Severe systemic hypersensitivity — sudden onset + airway/breathing/circulation compromise ± skin/mucosal changes.
Causes
- • Food (nuts, seafood)
- • Drugs (β-lactams, NSAIDs, contrast, muscle relaxants)
- • Insect stings
- • Latex, idiopathic
Clinical features
- • Urticaria, angio-oedema, wheeze, stridor, hypotension, GI symptoms
Management
- • Adrenaline 0.5 mg IM (anterolateral thigh) — repeat q5 min
- • Remove trigger, high-flow O₂, lie flat with legs raised
- • IV crystalloid 500-1000 mL fast
- • Second-line: chlorphenamine 10 mg IV, hydrocortisone 200 mg IV, salbutamol/ipratropium neb
- • Refractory: adrenaline infusion 0.05-1 mcg/kg/min, glucagon if on β-blocker
Follow-up
- • Observe ≥6 h (biphasic risk); adrenaline auto-injector × 2, action plan, allergist referral
- • Tryptase at 1-2 h and 24 h
References
- • Resus Council 2021 Anaphylaxis
Related in WardRound
Educational — verify locally.
