The anaphylaxis algorithm

Καλλή Κυριακή

Ωτορινολαρυγγολόγος, Επιμελήτρια Β Γεν. Νοσ. Ναυπλίου

According to figures issued by The Anaphylaxis Campaign, as many as half a million people may be affected by acute, severe food allergy [1]. A similar number of other people may be at risk of anaphylaxis from insect bites or stings, latex, drugs or a wide range of other triggers [2].

The incidence and prevalence of serious  allergic reactions such as anaphylaxis are increasing rapidly, as is the number of hospital admissions for anaphylactic shock[3].

Guidelines for the emergency treatment of anaphylaxis issued by the Royal College of Physicians and the Resuscitation Council (UK) in April 2009 recommend the use of adrenaline as the first line emergency treatment.[4].

Anaphylactic reaction? 

Airway, Breathing, Circulation, Disability, Exposure Diagnosis - look for:

Acute onset of illness
Life threatening Airway and/or Breathing and/or Circulation problems
And usually skin changes

Call for help

Lie patient flat

Raise patient's legs

Adrenaline

When skills and equipment available

Establish airway

High flow oxygen

IV fluid challenge

Chloropheniramine

Hydrocortisonr

Monitor: Pulse oximetry, ECG, Blood pressure

The recommended doses of adrenaline are [4]:
•    Adult: 500mcg IM

•    Child over 12 years: 500mcg IM

•    Child 6-12 years: 300meg IM

•    Child under 6 years: f5umcg IM

Doses to be repeated after 5 minutes if the patient is no better.
 

   References

1. The Anaphylaxis Campaign. Anaphylaxis - Key information. http://www.anaphylaxis.org.uk/information/press-info.aspx Accessed July 2009

2. Pumphrey R. Curr Opin Allergy Clin Immunol 2004;4:285-290.

3. Department of Health. Parliamentary written reply, 26 March 2009. http://www.theyworkforyou.com/wrans/?id=2009-03-26c.266146.h Accessed July 2009

4. Soar J on behalf of the multidisciplinary Guideline Development Group. Clin Med 2009;9(2):181 -185

 When skills and equipment available
 

•  Establish airway

•   Monitor

•   High flow oxygen

- Pulse oximetry
 

•   IV fluid challenge

- ECG

•   Chlorpheniramine

- Blood pressure
 

•   Hydrocortisone

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