Table 1 Management of Acute Anaphylaxis

   a. Assessment of airway, breathing, circulation, and adequacy of mentation

   b. Administer epinephrine intramuscularly every 5 to 15 minutes, in appropriate doses, as necessary, depending on the presenting signs and symptoms of anaphylaxis, to control signs and symptoms and prevent progression to more severe symptoms, such as respiratory distress, hypotension, shock, and unconsciousness.

II. Possibly appropriate subsequent measures depending on response to epinephrine

   a. Place patient in recumbent position and elevate lower extremities

   b. Establish and maintain airway

   c. Administer oxygen

   d. Establish venous access

   e. Isotonic sodium chloride solution intravenously for fluid replacement

III. Specific measures to consider after epinephrine injections, where appropriate

   a. Consider epinephrine infusion

   b. Consider H₁ and H₂ antihistamines

   c. Consider nebulized β₂ agonist (eg, albuterol [salbutamol]) for bronchospasm resistant to epinephrine

   d. Consider systemic corticosteroids

   e. Consider vasopressor (eg, dopamine)

   f. Consider glucagon for patient taking β-blocker

   g. Consider atropine for symptomatic bradycardia

   h. Consider transportation to an emergency department or an intensive care facility

   i. For cardiopulmonary arrest during anaphylaxis, high-dose epinephrine and prolonged resuscitation efforts are encouraged, if necessary (see reference for specific details)