the airway, and can lead to respiratory failure. The first step is to remove the patient from exposure to the potential allergen. The patient should then be evaluated for airway, breathing and cardiovascular compromise. [2] [3] [4] [5]

Another treatment for anaphylaxis is the administration of epinephrine (adrenaline). This is the treatment of choice. Epinephrine acts on Beta-2 adrenergic receptors in the lung as a powerful bronchodilator. Tachycardia can result from stimulation of Beta-1 adrenergic receptors. [6] [7] [8] [9] After administration of epinephrine, the patient should be placed supine and their vital signs should be monitored. If supplemental oxygen and intravenous fluid are indicated they should be administered. [10] [11]

Repetitive administration of epinephrine can cause tachycardia which can be fatal. Therefore protocols advise intramuscular injection of only 0.3–0.5mL of a 1:1,000 dilution. Some patients with severe allergies carry preloaded syringes containing epinephrine, diphenhydramine, and dexamethasone which can prevent anaphylactic reactions. [12] [13] [1] [14] [15]

Paramedic treatment in the field includes administration of epinephrine, Benadryl IM, steroids, IV Fluid administration, and vasopressors such as dopamine for hypotension, administration of oxygen, and intubation during transport to advanced medical care. [15] [16] [17]

Antihistamine drugs such as Benadryl (which inhibit the effects of histamine at histamine receptors) are continued but are usually not sufficient in anaphylaxis, and high doses of intravenous corticosteroids such as Decadron or Solu-Medrol are often required. Hypotension is treated with intravenous fluids and vasopressor drugs. For bronchospasm, bronchodilator drugs such as albuterol are used. Supportive care with mechanical ventilation may be required. [1] [18] [19]

The possibility of recurrence of anaphylaxis requires that patients be monitored after stabilization. [20] [3]

