Anaphylaxis: Emergency Department Treatment

Kelly McHugh; Zachary Repanshek

doi:10.1016/j.iac.2022.10.002

Anaphylaxis: Emergency Department Treatment

Immunol Allergy Clin North Am. 2023 Aug;43(3):453-466. doi: 10.1016/j.iac.2022.10.002.

Authors

Kelly McHugh¹, Zachary Repanshek²

Affiliations

¹ Department of Emergency Medicine, Lewis Katz School of Medicine, Temple University, 3401 North Broad Street, Philadelphia, PA 19140, USA.
² Department of Emergency Medicine, Lewis Katz School of Medicine, Temple University, 3401 North Broad Street, Philadelphia, PA 19140, USA. Electronic address: [email protected].

PMID: 37394252
DOI: 10.1016/j.iac.2022.10.002

Abstract

Anaphylaxis is a potentially life-threatening, multisystem allergic reaction that can cause airway, breathing, or circulatory compromise. Intramuscular epinephrine is the immediate treatment of all patients. Intravenous epinephrine should be used in patients in shock, either as a bolus or infusion, along with fluid resuscitation. Airway obstruction must be recognized, and early intubation may be necessary. For shock that is refractory to epinephrine, additional vasopressors may be needed. Disposition depends on patient presentation and response to treatment. Mandatory observation periods are not necessary, because biphasic reactions are difficult to predict and may occur outside of typical observation periods.

Keywords: Airway management; Anaphylactic shock; Anaphylaxis; Awake intubation; Epinephrine.

Publication types

Review

MeSH terms

Airway Obstruction* / etiology
Anaphylaxis* / diagnosis
Anaphylaxis* / etiology
Anaphylaxis* / therapy
Emergency Service, Hospital
Epinephrine / therapeutic use
Humans

Substances

Epinephrine