DIAGNOSIS

 ·       HISTORY............. of skin test , drug ingestion/ injection, vaccination, radiocontrast

study.

·       CF………hypotension (vascular collapse) , flushing, pruritus, urticarial, angioedema, stridor (laryngeal edema) wheezing (bronchoconstriction), tachycardias, arrhythmias, pink frothysputum (pulmonary edema).

·       PRESENTATION............................. Severe respiratory distress and/or

Vascular collapse with/without The other clinical features

·       MANAGEMENT……..

ADRENALINE….(1st drug)

Dosage……0.5-1.0ml 1:1000 promptly deep intramuscular route…do not waste

time ongetting IV lines!!

Repeat ……every 15 mins. Until BP stable.

If IV line available, adrenaline infusion 10mg/mt for 10 mts then 1-4 mg/mt Maintain airway and breathing…… intubate if necessary, oxygen.

ANTIHISTAMINES

Inj. Avil 50-100 mg IV. Or

Inj. Phenergan 25-50 mg IV –or-

InjChlorpheneramine Maleate 10-20 mg slow IV over 1 min. Maintain antihistamine cover for 24-48 hrs.

CORTICOSTEROIDS… Prevents late deterioration in severe cases – Not first line. Inj. Hydrocortisone 200- 500 mg IV or

Inj. Dexamethasone 4-8 mg IV

Continue for 12-24 hrs….. withdraw thereafter If symptoms reappear, add on another dose INTRAVENOUS VOLUME MAINTENANCE…

Infuse adequate volumes of crystalloids /colloids/ plasma expanders as needed.

MONITOR… for 24 hrs for late phase IgE response OTHER MEASURES…

AMINOPHYLLINE…..if airway obstruction is present OXYGEN………in all patients

VASOPRESSORS……. If BP remains low even after adequate infusion of fluids

Patients who have been on beta blockers may need higher doses of ADRENALINE – or consider usingGLUCAGON.