management of anaphylactic shock

Last reviewed 10/2021

The principles of management are (1):

• to recognize the serious life-threatening condition .
  
• call for help (don't be proud!)
  
• assesment of general condition and management based on an ABCDE approach.
  
• adrenaline therapy if indicated.
  
• investigation and follow-up by an specialist in allergy

The first line therapy in anaphylaxis, after removal of the allergen, is as any emergency; basic life support, centred on airway, breathing and circulation. In addition to this intravenous fluid support is needed, and 100% oxygen.

Further measures are as follows:

• adrenaline
• chlorphenamine
• hydrocortisone
• nebulised salbutamol/terbutaline if the patient is wheezy

If the response is poor then a cycle should continue (see linked algorithm outlines), of repeating adrenaline and consideration of volume expansion. An adrenaline infusion may be considered.

If the patient has hereditary angioneurotic oedema, an autosomal dominant trait, then this is relatively unresponsive to adrenaline (see menu option for management).

After emergency treatment for anaphylaxis (2):

• adults and young people aged 16 years or older who have had emergency treatment for suspected anaphylaxis should be observed for 6-12 hours from the onset of symptoms, depending on their response to emergency treatment. In people with reactions that are controlled promptly and easily, a shorter observation period may be considered provided that they receive appropriate postreaction care prior to discharge

• children younger than 16 years who have had emergency treatment for suspected anaphylaxis should be admitted to hospital under the care of a paediatric medical team.

Reference:

• (1) Emergency treatment of anaphylactic reactions. Guidelines for healthcare providers. Working Group of the Resuscitation Council (UK).2008
• (2) NICE (December 2011). Anaphylaxis: assessment to confirm an anaphylactic episode and the decision to refer after emergency treatment for a suspected anaphylactic episode.