Treatment of Anaphylaxis

Early (prompt) diagnosis of anaphylaxis is must to save life of patient with anaphylaxis, as death may occur within minutes to hours of development (appearance of first symptoms) of anaphylaxis. Treatment depends on the severity of symptoms of anaphylaxis. For example, mild form of anaphylactic reaction with mild symptoms such as pruritus (itching) and urticaria can be treated appropriately by administration of 0.3 to 0.5 ml of 1:1000 (1.0 mg/ml) epinephrine (adrenalin) subcutaneously or intramuscularly. The dose can be repeated as required at 5- to 20-min intervals.

If the antigenic material (the agent which has caused anaphylactic reaction) was injected (anaphylaxis occurs only if antigenic material is injected and not if taken orally) into an extremity application of a tourniquet proximal to the injected site to reduce absorption of the antigenic material and removal of insect stinger (if due to insect bite) without compression and administration of 0.2 ml of 1:1000 (1.0 mg/ml) epinephrine should be done.

An intravenous infusion should be started to provide a route for administration of 2.5 ml adrenalin, (at dilution of 1:10,000) at 5 -10 minutes intervals, volume expanders such as normal saline, and vasopressor agents such as dopamine (as anaphylaxis may cause severe fall in blood pressure). Sometimes several liters of normal saline may be required to replace the lost fluid through venoules.

Adrenalin/epinephrine is the drug of choice for treatment of anaphylaxis due to its effect on alpha and beta adrenergic receptors, which result in vasoconstriction (rise in blood pressure as a result), bronchial smooth-muscle relaxation (makes breathing easy), and reduce venular permeability which cause reduction in fluid loss through venoules.

If adrenalin fails to control the anaphylactic reaction, hypoxia due to airway obstruction or related to a cardiac arrhythmia, alone or along with anaphylaxis should be considered. Oxygen should be administered with nasal catheter to prevent hypoxia, but sometimes endotracheal intubation or a tracheostomy or both may be required to deliver oxygen. Other agents such as antihistamines, aminophylline etc. may also be required.

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