References

  1. ↑ 1.0 1.1 1.2 Alvarez-Perea A, Tanno LK, Baeza ML (2017). "How to manage anaphylaxis in primary care". Clin Transl Allergy. 7: 45. doi:10.1186/s13601-017-0182-7. PMC 5724339. PMID 29238519.
  2. ↑ Dhami S, Panesar SS, Roberts G, Muraro A, Worm M, Bilò MB; et al. (2014). "Management of anaphylaxis: a systematic review". Allergy. 69 (2): 168–75. doi:10.1111/all.12318. PMID 24251536.
  3. ↑ 3.0 3.1 Simons FE, Ebisawa M, Sanchez-Borges M, Thong BY, Worm M, Tanno LK; et al. (2015). "2015 update of the evidence base: World Allergy Organization anaphylaxis guidelines". World Allergy Organ J. 8 (1): 32. doi:10.1186/s40413-015-0080-1. PMC 4625730. PMID 26525001.
  4. ↑ Simons FE (2010). "Anaphylaxis". J Allergy Clin Immunol. 125 (2 Suppl 2): S161–81. doi:10.1016/j.jaci.2009.12.981. PMID 20176258.
  5. ↑ Dhami S, Sheikh A, Muraro A, Roberts G, Halken S, Fernandez Rivas M; et al. (2017). "Quality indicators for the acute and long-term management of anaphylaxis: a systematic review". Clin Transl Allergy. 7: 15. doi:10.1186/s13601-017-0151-1. PMC 5442671. PMID 28546858.
  6. ↑ Sheikh A, Ten Broek V, Brown SG, Simons FE (2007). "H1-antihistamines for the treatment of anaphylaxis: Cochrane systematic review". Allergy. 62 (8): 830–7. doi:10.1111/j.1398-9995.2007.01435.x. PMID 17620060.
  7. ↑ Kemp SF, Lockey RF, Simons FE, World Allergy Organization ad hoc Committee on Epinephrine in Anaphylaxis (2008). "Epinephrine: the drug of choice for anaphylaxis. A statement of the World Allergy Organization". Allergy. 63 (8): 1061–70. doi:10.1111/j.1398-9995.2008.01733.x. PMID 18691308.
  8. ↑ McLean-Tooke AP, Bethune CA, Fay AC, Spickett GP (2003). "Adrenaline in the treatment of anaphylaxis: what is the evidence?". BMJ. 327 (7427): 1332–5. doi:10.1136/bmj.327.7427.1332. PMC 286326. PMID 14656845.
  9. ↑ Campbell RL, Bellolio MF, Knutson BD, Bellamkonda VR, Fedko MG, Nestler DM; et al. (2015). "Epinephrine in anaphylaxis: higher risk of cardiovascular complications and overdose after administration of intravenous bolus epinephrine compared with intramuscular epinephrine". J Allergy Clin Immunol Pract. 3 (1): 76–80. doi:10.1016/j.jaip.2014.06.007. PMID 25577622.
  10. ↑ Muraro A, Roberts G, Worm M, Bilò MB, Brockow K, Fernández Rivas M; et al. (2014). "Anaphylaxis: guidelines from the European Academy of Allergy and Clinical Immunology". Allergy. 69 (8): 1026–45. doi:10.1111/all.12437. PMID 24909803.
  11. ↑ Kanwar M, Irvin CB, Frank JJ, Weber K, Rosman H (2010). "Confusion about epinephrine dosing leading to iatrogenic overdose: a life-threatening problem with a potential solution". Ann Emerg Med. 55 (4): 341–4. doi:10.1016/j.annemergmed.2009.11.008. PMID 20031267.
  12. ↑ Pumphrey RS (2003). "Fatal posture in anaphylactic shock". J Allergy Clin Immunol. 112 (2): 451–2. doi:10.1067/mai.2003.1614. PMID 12897756.
  13. ↑ Soar J, Pumphrey R, Cant A, Clarke S, Corbett A, Dawson P; et al. (2008). "Emergency treatment of anaphylactic reactions--guidelines for healthcare providers". Resuscitation. 77 (2): 157–69. doi:10.1016/j.resuscitation.2008.02.001. PMID 18358585.
  14. ↑ Simons FE (2004). "First-aid treatment of anaphylaxis to food: focus on epinephrine". J Allergy Clin Immunol. 113 (5): 837–44. doi:10.1016/j.jaci.2004.01.769. PMID 15131564.
  15. ↑ 15.0 15.1 Simons KJ, Simons FE (2010). "Epinephrine and its use in anaphylaxis: current issues". Curr Opin Allergy Clin Immunol. 10 (4): 354–61. doi:10.1097/ACI.0b013e32833bc670. PMID 20543673.
  16. ↑ Nurmatov UB, Rhatigan E, Simons FE, Sheikh A (2014). "H2-antihistamines for the treatment of anaphylaxis with and without shock: a systematic review". Ann Allergy Asthma Immunol. 112 (2): 126–31. doi:10.1016/j.anai.2013.11.010. PMID 24468252.
  17. ↑ Choo KJ, Simons E, Sheikh A (2010). "Glucocorticoids for the treatment of anaphylaxis: Cochrane systematic review". Allergy. 65 (10): 1205–11. doi:10.1111/j.1398-9995.2010.02424.x. PMID 20584003.
  18. ↑ Ring J, Beyer K, Biedermann T, Bircher A, Duda D, Fischer J; et al. (2014). "Guideline for acute therapy and management of anaphylaxis: S2 Guideline of the German Society for Allergology and Clinical Immunology (DGAKI), the Association of German Allergologists (AeDA), the Society of Pediatric Allergy and Environmental Medicine (GPA), the German Academy of Allergology and Environmental Medicine (DAAU), the German Professional Association of Pediatricians (BVKJ), the Austrian Society for Allergology and Immunology (ÖGAI), the Swiss Society for Allergy and Immunology (SGAI), the German Society of Anaesthesiology and Intensive Care Medicine (DGAI), the German Society of Pharmacology (DGP), the German Society for Psychosomatic Medicine (DGPM), the German Working Group of Anaphylaxis Training and Education (AGATE) and the patient organization German Allergy and Asthma Association (DAAB)". Allergo J Int. 23 (3): 96–112. doi:10.1007/s40629-014-0009-1. PMC 4479483. PMID 26120521.
  19. ↑ "StatPearls". 2021. PMID 29489197.
  20. ↑ Manivannan V, Campbell RL, Bellolio MF, Stead LG, Li JT, Decker WW (2009). "Factors associated with repeated use of epinephrine for the treatment of anaphylaxis". Ann Allergy Asthma Immunol. 103 (5): 395–400. doi:10.1016/S1081-1206(10)60358-4. PMC 3723113. PMID 19927537.

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References

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