Management of Allergic Reactions

Initial Treatment

• The American Academy of Allergy, Asthma, and Immunology recommends epinephrine 0.01 mg/kg IM (maximum 0.5 mg) into the anterolateral thigh as the only first-line treatment for anaphylaxis, repeated every 5-15 minutes as needed 1, 4
• The American College of Allergy, Asthma, and Immunology advises against delaying epinephrine to give steroids or antihistamines 2, 3

Adjunctive Therapy

• The National Institute of Allergy and Infectious Diseases recommends methylprednisolone 1-2 mg/kg IV every 6 hours for adjunctive treatment of allergic reactions 1, 2, 3
• The American Academy of Allergy, Asthma, and Immunology suggests famotidine 20 mg IV as an adjunctive treatment for allergic reactions 1, 3

Ongoing Management

• The American College of Allergy, Asthma, and Immunology recommends continuing methylprednisolone every 6 hours for 48-72 hours for ongoing management of allergic reactions 2
• The National Institute of Allergy and Infectious Diseases advises observing patients for at least 6 hours after treatment for allergic reactions 3

Special Considerations

• The American Heart Association recommends glucagon 1-5 mg IV over 5 minutes for patients on beta-blockers who are refractory to epinephrine 1, 3
• The National Institute of Allergy and Infectious Diseases suggests that methylprednisolone dosing does not require adjustment for patients with renal insufficiency 2

Discharge Medications

• The American Academy of Allergy, Asthma, and Immunology recommends prescribing two epinephrine auto-injectors with training for patients being discharged after treatment for allergic reactions 1, 3
• The National Institute of Allergy and Infectious Diseases suggests continuing oral prednisone 0.5-1 mg/kg daily for 2-3 days after discharge 1, 4