- Anaphylaxis is a severe generalized
allergic reaction characterized by widespread dilation of
the blood vessels of the body, resulting in a marked drop in
blood pressure. It is caused by an IgE (a type of an
antibody) mediated reaction to an
- Severe drop in blood pressure --
lightheadedness and fainting are common
- Respiratory distress -- severe
wheezing in the lungs or spasm in the larynx (throat feels
like it is closing off). Stridor (whistling sound) may be
heard coming from the throat.
- Gastrointestinal tract muscles
- Uterine muscles contract (spasm)
- Lip swelling
- Tongue swelling
- Tryptase (a substance found in mast
cells) is elevated 60-90 minutes after an attack.
- Insect stings or bites, e.g., bee
- Certain foods, e.g., peanuts
- Aqueous epinephrine 1:1000, 0.2 to
0.5 ml subcutaneously, or via intramuscular injection. May
be repeated every 15 to 30 minutes.
- Rapid infusion of large volumes of
intravenous fluids, such as normal saline, lactated Ringer's
solution, plasma, colloid solutions, or plasma expanders
- Other vasopressive drugs, if not
responsive to epinephrine, e.g., dopamine, norepinephrine,
- If airway obstruction occurs (or is
impending), endotracheal intubation or tracheostomy will be
- Beta 2 agonist inhaled (e.g.,
Albuterol) can help with bronchospasm.
- Intravenous theophylline may also
be helpful with bronchospasm.
- Antihistamines H1 (e.g., Atarax, Benadryl) and H2
(Ranitidine) are adjunct therapies.
- Patients chronically on beta
blockers (used for blood pressure, heart problems, and
migraine prevention) may be refractory to epinepherine and
may require higher doses of adrenergic drugs or intravenous
- Warning: 6 -12 hours after an
anaphylactic reaction there may be a late phase response (a
recurrence of symptoms), requiring monitoring (in a
hospital) for 24 hours after an
- If you have an Epi Pen, use it
immediately as directed by your physician. Seek immediate
emergency medical treatment as quickly as possible (in the
United States dial 911). This condition is often fatal if
- There is no reliable way to truly
prevent an attack, once exposed to the allergen (it can be
- The best prevention is avoidance of
inciting allergens. Allergy skin testing and RAST
(radioallergosorbent test) testing can identify allergens
(substances) to be avoided.
- Long term antihistamine and
corticosteroid oral therapy may decrease the occurrence of
- Persons with a history of
anaphylaxis should carry an Epi Pen with them at all times.
This is self-injection epinephrine kit for
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