Anaphylaxis/Allergic Reaction Administrative Guideline

Question 1

History

Answer 1

• Onset and location
• Insect sting or bite
• Food or med allergy/exposure
• Past history of reactions

Question 2

Signs and symptoms

Answer 2

• Dyspnea/hypoxia
• Wheezing
• Stridor
• Difficulty swallowing
• Oropharyngeal/tongue swelling
• Shock/decreased perfusion
• Urticaria
• Abdominal pain/vomiting

Question 3

Differential

Answer 3

• Urticaria (rash only)
• Anaphylaxis (systemic)
• Infection/sepsis
• Angioedema
• Airway obstruction
• Asthma/COPD
• CHF

Question 4

Suspected allergic reaction or anaphylaxis

Answer 4

Well, it is localized or is it multi-system?

Question 5

Localized allergic reaction

Answer 5

Administer 1 mg/kg diphenhydramine

(max 50 mg) IV/IM/PO

Question 6

Anaphylaxis,
multisystem reaction, or
shock

Answer 6

Administer epinephrine (1 mg/mL concentration) 0.01 mg/kg IM 
(max 0.5 mg) IM at upper lateral thigh
May repeat epinephrine dose every 5-15 minutes

Question 7

After you’ve given IM epi…

Answer 7

IV/IO access
Cardiac Monitor, EtCO 2 if available
Consider appropriate airway management adjuncts
Assess for signs of shock (poor perfusion, decreased mental status)

Question 8

After you’ve got monitor and access

Answer 8

Administer albuterol 2.5 mg SVN for wheezing
May repeat albuterol to max of 3 doses
Consider administration of ipratropium (Atrovent) 0.5 mg
nebulized with albuterol x 1
Administer 20 mL/kg NS/LR bolus for hypotension
Administer diphenhydramine 1 mg/kg (max 50 mg) IV/IM
Administer methylprednisolone 2 mg/kg IV/IM max dose 125 mg

Question 9

Anaphylaxis is defined as:

Answer 9

• Severe, acute onset AND one of the following:
• Respiratory compromise (dyspnea, wheeze, stridor, hypoxemia)
• Decreased BP (SBP<90)
  OR
• A combination of 2 of the following:
• Urticaria
• Swollen tongue or lips
• Nausea/Vomiting
• Abdominal pain
• Syncope
• Incontinence