What is the treatment for anaphylaxis related to sunlight exposure?

Treatment for Anaphylaxis Related to Sunlight Exposure

Epinephrine is the first-line treatment for anaphylaxis related to sunlight exposure and should be administered immediately upon recognition of anaphylactic symptoms. 1

First-Line Treatment

1. Epinephrine administration:

   • Administer intramuscularly into the anterolateral thigh 1
   • Adult dose: 0.3-0.5 mg of 1:1000 solution 1, 2
   • Pediatric dose: 0.01 mg/kg of 1:1000 solution (maximum 0.3 mg) 1
   • May repeat every 5-15 minutes if symptoms persist 1

2. Patient positioning:

   • Place patient in recumbent position with elevated lower extremities if experiencing cardiovascular symptoms 1
   • Establish and maintain airway 1
   • Administer oxygen to patients with respiratory distress 1

Adjunctive Therapies

After epinephrine administration, provide the following in sequence:

1. IV fluid resuscitation:

   • Administer normal saline early, especially for patients with cardiovascular involvement 1

2. Glucocorticoids:

   • Hydrocortisone 200 mg IV (adult dose) 1
   • Note: Glucocorticoids have slow onset and are not effective for acute management but may help prevent protracted or biphasic anaphylaxis 3, 1

3. Antihistamines:

   • H1-antagonists: Diphenhydramine 1-2 mg/kg IV/IM (maximum 50 mg) 1
   • H2-antagonists: Ranitidine 1 mg/kg IV (if available) 1
   • Note: Antihistamines should never be used alone or before epinephrine 1

4. For bronchospasm resistant to epinephrine:

   • Consider inhaled β2-agonists (e.g., nebulized albuterol, 2.5-5 mg in 3 mL saline) 3

Monitoring and Observation

• Monitor patients for at least 4-6 hours after initial symptoms resolve 1
• Watch for biphasic reactions (recurrence of symptoms after initial resolution) 1
• Longer observation periods may be needed for severe reactions or those requiring multiple epinephrine doses 1

Special Considerations for Sunlight-Induced Anaphylaxis

While the treatment protocol follows standard anaphylaxis management, prevention is particularly important for sunlight-triggered reactions:

• Strict sun avoidance during peak hours
• Use of protective clothing, broad-spectrum sunscreens, and physical barriers
• Consider consultation with both allergist-immunologist and dermatologist for specialized management

Discharge Planning

1. Epinephrine autoinjector prescription:

   • Provide patient with epinephrine autoinjector before discharge 1
   • Train patient and caregivers on proper use of autoinjector 1

2. Emergency action plan:

   • Develop personalized anaphylaxis emergency action plan 3
   • Review plan regularly with patient 3

3. Specialist referral:

   • Arrange consultation with an allergist-immunologist 1
   • Consider dermatology consultation for sunlight-triggered reactions

Common Pitfalls to Avoid

• Delaying epinephrine administration - This is the most common and dangerous mistake 1, 4
• Using antihistamines or corticosteroids as first-line treatment - These should never replace epinephrine 1
• Administering epinephrine subcutaneously - Intramuscular route provides faster and more reliable absorption 1
• Discharging patients too early - Observe for adequate time to monitor for biphasic reactions 1
• Failing to provide autoinjector and training - Essential for managing future episodes 3

Remember that epinephrine is the cornerstone of anaphylaxis management, and its prompt administration is critical for preventing fatal outcomes, regardless of the trigger being sunlight or other allergens.