Skip to main content

Physician Management of Anaphylaxis and Systemic Reactions

I. DEFINITION:

Anaphylaxis – an anaphylactic response is an acute systemic allergic reaction following antigen exposure in a sensitized person. Anaphylactoid reactions are thought to reflect a release of inflammatory mediators by non-immunologic mechanisms. Either response is a medical emergency. Most reactions will occur within 5 – 30 minutes following administration of a specific antigen, but may be prolonged or may be recurrent (biphasic) within 8 to 12 hours (J Allergy Clin Immunology, Sept 2002).

II. MANIFESTATION:

A. General - Patients often report sudden anxiety, morbid fear and a sense that “something is very wrong.” Palpitation may occur as well as dizziness or “graying out”.
B. Cutaneous Reactions - intense itching; especially of scalp, palms and groin areas; erythema +/-hives
C. Laryngeal Edema - may be experienced as a “lump” in the throat, hoarseness or stridor
D. Angioedema - sensed as fullness, numbness or other awareness of the swollen part.
E. Lower Airways - feeling of tightness in the chest, cough or wheezing; shortness of breath
F. Gastrointestinal/Visceral - nausea, vomiting, or diarrhea; abdominal and uterine cramping
G. Cardiovascular - lightheadeness, palpitations, hypotension with or without syncope and/or cardiac arrhythmias

III. ASSESSMENT:

The identification of an anaphylactic reaction depends largely upon an accurate history revealing the onset of one or more of the following:

  1. Cutaneous reactions – diffuse or localized erythema, pruritis, urticaria and/or angioedema
  2. Upper airway - laryngeal edema with possible dysphoria, stridor; rhinitis symptoms
  3. Lower Airway bronchospasm - respiratory distress, cough, wheeze, dyspnea
  4. Cardiovascular system – hypotension with or without syncope possibly progressing to vascular collapse, cardiac arrhythmias, cardiac arrest
  5. Gastrointestinal system – gastrointestinal spasm and edema leading to nausea, vomiting and/or diarrhea

IV. PLAN:

LOCAL REACTIONS

Usually no treatment is required other than application of ice pack and adjustment of dosage for subsequent allergy shots. If an unusually large reaction is noted before patient leaves the office, a tablet or capsule of an antihistamine such as Benadryl, Chlor- Trimentron, Claritin, Allegra, Zyrtec, or Clarinex, maybe given.

MILD SYSTEMIC REACTIONS

(itching of palms, scalp, roof of mouth or groin areas, mild hay fever or asthma): Administer aqueous epinephrine 1:1000 dilution 1 mg/ml.), 0.2 -0.5 ml, (0.01 mg/kg in children; maximum dose, 0.3 mg dosage) intramuscularly (*prefereably initially into the arm that received the allergy shot), every 5 minutes, as necessary, to control symptoms and blood pressure. Diphenhydramine 25 to 50 mg. may be given (parenterally). Consider giving an oral corticosteriod (e.g. prednisone (0.5 mg./kg.) to to prevent recurrent and protracted reactions.

SEVERE SYSTEMIC REACTIONS

(anaphylactic shock, hypotension with or without lightheadedness, bronchospasm, worsening angioedema with or without laryngeal edema, visceral spasm):

FOR INADEQUATE CLINICAL RESPONSE – CALL 911
FOR GOOD CLINICAL RESPONSE

8/21/9 ja
9/1/09 jkl
7/12/2018 jkl

-->