MANAGEMENT OF ANAPHYLAXIS

1. FIRST LINE TREATMENT 

STEP ONE
EPINEPHRINE - This needs to be given as early as possible.
LOCATION - Anterolateral Thigh intramuscularly  ( absorbs 7 times more than deltoid muscle )
DOSE - its 0.01 mg / kg IM with maximum upto 0.5 mg.

STEP TWO
If still symptoms not relieved with Hypotension and one show signs of anaphylactic shock 
ANOTHER DOSE OF 1 mg of EPINEPHRINE in one liter of Normal saline to be given (equivalent to 1 mcg/ml). Give PUSH DOSE OF 5-10 ml q 2-5 minutes and with  infusion pump as 1-20 ml per minute (equivalent to 1-20 mcg/min)

STEP THREE
If the patient is still Refractory give vasopressors with 1-5 mg IV bolus followed by 1-5 mg /hr infusion. 

SECOND LINE TREATMENT 

This includes H1 and H2 blockers, Diphenhydramine, Ranitidine
And STEROIDS.                                                                                                     
THESE DO NOT PREVENT MORTALITY

Expert says only give steroids if you administer epinephrine.
However, there is no strong evidence presently exists but further Study is required before recommending the exclusion of steroids. 

THIRD LINE TREATMENT

The patient needs to be admitted and kept under observation for 48 hours.

The patient should only be discharged if one is symptom-free.

Biphasic reactions in anaphylaxis can occur in 2-5 % of the patients about 1-8 hours of the onset of initial symptoms.

STEROIDS DO NOT prevent mortality ALONE.

HIGH RISK PATIENTS NEED EXTRA CARE 

In the case of the following patients, extra care is needed.
1. Antihypertensive medications
2. Early symptoms and late treatment initiation
3. Asthmatics
4. Past history of severe reactions.

Bottomline
Always reach out to your physician at once.
Call for 911 in case of an emergency.
Prevention is better than cure.
Always tell your doctor about the allergic reactions in the past.
Stay safe, stay healthy.