Medication Summary
Goals of therapy are to treat anaphylaxis and prevent complications.
Cardiovascular agents
Class Summary
These agents act to decrease the muscle tone in the small and large pulmonary airways and increase vascular tone.
Epinephrine (Adrenalin, Bronitin, EpiPen)
Epinephrine is the drug of choice for shock, angioedema, airway obstruction, bronchospasm, and urticaria in severe anaphylactic reactions. Administer IM; administer IV to patients in extremis, It may be administered SL or ET when no IV access is available. Continuous infusion may be given in cases of refractory shock.
Bronchodilators
Class Summary
Through activation of cyclic adenosine monophosphate (cAMP), beta agonists stimulate the ATPase pump, thereby shifting potassium into the intracellular compartment and stimulating an adrenergic response.
Albuterol (Ventolin)
Albuterol is a beta agonist useful in treating bronchospasms refractory to epinephrine. It relaxes bronchial smooth muscle by action on beta2 receptors and has little effect on cardiac muscle contractility. Numerous inhaled beta agonists are used for treatment of bronchospasm; albuterol is used most commonly.
Antihistamines
Class Summary
These agents prevent histamine response in sensory nerve endings and blood vessels; they are more effective in preventing histamine response than in reversing it. H2 antihistamines are useful in treatment of anaphylactic reactions when used concomitantly with H1 antagonists. Many H2 blockers are available. Cimetidine is the prototype drug.
Diphenhydramine (Benadryl)
Diphenhydramine is used for symptomatic relief of allergic symptoms caused by histamines released in response to allergens. There are many effective H1 blockers; diphenhydramine is effective and widely available.
Cimetidine (Tagamet)
Cimetidine is an H2 antagonist that, when combined with H1 type, may be useful to treat itching and flushing in anaphylaxis, pruritus, urticaria, and contact dermatitis that do not respond to H1 antagonists alone. Use it in addition to H1 antihistamines.
Corticosteroid, Systemic
Class Summary
These agents have anti-inflammatory properties and cause profound and varied metabolic effects. In addition, these agents modify the body's immune response to diverse stimuli. Prednisone and methylprednisolone are typical drugs of this class. Oral bioavailability is generally similar to parenteral; administer oral prednisone when indicated if a patient is not in extremis and can comfortably take it orally; administer parenteral steroids when indicated for a patient in more severe circumstances.
Prednisone
Prednisone is believed to ameliorate delayed effects of anaphylactic reactions and may limit biphasic anaphylaxis. Doses are general guidelines for usage; dosing is highly individualized.
Methylprednisolone (Solu-Medrol, Depo-Medrol)
Methylprednisolone is useful for treating inflammatory and allergic reactions. By reversing increased capillary permeability and suppressing PMN activity, it may decrease inflammation. A multitude of corticosteroid preparations is available. Methylprednisolone is widely available in the ED because of its other uses (ie, acute asthma, spinal cord injury) and is supplied in both parenteral and oral formulations.
Toxoids
Class Summary
These are used for active immunity against tetanus.
Tetanus toxoid adsorbed or fluid
Tetanus toxoid adsorbed or fluid is used to induce active immunity against tetanus in selected patients. The immunizing agents of choice for most adults and children older than 7 years are tetanus and diphtheria toxoids. It is necessary to administer booster doses to maintain tetanus immunity throughout life.
Pregnant patients should receive only tetanus toxoid, not a diphtheria antigen-containing product.
In children and adults, it may be administered into deltoid or midlateral thigh muscles. In infants, the preferred site of administration is the mid thigh laterally.
Immunoglobulins
Class Summary
These consist of immunoglobulins pooled from serum of immunized patients.
Tetanus immune globulin (TIG)
Tetanus immune globulin is used for passive immunization of any person with a wound that may be contaminated with tetanus spores.
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Yellow jacket wasp. Image courtesy of US Centers for Disease Control and Prevention.
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Anopheles albimanus mosquito feeding on human host. Image courtesy of US Centers for Disease Control and Prevention.
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Insect Bites. Louse, Pediculus humanus, dorsal view after feeding on blood. Most lice are scavengers, feeding on skin and other debris found on the host's body, but some species feed on sebaceous secretions and blood. Image courtesy of US Centers for Disease Control and Prevention.
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Insect Bites. World Allergy Organization anaphylaxis pocket card. Reprinted from The Journal of Allergy and Clinical Immunology, Vol 127, Issue 3, Simons FER et al, World Allergy Organization anaphylaxis guidelines; Summary, Pgs 587-93, March 2011, with permission from Elsevier. Available at http://www.jacionline.org/article/S0091-6749(11)00128-X/fulltext.
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Fire ant (Solenopsis invicta). Image courtesy of Wikimedia Commons.
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Fecal staining from bed bugs in the crevice of a mattress. © 2014 Australian Family Physician. Reproduced with permission from The Royal Australian College of General Practitioners (RACGP), published in Doggett SL, Russell R. Bed bugs - What the GP needs to know. Aust Fam Physician. Nov 2009;38(11):880-4.
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Various stages of the bed bug life cycle. © 2014 Australian Family Physician. Reproduced with permission from The Royal Australian College of General Practitioners (RACGP), published in Doggett SL, Russell R. Bed bugs - What the GP needs to know. Aust Fam Physician. Nov 2009;38(11):880-4.
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Kissing bug (Triatoma sanguisuga) can be a vector for Chagas disease. Image courtesy of US Centers for Disease Control and Prevention.
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The Oriental rat flea (Xenopsylla cheopis). Image courtesy of US Centers for Disease Control and Prevention.
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Typical bed bug rash. Image courtesy of Wikimedia Commons.
