Definition:

The European Academy of Allergology and Clinical Immunology Nomenclature Committee

proposed the following broad definition: 11
Anaphylaxis is a severe, life-threatening, generalised or systemic
hypersensitivity reaction.

This is characterised by rapidly developing life-threatening airway and/or breathing

and/or circulation problems usually associated with skin and mucosal changes.

Symptoms and Signs:

Symptons Signs
Mild Burning sensation in mouth Urticarial Rash
Itching of lips, mouth, throat Angio-Oedema
Feeling of warmth Conjunctivitis
Nausea
Abdominal Pain
Moderate (Mild +) Coughing/ wheezing Bronchospasm
Loose bowel motions Tachycardia
Sweating Pallor
Irritability
Severe (Moderate+) Difficulty breathing Severe bronchospasm
Collapse Laryngeal oedema
Vomiting Shock
Uncontrolled defecation Respiratory arrest
Cardiac arrest

Emergency treatment

Adapted from Advanced Pediatric Life Support 4th edition.

 Remove
Allergen

Assess Airway Partial Adrenaline 10mcg/kg IM (0.01 ml/kg of 1:1000

obstruction/stridor Nebulized adrenaline 5mls of 1:1000
Repeat nebulizer after every 10mins as required
Hydroccortisone 4mg/kg initial dose then 2-
4mg/kg q 6hrs
No
problem

Complete Intubation with cricoids pressure or surgical

obstruction airway or laryngeal mask

Assess Wheeze Adrenaline IM 0.01 ml/kg of 1:1000

Breathing Nebulized salbutamol 2.5mg if <5yrs; 5mg if
>5yrs
Repeat Salbutamol as required
Hydrocortisone 4mg/kg initial dose then 2-
4mg/kg q 6hrs
Consider aminophylline 5mg/kg IV over 15mins
No
or IV salbutamol
problem

Apnoea Bag-Mask ventilation

Adrenaline 10mcg/kg IM

Assess No pulse Basic and advanced life support

circulation

Shock Adrenaline IM 0.01 ml/kg of 1:1000 repeat

every 5mins if necessary
0.09% saline 20ml/kg IV
No Infusion dose of adrenaline 0.1-5 mcg/kg/min
problem

Reassess ABC Chlorpherinamine tds for 48hrs to prevent

recurrence