The management of ANAPHYLAXIS in primary care

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Key Reviewer: Dr Richard Steele, Clinical Immunologist and Immunopathologist, Wellington Hospital and Aotea Pathology

Anaphylaxis treatment algorithm

Confirm anaphylaxis*

Is onset of symptoms acute?
Are there life-threatening airway, breathing or circulation problems?
Are skin changes present?
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Call for help/Dial 111

Treat ABC
Lie patient flat and raise their legs (or place in a sitting position if breathing difficulties).
Remove the trigger if possible e.g. stop delivery of any drug, remove a bee sting. Do not induce vomiting after food-induced anaphylaxis.
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Administer adrenaline

Adult and child >12 years: 0.5 mg IM (0.5 mL 1:1000 solution)
Child 6 – 12 years: 0.3 mg IM (0.3 mL 1:1000 solution)
Child <6 years: 0.15 mg IM (0.15 mL 1:1000 solution)
Infant <6 months: 0.01 mg/kg IM (0.01 mL/kg 1:1000 solution)
Repeat dose at 5 minute intervals
If an auto-injector is the only form of adrenaline available, this should be administered

If skills and equipment available:

Establish airway
Monitor pulse oximetry, blood pressure, ECG
Administer high flow oxygen 		Gain IV access
Administer IV fluids (0.9% saline)
Consider an antihistamine or hydrocortisone
Adapted from the UK Working Group of the Resuscitation Council1
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