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Anaphylaxis Algorithm

Anaphylaxis is a severe, life-threatening , generalised or systemic hypersensitivity reaction (Resuscitation Council UK )


Airway Breathing Circulation Disability Exposure

Diagnosis → look for Acute onset of illness Life threatening Airway and / or Breathing
and / or circulation problems* And usually skin changes

Life threatening problems*

 Airway → swelling , hoarseness , stridor Breathing → rapid breathing , wheeze , fatigue , cyanosis , SpO2 < 92 % , confusion Circulation → pale , clammy , low BP , faintness , drowsy / coma

Call for help Lie patient flat Raise patients leg


AFDRENALINE → GIVE IM Unless experienced with IV

IM doses of 1 : 1000 Adrenaline
( Repeat after 5 mins if no better )

 Adult → 500 micrograms IM ( 0.5 ml ) Child > 12 yrs → 500 micrograms IM ( 0.5 ml ) Child 6-12 yrs → 300 micrograms ( 0.3 ml ) Child < 6 yrs → 150 micrograms ( 0.15 ml )

Adrenaline IV to be given only by experienced specialists Titrate : Adults 50 micrograms ; Children 1 micrograms / kg

IV fluid Challenge

Adult → 500 – 1000 mL Child → crystalloid 20 mL / kg Stop IV colloid if this might be the cause of anaphylaxis

When skills and equipment available
 Establish airway High flow Oxygen IV fluid challenge Chlorphenamine Hydrocortisone

 Pulse oximetry ECG Blood pressure

Adult or child > 12 ——–> child 6-12 yrs ————-> Child 6 month to 6 yrs -> Child < 6 months ———>10mg 5 mg 2.5 mg 250 mcgm/kg Hydrocortisone-200 mg 100 mg 50 mg 25 mg

Reproduced with the kind permission of Resuscitation Council UK March 2008

For further information please visit

Links and Resources

Anaphylaxis charity helping people with severe allergies

National Allergy Strategy Group working to improve NHS allergy services

Action against allergy

British Society for Allergy and Clinical Immunology – for healthcare professionals




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