Anaphylaxis Treatment for Severe Allergic Reaction

Anaphylaxis is a severe allergic reaction that requires immediate attention and emergency treatment.

Unlike a standard allergic reaction, anaphylaxis tends to develop in several areas of your body at once. It may include skin symptoms such as hives or swelling, difficulty breathing, and a sense of panic or doom.

If you experience anaphylaxis for the first time, you may not recognize its symptoms and you may be unsure what to do. If you’re not sure if your symptoms indicate anaphylaxis or another condition, you should seek emergency medical care.

If you’ve experienced anaphylaxis before and know that you’re at risk for it, your doctor will instruct you to carry epinephrine to treat yourself in case of exposure to a known allergen.

After treating an anaphylactic reaction with epinephrine, it’s important to follow up right away with a visit to the emergency room. There, you can be evaluated for any other treatments needed to stabilize your condition.

If you have an anaphylactic reaction and don’t have access to epinephrine, it’s crucial to call 911 or otherwise seek emergency care immediately.

If someone you know is having an anaphylactic reaction and is having trouble breathing, administering epinephrine or CPR (cardiopulmonary resuscitation) may help save their life. (1,2)

First Aid for Anaphylaxis

If you’re at risk for anaphylaxis, it’s important to have an action plan in place. (3)

This action plan should include written instructions about how to respond if you develop anaphylaxis, in case you aren’t able to give yourself epinephrine and seek emergency care on your own.

Your anaphylaxis action plan should be developed with your doctor and shared with your family, coworkers, and friends. A written copy should be made accessible at home, at school or work, and at any place where you’ll be away from home, such as camp or field trips.

The most important step in any action plan is to give yourself an epinephrine injection. To do this, you’ll need to have an epinephrine autoinjector with you at all times.

This device contains a predetermined single dose of epinephrine, which you’ll inject into your thigh if you develop anaphylaxis.

If you think you’re having an anaphylactic reaction, use your epinephrine autoinjector immediately and then call 911 or arrange to be brought immediately to an emergency room.

Do this at the first sign of anaphylaxis. You shouldn’t take an antihistamine or a dose from your inhaler instead, or wait to see if your symptoms get worse or better. (3)

If you’re in the presence of someone experiencing symptoms of anaphylaxis, take the following steps to help:

1. Call 911 for emergency medical help.
2. Help the person inject epinephrine, or do it yourself if they cannot.
3. Help the person lie down, and keep their legs in an elevated position. Cover them with a coat or blanket if possible.
4. Check the person’s pulse and breathing, and administer CPR if needed. (2)

If you’re allergic to bee or wasp venom, it’s important to scrape the stinger off the sting area with your fingernail or a credit card. This should be done as soon as you notice the sting.

Don’t try to take any medicine by mouth, such as an antihistamine or inhaler, if you’re having trouble breathing.

Lying down with your legs elevated can help prevent anaphylactic shock, a serious reaction in which your blood pressure drops because of anaphylaxis. Your feet should be raised about 12 inches (30 centimeters).

Don’t place a pillow under the head of someone with anaphylaxis, since this can interfere with breathing.

Don’t try to help someone with anaphylaxis lie down if you suspect they’ve had a head, neck, or back injury, or if doing so causes visible discomfort. (1)

If you’re in a wilderness area or somewhere else that can’t be accessed by emergency first responders, go back to your vehicle and head to a hospital emergency room as quickly as possible.

Otherwise, it’s best to stay in place and wait for first responders to arrive, since they can administer CPR or any other needed help before you arrive at the hospital.

Emergency and Hospital Care for Anaphylaxis

When emergency first responders arrive, they’ll take steps to quickly assess your condition and administer CPR if needed. They’ll give you epinephrine if this hasn’t been done already.

Paramedics may insert a specialized tube into your nose or mouth to help you breathe.

If your airways are so constricted that you still can’t breathe, they may perform an emergency surgery to place a tube directly into your trachea (in your neck). (1)

Once you’re in the ambulance or at the hospital, your pulse and other vital signs will be monitored, and you may be given oxygen to help you breathe.

You may be given intravenous (IV) fluids to help stabilize your blood pressure and make it easier to give you any drugs you may need by IV. (4)

You may also be given one or more of the following drugs:

Epinephrine Continued doses of epinephrine may be required to help stabilize your vital signs. These will most likely be given by IV.

Vasopressors (Vasoconstrictors) These drugs are designed to raise your blood pressure by narrowing your blood vessels.

Drugs in this group that you may be given include:

• Dopamine
• Norepinephrine
• Phenylephrine

Antihistamines and H2 Blockers These drugs work by blocking certain chemicals that your immune system produces in an anaphylactic reaction.

Medications in this group that you may be given include:

• diphenhydramine (Benadryl)
• cimetidine (Tagamet)

Beta-Agonists These inhaled drugs help widen your airways to make it easier to breathe. The most commonly given drug of this type is albuterol (Ventolin).

Corticosteroids These medications are given to help prevent your symptoms from recurring hours later. Drugs in this group include:

• hydrocortisone (Solu-CORTEF)
• prednisone (Deltasone) (4,5)

Once your anaphylaxis symptoms are resolved and your vital signs are stable, how long you stay in the hospital will likely depend on the severity of your reaction and other factors.

Current guidelines for anaphylaxis treatment suggest keeping someone in the hospital for 8 to 24 hours of observation if they had a moderate to severe reaction.

You may also be kept for observation if:

• You have asthma and you’re wheezing.
• You ingested an allergen that may still be in your digestive system.
• You have a history of a prolonged or two-phase anaphylactic reaction. (5)