see also adrenaline, angioedema, allergy and hypersensitivity reactions, radiologic contrast media precautions and adverse reactions

• 1:1000 im 0.01ml/kg to maximum 0.5ml (Adult 0.5ml) im into lateral thigh, repeat after 5min if no improvement
  • do not give s/c as absorption is unreliable
  • do not give iv adrenaline bolus doses unless arrest imminent
• if hypotensive:
  • elevate legs, lie patient flat, although may need to have head up at 45 deg if short of breath
  • iv fluid boluses of 10-20ml/kg 0.9% saline
• if upper airway obstruction, consider nebulised adrenaline as for croup (below) in addition to im adrenaline
• if inadequate response to repeat im adrenaline dose:
  • commence iv adrenaline infusion at 0.05-1.0mcg/kg/min (see adrenaline for infusions)
• if airway obstruction not settling, consider early intubation and rapid sequence induction
• if requires 2 or more adrenaline doses or more than 20ml/kg saline, contact ICU

• nebulised salbutamol as for asthma

• may be given, especialy if bronchospasm present, although otherwise, no clear benefits demonstrated
• methylprednisolone iv 1mg/kg or hydrocortisone

• may help pruritus
• preferably non-sedating second generation antihistamines
• avoid promethazine as it is sedating and may cause hypotension

• all patients with anaphylaxis should be observed for 6-12 hours or overnight as risk of rebound if either:
  • more than 1 dose of adrenaline needed
  • if iv fluid bolus needed
  • if lives too far from hospital to return ASAP
• consider ED Short Stay Observation Unit if suitable
• discharge advice
• consider EpiPen
  • see Allergy.org.au guidelines for prescribing EpiPen
• consider MedicAlert bracelet

• RCH allergy action plan (pdf)
• RCH peanut and tree nut allergy handout (pdf)

• RCH guideline - anaphylaxis
• Aust Presc 2007 - Emergency management of anaphylaxis in the community - wall chart
• Anaphylaxis in the emergency department: a paediatric perspective. Current Opinion in Allergy & Clinical Immunology. 8(4):321-329, August 2008. Paper hosted on NICS blog
• EMA April 2006 - review article: Anaphylaxis