Lime Tree Surgery
TREATMENT OF ANAPHYLAXIS
INTRODUCTION
Anaphylaxis (also called Anaphylactic Shock) is a sudden, severe, and potentially life-threatening
allergic reaction caused by medications, food allergy, insect stings or substance allergy. The
purpose of this protocol is to provide a summary of the immediate treatment required.
EQUIPMENT AVAILABLE
The Anaphylaxis Treatment kit is located in each treatment room and on crash trolley and is
restocked by the practice nurse manager.
Suggested content of an anaphylaxis pack
2 x ampoules adrenaline (epinephrine) 1:1,000
4 x 23g needles (green)
4 x graduated 1ml syringes
Laerdal masks or equivalent suitable for children and adults
KEY TO MANAGEMENT OF ANAPHYLAXIS
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Awareness
Recognise it (consider in differential diagnosis)
Treat quickly
POSSIBLE SYMPTOMS (which may occur alone or in combination)
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Erythema
Pruritus (generalised)
Urticaria
Angio-oedema
Laryngeal oedema
Asthma
Rhinitis
Conjunctivitis
Itching of palate or external auditory meatus
Nausea, vomiting, abdominal pain
Palpitations
Sense of impending doom
Fainting, light headedness
Collapse
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Loss of consciousness
CAUSES
Anaphylaxis can occur in response to almost any foreign substance even if it has been given,
touched or eaten before. Anaphylaxis occurs as the result of a previously sensitised person
coming into contact with or receiving the sensitising antigen (i.e., a substance capable of
stimulating the formation of an antibody). Antigens known to be responsible for anaphylaxis
include:
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Antibiotics and Other Drugs
o
o
o
o
o
o
o
o
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Foods
o
o
o
o
o
o
o
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Fish and Seafood (particularly shellfish)
Milk
Eggs
Nuts (particularly peanuts)
Pulses
Wheat
Soy and Sesame Seeds
Pollens and other inhaled allergens
o
o
o
o
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Penicillins
Cephalosporins
Nitrofurantoin
Anti-seizure Medications
NSAIDs
Lignocaine
Iron
Dextran
Plant Moulds
Grasses
Weeds
Trees
Animal/Insect Venoms
o
o
o
Bees/Wasps/Hornets
Snake
Spiders & Scorpions
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Other
o
o
Rubber products
Latex
DIAGNOSIS
Reactions usually begin within minutes of exposure, but may be delayed. Sometimes symptoms
resolve, only to recur or progress a few hours later. The most dangerous symptoms are low
blood pressure, breathing difficulties, shock and loss of consciousness, all of which can be fatal.
Physiological Effect
Capillary leakage
Mucosal oedema
Smooth muscle contraction
Clinical Symptoms
Urticaria
Angio-oedema
Laryngeal oedema
Hypotension
Laryngeal oedema
Rhinitis
Asthma
Asthma
Abdominal Pain/Cramp
Vomiting/Diarrhoea
Danger
Asphyxia
Shock
Asphyxia
Respiratory arrest
Respiratory arrest
TREATMENT
The treatment depends on the severity of the attack. It may be possible to remove the cause
of the attack (but don’t waste time – for example, in trying to remove insect ‘stingers’ as this will
not stop the reaction).
Assess the patient’s condition (ABC of Resuscitation - Airways, Breathing and Circulation)
Mild Reaction:
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Make the patient comfortable.
Put them in a sitting position to help breathing with legs slightly raised
Give oxygen available from TR2, crash trolley, TR3
Call for help, i.e. dial 999, and seek another member of staff to assist, as well as requesting a
doctor
Observe blood pressure, pulse rate and respiratory rate (breathing) Sa)2
Moderate/Severe Reaction:
AGE
DOSAGE OF ADRENALINE
(epinephrine)
Under 6 months
150 mcg IM (0.15mls)
Over 6 months but under 6 years
150 mcgs IM (0.15 mls)
6-12 years
300 mcgs IM ( 0.30mls)
Over 12 years
500 mcgs IM (0.5mls)
300 mcgs IM if patient is small or
prepubertal
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A suitable syringe for small volumes should be used.
Record all batch numbers of medications used in the patient’s notes. The reaction should
be reported to the Medicines Control Agency using the yellow card scheme at the back of
the BNF.
FURTHER MANAGEMENT
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Anti-histamines and/or Hydrocortisone are not recommended in the emergency
anaphylaxis in Primary Care. They should be considered however, in the further
management of anaphylaxis by appropriately trained staff.
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All health professionals responsible for immunisation must be familiar with techniques for
resuscitation of a patient with anaphylaxis to prevent disability and loss of life. An
anaphylaxis pack must always be available and a system in place to ensure the checking
of expiry dates.
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Administer oxygen in as high a concentration as appropriate for the individual
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IV fluids if the patient is shocked and does not respond to drug treatment
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Salbutamol intravenously or by nebuliser (used to stop broncho-constriction which causes
wheezing)
FOLLOW-UP CARE
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Advise to avoid allergen if known (this may need investigation).
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Appropriate advice regarding the risk of recurrence
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Patients with a known propensity for anaphylaxis should be taught how to deal with an
attack. If there is a chance that an attack might develop away from medical assistance, the
patient and/or carer should be trained and equipped to inject adrenaline.
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Many patients prefer pre-assembled adrenaline-containing syringes, such as EpiPen or EpiPen
Junior
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Advise to wear SOS Talisman, Medic Alert or similar device.
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It is important to ensure an allergic reaction warning is highlighted both on the
Patients computer Notes as well as the Lloyd George notes
For further leaflets and advice contact the: - www.resus.org.uk (Resuscitation Council UK)
Review Date
August 2013
Comment
Staff Member
MJ