Anaphylaxis Management

Anaphylaxis Opener

This module describes how to recognise and manage anaphylaxis.


Anaphylaxis presents with

  1. related to respiratory difficulty and/or cardiovascular dysfunction after exposure to a known allergen

  2. related to skin/mucosal involvement, combined with respiratory difficulty, cardiovascular dysfunction and/or severe gastrointestinal symptoms


  1. Pulseless patients should be treated according to cardiac arrest algorithms


Some patients may be haemodynamically unstable and unable to understand; communicate with family members if present.

How do I explain this procedure?

“You are having a very serious allergic reaction called anaphylaxis. Your body is overreacting to a harmless substance, such as bee venom or peanuts, which we call an allergen. Your immune cells react to it as though it is a threat, releasing a flood of chemicals such as histamine. This flooding can cause you to go into shock, lowering your blood pressure and/or narrowing your airways. I’m going to give you emergency medication to counteract the reaction.”

What can my patient expect?

“I’m going to give you an injection, some medication through a drip, and I might give you oxygen or medication through a mask. We will also keep you connected to monitors to show how you are doing. We will need to keep you in hospital for at least 4-6 hours to prevent flare-ups.”

What is my patient’s role?

“Although anaphylaxis is frightening, try to stay calm and follow my instructions. Tell me how you’re doing and if you’re feeling better or worse. When it’s time to discharge you, we need to talk about a home management plan for your allergies.”


Anaphylaxis management is an emergency procedure. Always:

  1. Know where defibrillators, transcutaneous pads, and red trolleys are kept. Know the relevant staff and keep your seniors’ contact details close at hand.

  2. Familiarise yourself with the defibrillators in your work area. Check that they are maintained regularly and have pads and the correct connections.

  3. Keep unstable patients in resuscitation bays with continuous monitoring.


The patient should be supine or semi-recumbent on a firm surface. If hypotensive, raise the legs. Ensure space behind the head of the bed for staff to administer rescue breaths if the patient deteriorates.


Follow medical asepsis with non-sterile gloves.

  1. Hello

    1. Tap the patient’s shoulder and call hello. Look for a response.
    2. Feel and listen for breathing with your ear close to the patient’s mouth. Look for chest rise. Don’t take more than 10 seconds.
    3. Feel for a pulse on the neck. Don’t take more than 10 seconds. Identify tachycardia.
  2. Airway: open and maintain if necessary. Consider early intubation if compromised.

  3. Breathing: attach sats probe. Administer oxygen/ventilation if necessary.

  4. Circulation: attach BP cuff and cardiac monitoring.

  5. Give

    Repeat every 5-15 minutes if no improvement.

  6. Establish two large-bore IV lines. Administer

    Give adjunctive treatment as required, which may include the following drugs:

  7. ONLY if unresponsive to IM adrenaline & fluids


When can I discharge this patient?

Keep in casualty 4-6 hours after resuscitation and discharge only if clinically stable.


  1. Poor response & death

  2. Adverse reaction to medication


  1. Resuscitation Council of Southern Africa. Emergency Management of Adult and Child Anaphylaxis. 2021.