Anaphylaxis in the ICU

• Give adrenaline 0.5 mg IM into the anterolateral thigh immediately for adult anaphylaxis and repeat after 5 minutes if airway, breathing or circulation problems persist.
• Anaphylaxis can occur without skin findings. Lay the patient flat unless breathing requires a supported position; give oxygen for hypoxemia, secure IV access and give reassessed crystalloid boluses for hypotension.
• Use an H1 antihistamine only for persistent skin symptoms after airway, breathing and circulation are stable. H2 blockers and corticosteroids are not routine emergency treatment.
• For refractory anaphylaxis, use a monitored IV adrenaline infusion with expert support. Consider glucagon when shock remains refractory in a patient taking a beta-blocker.
• Choose observation by reaction severity, treatment required, comorbidity and access to emergency care; provide locally authorized adrenaline devices, training, an action plan and allergy referral.

First tests: Bedside clinical assessment.

Only if indicated: Serum mast-cell tryptase, 12-lead ECG, Arterial blood gas.

Repeat monitoring: Specialist allergy assessment.

• Acute Care of Patients With Anaphylaxis