From the Guidelines
The immediate treatment for anaphylaxis shock is epinephrine (adrenaline) administered as an intramuscular injection, typically 0.3-0.5 mg for adults or 0.15 mg for children, using an auto-injector like EpiPen or a manual syringe into the outer thigh. This should be given as soon as anaphylaxis is suspected, even before calling emergency services 1. The dose can be repeated every 5-15 minutes if symptoms persist 1. After administering epinephrine, the patient should be placed in a position of comfort, typically lying flat with legs elevated unless they are having breathing difficulties. Call emergency services (911) immediately after giving epinephrine. Secondary treatments include antihistamines (like diphenhydramine 25-50 mg) and corticosteroids, but these should never replace or delay epinephrine 1. Epinephrine works rapidly to reverse the life-threatening symptoms by constricting blood vessels to increase blood pressure, relaxing airway muscles to improve breathing, and reducing hives and swelling. Even after symptoms improve, medical observation is necessary as anaphylaxis can have a biphasic response with symptoms returning hours later. Some key points to consider when treating anaphylaxis include:
- Assessing the patient's airway, breathing, circulation, and skin, and calling for help immediately 1
- Administering epinephrine promptly, and repeating the dose as necessary 1
- Providing supplemental oxygen and fluid resuscitation if needed 1
- Using antihistamines and corticosteroids as secondary treatments, but not as a replacement for epinephrine 1
From the FDA Drug Label
1 INDICATIONS & USAGE Adrenalin® is available as a single-use 1 mL vial and a multiple-use 30 mL vial for intramuscular and subcutaneous use. Emergency treatment of allergic reactions (Type I), including anaphylaxis, which may result from allergic reactions to insect stings, biting insects, foods, drugs, sera, diagnostic testing substances and other allergens, as well as idiopathic anaphylaxis or exercise-induced anaphylaxis.
The immediate treatment for anaphylaxis shock is intramuscular injection of epinephrine (IM), as it is indicated for the emergency treatment of allergic reactions, including anaphylaxis 2.
- The key symptoms of anaphylaxis include:
- Flushing
- Apprehension
- Syncope
- Tachycardia
- Thready or unobtainable pulse associated with hypotension
- Convulsions
- Vomiting
- Diarrhea and abdominal cramps
- Involuntary voiding
- Airway swelling
- Laryngospasm
- Bronchospasm
- Pruritus
- Urticaria or angioedema
- Swelling of the eyelids, lips, and tongue The main goal is to administer epinephrine promptly to alleviate these symptoms.
From the Research
Immediate Treatment for Anaphylaxis Shock
The immediate treatment for anaphylaxis shock involves several key steps:
- Administering epinephrine (adrenaline) intramuscularly as the first line of treatment 3, 4, 5, 6
- Removing the trigger that caused the anaphylaxis, if possible 5
- Providing supportive care for the patient's airway, breathing, and circulation 5, 6
- Monitoring the patient for potential biphasic reactions, which can occur several hours after the initial reaction 5, 7
Epinephrine Administration
Epinephrine is the cornerstone of anaphylaxis management and should be administered immediately upon evidence of anaphylaxis 3, 4. The recommended dose is 0.3-0.5 mg for adults, injected intramuscularly in the anterolateral aspect of the mid-thigh 3, 4. For children, the dose is 0.01 mg/kg 4. In cases where symptoms do not resolve after the initial dose, a second dose of epinephrine may be necessary 7.
Additional Treatment
After epinephrine administration, adjunct medications such as histamine H1 and H2 antagonists, corticosteroids, beta2 agonists, and glucagon may be considered 5. In cases of shock that is refractory to epinephrine, additional vasopressors may be needed, along with fluid resuscitation 6. Airway obstruction must be recognized and treated promptly, with early intubation if necessary 6.