Anaphylaxis Management

Patient Monitoring

Patients with pre-existing cardiovascular disease or concerning symptoms should undergo ECG monitoring, as recommended by the American Academy of Allergy, Asthma, and Immunology 1
Intensive monitoring, including continuous heart rate monitoring or frequent pulse checks, is required for patients with cardiovascular disease, hypertension, hyperthyroidism, or those taking medications that may interact with epinephrine 1

Hypotensive patients should be positioned in a recumbent position, and IV fluids may be administered if needed, as recommended by the American Academy of Allergy, Asthma, and Immunology 1

Administer intramuscular (IM) epinephrine into the anterolateral aspect of the thigh, through clothing if necessary, with a dose of 0.3 to 0.5 mg (0.3 to 0.5 mL) of 1:1000 epinephrine solution, which may be repeated every 5-10 minutes as necessary based on clinical response, as recommended by the American Academy of Allergy, Asthma, and Immunology 1
For children, the dose is 0.01 mg/kg (0.01 mL/kg) of 1:1000 epinephrine solution, up to a maximum of 0.3 mg (0.3 mL), administered via intramuscular injection into the anterolateral thigh, which may be repeated every 5-10 minutes as necessary 1
A second dose of epinephrine may be administered after 5-10 minutes if symptoms persist or worsen, as supported by the American Academy of Allergy, Asthma, and Immunology 2, 1
Patients should be monitored closely for resolution of symptoms, potential side effects, and signs of improvement or deterioration, and placed in a recumbent position with lower extremities elevated, with medical attention sought as soon as possible, even if symptoms appear to resolve, as advised by the American Academy of Allergy, Asthma, and Immunology 1

For digital injections with severe vasoconstriction, consider topical nitroglycerin or locally injected phentolamine, as recommended by the American Academy of Pediatrics 3
H1 antihistamines are second-line therapy and should never be used alone for anaphylaxis, with a strength of evidence supporting this recommendation, as stated by the American Academy of Allergy, Asthma, and Immunology 4, 1
Precautions to be avoided in anaphylaxis management include improper injection technique, using expired medication, and delayed administration of epinephrine, as emphasized by the American Academy of Allergy, Asthma, and Immunology 1