A multidisciplinary emergency treatment process for severe allergic reactions triggered by food, medication, or insect stings, centered on intramuscular epinephrine.
Indication
- Widespread urticaria, itching, and skin redness accompanied by breathing difficulty
- Swelling of the face, lips, tongue, or throat (angioedema)
- Wheezing, hoarseness, difficulty swallowing
- Low blood pressure, dizziness, fainting
- Sudden symptoms after exposure to a known allergen (peanut, seafood, latex, antibiotic, bee sting)
- Early-stage findings in a patient with a previous history of anaphylaxis
Preparation
- The patient is laid on their back with legs elevated (if there is no respiratory distress)
- If an auto-injector (EpiPen) is available, it is immediately applied to the outer thigh
- 112 (emergency line) is called; the patient is not left alone
- The known allergen is removed from the environment (a bee stinger is scraped off at skin level with a fingernail)
How it's performed
- Once anaphylaxis is recognized, intramuscular epinephrine (adrenaline) is administered to the outer thigh — the first-line and life-saving treatment; repeated every 5-15 minutes if needed
- High-flow oxygen and intravenous access are established; fluid resuscitation is provided
- Adjunctive antihistamines (chlorpheniramine, diphenhydramine) and corticosteroids (methylprednisolone) are given
- If bronchospasm is present, a nebulized beta-2 agonist (salbutamol) is administered
- When airway closure is a risk, early intubation or cricothyrotomy is considered
- The patient is observed for at least 4-6 hours due to the risk of late-phase reaction
Post-procedure
- At discharge, the patient is prescribed two epinephrine auto-injectors (EpiPen) and advised to carry them at all times
- Referral to an allergy-immunology specialist; trigger allergen testing is planned
- A written anaphylaxis emergency action plan is provided to the patient
- Family members and the school/workplace receive training on EpiPen use
- A medical bracelet/necklace is recommended for the known allergen
Risks
- Biphasic (delayed) reaction — recurrence of symptoms 4-12 hours after initial improvement
- Airway obstruction, respiratory arrest
- Cardiovascular collapse, cardiac arrest
- Epinephrine side effects (tachycardia, palpitations, headache)
- Fatal outcome if treatment is delayed
FAQ
Why is epinephrine the first choice for someone experiencing anaphylaxis?
Epinephrine constricts blood vessels, opens the airways, and supports circulation. Antihistamines or corticosteroids cannot replace it; these are adjunctive medications.
Who can use an EpiPen (auto-injector)?
Thanks to its design, a family member or even the patient can use it. It can be applied to the outer thigh, even through clothing.
Should I be afraid to use the EpiPen for a suspected reaction?
Delays in anaphylaxis are life-threatening. When in doubt, the auto-injector should be used early; serious side effects in a healthy person are rare.
Can I go home after surviving anaphylaxis?
Due to the risk of recurrence, the patient is observed in the emergency department for at least 4-6 hours. In severe cases, 24-hour hospital monitoring may be advised.
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