Anaphylaxis: emergency management for health professionals
- Aust Prescr 2018;41:54
- 2 April 2018
- DOI: 10.18773/austprescr.2018.014
Updated 5 May 2022. View update notification.
This is the most up-to-date version of the Anaphylaxis Wallchart (v2).
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Any acute onset of hypotension or bronchospasm or upper airway obstruction where anaphylaxis is considered possible, even if typical skin features are not present
Any acute onset illness with typical skin features (urticarial rash or erythema/flushing, and/or angioedema)
Involvement of respiratory, cardiovascular, or persistent severe gastrointestinal symptoms
Adrenaline dose chart (1:1000 ampoules containing 1 mg adrenaline per 1 mL)
|Age (years)||Weight (kg)||Adrenaline volume 1:1000|
|>12 and adult||>50||0.5 mL|
Repeat adrenaline every 5 minutes as needed.
If multiple doses are required, consider adrenaline infusion if skills and equipment available (see Step 5).
An adrenaline autoinjector, e.g. EpiPen or Anapen, may be used instead of an adrenaline ampoule and syringe.
Instructions are on device labels and ASCIA Action Plans.
Remove allergen (if still present): flick out insect stings, freeze ticks with liquid nitrogen or ether-containing spray (if available) and allow to drop off.
ALWAYS give adrenaline FIRST, then asthma reliever puffer, if someone with known asthma and allergy to food, insects or medicine has SUDDEN BREATHING DIFFICULTY (including wheeze, persistent cough or hoarse voice) even if there are no skin symptoms.
When skills and equipment are available:
If inadequate response or deterioration, start an intravenous adrenaline infusion as follows:
Give only in liaison with an appropriate specialist. Phone ………………………………………………
For upper airway obstruction
For persistent hypotension/shock
For persistent wheeze
Prolonged and biphasic reactions may occur.
Observe the patient for at least 4 hours after last dose of adrenaline.
Observe longer (overnight) if the patient:
Document food, medicine, sting/bite exposure in the 2–4 hours before anaphylaxis.
The role of corticosteroids is unknown. It is reasonable to prescribe a 2-day course of oral steroid (e.g. prednisolone 1 mg/kg, maximum 50 mg daily) to reduce the risk of symptom recurrence after a severe reaction or a reaction with marked or persistent wheeze. Corticosteroids should only be administered after adrenaline and resuscitation.
Prescribe an autoinjector, pending specialist review. Train the patient in autoinjector use and give them an ASCIA Action Plan for Anaphylaxis.
Refer patients with anaphylaxis for review.
Antihistamines have no role in treating respiratory or cardiovascular symptoms of anaphylaxis. Oral non-sedating antihistamines treat itch and urticaria. Injectable promethazine should NOT be used in anaphylactic shock as it can worsen hypotension.
Date published : 1 April 2018
Endorsed by the Australasian College for Emergency Medicine, the Australasian Society of Clinical and Experimental Pharmacologists and Toxicologists, the Australasian Society of Clinical Immunology and Allergy (ASCIA), the Australian College of Rural and Remote Medicine, the Australian Dental Association, the Internal Medicine Society of Australia and New Zealand, the Royal Australasian College of Physicians, and the Royal Australian and New Zealand College of Radiologists.
This Anaphylaxis Wallchart has been officially recognised as an Accepted Clinical Resource by the Royal Australian College of General Practitioners.
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