Anaphylaxis

Key signs of anaphylaxis:

  • Marked upper airway (laryngeal) oedema and bronchospasm, causing stridor and wheezing
  • Tachycardia (heart rate > 110 per minute) and increased respiratory rate

Symptoms include:

  • Abdominal pain, vomiting, diarrhoea, and a sense of impending doom
  • Flushing, but pallor might also occur
  • Patients may also display symptoms of mild allergy

Management

The priority is to transfer the patient to hospital as an emergency.

  • Assess the patient.
  • Call for an ambulance.
  • Secure the patient’s airway and help to restore their blood pressure by laying the patient flat and raising their feet.
  • Remove the source of anaphylaxis, if known, using suction if required.

Administer 100% oxygen – flow rate:

15 litres/minute.

As for adults

For adults:

Administer 100% oxygen – flow rate:

15 litres/minute.

For children:

As for adults


Administer adrenaline, 0.5 ml (1:1000), i.m. injection repeated after 5 minutes if needed.

Adrenaline (1:1000)

6 months-5 years: 

 0.15ml

6–11 years:

0.3 ml

12–17 years¥:

0.5ml 

For adults:

Administer adrenaline, 0.5 ml (1:1000), i.m. injection repeated after 5 minutes if needed.

For children:

Adrenaline (1:1000)

6 months-5 years: 

 0.15ml

6–11 years:

0.3 ml

12–17 years¥:

0.5ml 

¥Use 0.3 ml adrenaline for children aged 12–17 years if the child is small or prepubertal.

  • If cardiac arrest follows an anaphylactic reaction, initiate basic life support (BLS) and carry out early defibrillation where defibrillator is available.*
    [Refer to Resuscitation Council (UK) guidance for details of BLS for adults and children.]

*In August 2014 the Scottish Government commenced roll-out of defibrillators to NHS dental practices in Scotland. All dental teams should be trained in the use of these devices.