Where exposure is unavoidable give prednisolone 50mg PO 6hly (3 doses) starting 18hrs pre-exposure. This is given together with an oral antihistamine 1 hr pre-exposure.
Carrying “Allergy Card” as well as an adrenaline injection if highly predisposed.
To avoid further exposure to the offending substance.
Lie patient flat with raised legs.
The key medicine for treatment of anaphylaxis is adrenaline (1:1000 solution) 0.3-0.5mL IM in adults or 0.01mL/kg in children, repeated after every 10-15 minutes (upto 3 doses). However, patients with collapsed CVS or severe respiratory obstruction are given 3-5 mL solution over 5 min or by infusion 15 - 60 mL/hr.
Nebulized bronchodilators such as salbutamol 5mg and /or ipratropium 0.5mg OR
Aminophylline 6mg/kg IV over 20 minutes in case of occurrence of wheezing and when it is not possible to nebulized.
Chlorpheniramine 10mg for adults and 0.1mg/kg in children IV slowly or IM or SC then repeat 8 hourly for 1-2 days
Hydrocortisone 100mg IV (to prevent delayed reaction) 2-6 mg/kg or dexamethasone 0.1-0.4 mg/kg intravenously.
Normal saline or Hartmann’s solution (20mL/kg) to treat hypotension and in case it is not successful give dopamine 5mcg/kg/min.
Intubation and oxygen are necessary in cases of wheezing and stridor that are not responsive to adrenaline.
Cricothyrotomy in case of upper airway edema that prevents endotracheal intubation.
In case the patient is on a beta-blocker, give glucagon 1mg bolus in adults and 20 - 30 mcg/kg in children to be followed by 1mg/hr infusion
H2-antihistamines such as ranitidine
NB: both antihistamines and corticosteroids play minor role in acute reactions.
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