What is the treatment for anaphylaxis in a patient?

From the Guidelines

For anaphylaxis in a patient care setting, immediately administer epinephrine (adrenaline) 0.3-0.5 mg (0.3-0.5 mL of 1:1000 solution) intramuscularly in the mid-outer thigh, as recommended by the most recent guidelines 1. This can be repeated every 5-15 minutes if symptoms persist. The dose of epinephrine should be 0.01 mg/kg of a 1:1000 solution to a maximum of 0.5 mg in adults and 0.3 mg in children, as stated in the 2020 practice parameter update 1. Position the patient flat with legs elevated unless they have respiratory distress. Provide high-flow oxygen and establish IV access. Additional treatments include IV fluids (normal saline 1-2 L for adults) to counter hypotension, H1-antihistamines such as diphenhydramine 25-50 mg IV/IM, H2-blockers like ranitidine 50 mg IV, and corticosteroids such as methylprednisolone 125 mg IV. For persistent bronchospasm, administer albuterol via nebulizer. Continuous monitoring of vital signs is essential. Epinephrine is the first-line treatment because it rapidly reverses the life-threatening effects of anaphylaxis by constricting blood vessels, increasing blood pressure, relaxing bronchial smooth muscles, and reducing inflammation through its alpha and beta-adrenergic effects, as explained in the guidelines 2. The use of epinephrine has been consistently supported by recent studies, including the 2020 practice parameter update 1, which emphasizes the importance of prompt administration of epinephrine in the treatment of anaphylaxis. Other treatments, such as antihistamines and glucocorticoids, may be used as adjunctive therapy, but epinephrine remains the primary treatment for anaphylaxis, as stated in the guidelines 1, 2.

Some key points to consider when treating anaphylaxis include:

• The importance of prompt administration of epinephrine, as delayed treatment has been associated with increased morbidity and mortality 1, 2
• The need for continuous monitoring of vital signs and adjustment of treatment as necessary 3
• The potential for biphasic anaphylaxis, which may require prolonged observation and treatment 1
• The importance of patient education and awareness of anaphylaxis symptoms and treatment, as emphasized in the guidelines 1, 2

Overall, the treatment of anaphylaxis requires a comprehensive approach that includes prompt administration of epinephrine, adjunctive therapy with antihistamines and glucocorticoids, and continuous monitoring of vital signs, as recommended by the most recent guidelines 1, 2.

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.

For anaphylactic patient setup, epinephrine (IM) should be administered. The key points are:

• Emergency treatment of allergic reactions, including anaphylaxis
• Intramuscular administration
• Available in single-use 1 mL vial and multiple-use 30 mL vial 4

From the Research

Anaphylactic Patient Setup

In the event of an anaphylactic reaction, it is crucial to provide immediate and effective treatment. The following steps can be taken:

• Remove the trigger: If possible, remove the allergen or trigger that caused the anaphylactic reaction 5, 6.
• Administer epinephrine: Intramuscular epinephrine is the first-line treatment for anaphylaxis, and it should be administered as soon as possible 5, 6, 7.
• Provide supportive care: Supportive care for the patient's airway, breathing, and circulation is essential, and may include oxygen therapy, fluid resuscitation, and cardiac monitoring 5, 6, 7.
• Consider adjunct medications: After epinephrine administration, adjunct medications such as histamine H1 and H2 antagonists, corticosteroids, beta2 agonists, and glucagon may be considered 5, 6.

Monitoring and Observation

• Monitor for biphasic reactions: Patients should be monitored for a biphasic reaction, which can occur 4-12 hours after the initial reaction 5, 6.
• Observe for 4-12 hours: The length of observation depends on the severity of the reaction and the patient's risk factors for severe anaphylaxis 5, 6.
• Develop an emergency action plan: After an anaphylactic reaction, patients should develop an emergency action plan, which includes referral to an allergist and patient education on avoidance of triggers and use of an epinephrine auto-injector 5, 8.

Education and Training

• Patient education: Patients should be educated on the recognition and treatment of anaphylaxis, including the use of epinephrine auto-injectors 5, 8.
• Educational programs: Educational programs, such as the one developed by the German Working Group for Anaphylaxis Training and Education (AGATE), can help patients and parents of children with a high risk of anaphylaxis to prevent and manage anaphylactic reactions 9.