18th March 2024

Treatment of anaphylaxis

Prompt recognition of symptoms is essential. Removal of the trigger is especially important, particularly in the context of medications, for example, disconnecting intravenous medications. Adrenaline and fluid replacement are central to the management of anaphylaxis. Acute management is defined by the emergency treatment of anaphylaxis guidelines produced by the UK Resuscitation Council. This was updated in 2021 and significant changes to previous guidance include:

• Emphasis on prompt administration of IM adrenaline with dose repeated at 5 minutes if symptoms persist
• Advice to avoid sudden postural changes and maintain a supine position
• Treatment of refractory anaphylaxis and early involvement of definitive airway support if appropriate
• Corticosteroids are no longer recommended in the management of emergency anaphylaxis
• Antihistamines are considered third-line agents and do not form part of the initial management
• Guidance relating to monitoring of patients following stabilisation and safe discharge
• Consideration of fast-track discharge following a two hour observation period may be appropriate in the context of: a good response to a single dose of adrenaline with complete resolution of symptoms in a patient in possession of unused auto-injectors, trained in their use with adequate supervision following discharge