Anaphylaxis

• The incidence of anaphylaxis appears to be rising.
• Recall that death can occur anywhere from 5 to 30 minutes after allergen exposure.
• A few important pearls in management:
  • Epinephrine is the drug of choice and should be given intramuscularly (not subcutaneous) in the mid-anterolateral thigh.
  • Be aggressive with IV fluids, as up to 35% of circulating volume can be extravasated within 10-15 minutes of symptom onset.
  • Get an ECG ASAP! Mast cells are located around the coronary arteries.  The release of mediators can induce vasospasm and precipitate an acute coronary syndrome.

References

De Bisschop MB, Bellou A. Anaphylaxis. Curr Opin Crit Care 2012; 18:308-17.