Action
Manage by ACLS (Class I)
- Airway (intubation, cricothyroidotomy)
- Breathing
- Circulation
Decision
Do symptoms meet criteria for anaphylaxis?
Background
“The classic finding of urticaria is present in up to 90% of patients with anaphylaxis, meaning 10% of patients with anaphylaxis do not have skin involvement. Children, especially infants, have additional symptoms to ask about, including irritability, hoarse cry, cyanosis, drooling, and croup- like cough. Patients should also be asked whether they have taken any medications for the reaction, and if they have, then the dosage and timing of those medications should be recorded.”
Organ System
| Symptoms
| Approximate Incidence |
Skin | Urticaria, angioedema, flushing, itching | 90% |
Respiratory | Shortness of breath, wheezing, oral edema, rhinitis | 70% |
Gastrointestinal | Nausea, emesis, abdominal cramping, diarrhea | 40% |
Cardiovascular | Hypotension, chest pain | 35% |
Neurologic | Headache, seizure, altered mental status | 8% |
Anaphylaxis is highly likely when any 1 of the following 3 criteria is fulfilled:
- Acute onset of an illness (minutes to several hours) with involvement of the skin, mucosal tissue, or both (eg, generalized hives, pruritus or flushing, swollen lips-tongue-uvula) AND AT LEAST ONE OF THE FOLLOWING:
- Respiratory compromise (eg, dyspnea, wheeze-bronchospasm, stridor, reduced peak expiratory flow, hypoxemia)
- Reduced blood pressure or associated symptoms of end-organ dysfunction (eg, hypotonia [collapse], syncope, incontinence)
- Two or more of the following that occur rapidly after exposure to a likely allergen for that patient (minutes to several hours):
- Involvement of the skin-mucosal tissue (eg, generalized hives, itch-flush, swollen lips-tongue-uvula)
- Respiratory compromise (eg, dyspnea, wheeze-bronchospasm, stridor, reduced peak expiratory flow, hypoxemia)
- Reduced blood pressure or associated symptoms (eg, hypotonia [collapse], syncope, incontinence)
- Persistent gastrointestinal symptoms (eg, crampy abdominal pain, vomiting)
3. Reduced blood pressure after exposure to known allergen for that patient (minutes to several hours):
- Infants and children: low systolic blood pressure (age specific) or >30% decrease in systolic blood pressure
- Adults: systolic blood pressure of <90 mm Hg or >30% decrease from that person’s baseline
Reprinted from Journal of Allergy and Clinical Immunology. Volume 117, Issue 2. Hugh A. Sampson, Anne Muñoz-Furlong, Ronna L. Campbell, et al. Second symposium on the definition and management of anaphylaxis: summary report—Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium. Pages 391-397. Copyright 2006, with permission from Elsevier.
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