Algorithm
- Remove trigger if possible; call for help; place supine with legs elevated (unless vomiting/respiratory distress — lateral/recovery position).
- Assess ABC: airway, breathing (wheeze, stridor), circulation (BP, pulse, capillary refill).
- IM adrenaline 1:1000 anterolateral thigh — do NOT delay for antihistamines or steroids.
- High-flow oxygen if SpO₂ <94% or respiratory distress.
- IV access; crystalloid bolus 500–1000 mL if hypotension persists after adrenaline.
- Repeat IM adrenaline q5–15 min if no improvement.
- Refractory shock: IV adrenaline infusion 0.05–0.1 mcg/kg/min (specialist/ICU); continuous monitoring.
- Observe ≥4–12 h; discharge with adrenaline auto-injector prescription and allergy referral.
Red flags
- • Airway compromise / stridor
- • Hypotension or collapse
- • Refractory shock after 2 IM adrenaline doses — escalate to ICU/IV infusion
Medications by step
Step 1 — First-line
- Adrenaline (Epinephrine) · i.m.
0.5 mg IM (1:1000); repeat 0.5 mg q5–15 min
Step 2 — Adjunct bronchospasm
- Salbutamol (Albuterol) · inhaled
5 mg nebulized; repeat PRN
Step 3 — Circulatory support
- Sodium chloride 0.9% · i.v.
500–1000 mL IV bolus; repeat PRN
Step 4 — Refractory shock (specialist)
- Adrenaline (Epinephrine) · i.v. infusion
0.05–0.1 mcg/kg/min IV infusion (1:10 000)
Step 5 — Adjunct (non-delaying)
- Chlorphenamine · i.v.
10 mg IV slow
- Hydrocortisone · i.v.
200 mg IV
References
Updated: Июль 2026