Treatment of Severe Allergic Reaction to Adhesive Tape After Surgery

Immediate Management

The British Journal of Anaesthesia recommends immediately administering intramuscular epinephrine as first-line treatment for any severe allergic reaction, regardless of the trigger, followed by aggressive fluid resuscitation and supportive care 1, 2
Administer intramuscular epinephrine immediately for Grade II-IV reactions (moderate to severe symptoms including hypotension, bronchospasm, or cardiovascular compromise) 1, 2
Dosing for adults: Start with 50 mg IV bolus for Grade III reactions; escalate to 100-200 mg if inadequate response after 2 minutes 1
For Grade II reactions: Begin with 20 mg IV bolus, escalate to 50 mg if inadequate response 1
Repeat every 2 minutes as needed, titrating to clinical response 1
If no IV access is available, give 300 mg intramuscularly 1

Administer 500 mL rapid crystalloid bolus for Grade II reactions; review response and repeat as needed 1
For Grade III reactions: Give 1 L rapid bolus initially, then repeat as needed up to 30 mL/kg 1
Aggressive volume replacement is essential as anaphylaxis causes massive fluid shifts 1
Bronchodilators (inhaled or IV) for persistent bronchospasm despite epinephrine 1

Double the epinephrine dose and consider adding continuous epinephrine infusion at 0.05-0.1 mcg/kg/min 1
Add vasopressin 1-2 IU with or without infusion at 2 IU/hour for persistent hypotension 1
Consider norepinephrine infusion 0.05-0.5 mcg/kg/min 1
Glucagon 1-2 mg if patient is on beta-blockers 1
Suggest extracorporeal life support (ECLS) where available for refractory cases 1

Obtain serum tryptase levels at 1 hour post-reaction onset, again at 2-4 hours, and a baseline sample at least 24 hours later 1, 2
An increase above 1.2 × baseline + 2 μg/L confirms mast cell degranulation 2
Document all exposures meticulously: Include exact timing of tape application, type of adhesive used, all other substances the patient contacted, symptom onset, and treatment response 1, 2, 3

All Grade II-IV reactions and Grade I reactions with generalized urticaria or erythema must be referred to specialized allergy clinics for formal investigation 1, 2, 3
Testing should occur 4-6 weeks after the reaction and include skin testing, specific IgE antibody testing, and potentially drug provocation testing 2
Investigations should be performed in specialized clinics with collaboration between allergists and anesthesiologists 1, 3
Strictly avoid the confirmed culprit adhesive and ensure all healthcare personnel are informed 2, 4
Provide written information to the patient detailing exposures to avoid until formal testing is completed 3