Education And Debate

Fortnightly Review: Treatment of acute anaphylaxis

BMJ 1995; 311 doi: (Published 16 September 1995) Cite this as: BMJ 1995;311:731
  1. Malcolm Fisher, heada
  1. aIntensive Therapy Unit, Royal North Shore Hospital, St Leonards, New South Wales 2065, Australia

    Summary points

    • Adrenaline is the treatment of choice for clinical anaphylaxis

    • Volume replacement is indicated in anaphylactic cardiovascular collapse

    • Follow up, diagnosis, and detailed communications are essential in preventing second reactions

    On the receiving end of current treatment

    Last night I had the fright of my life. Our 5 year old daughter started to cough and complained of a sore throat while eating nuts (a mixture of peanut, hazel nut, walnut, and brazil nut). I looked at her throat and found nothing amiss. She then went upstairs to brush her teeth for bed, still complaining of a sore throat. Her protests on the stairs were ignored, given her renowned reputation for the “Shirley Temples.” By the time she reached the bathroom, her face had broken out in acute urticaria and her tongue had became grossly (and unevenly) swollen.

    I rushed her downstairs into the car. On the way to the emergency department she started to wheeze. She could hardly speak. I drove like a lunatic. I would estimate that 3-4 minutes had elapsed between ingestion of nuts and development of urticaria angio-oedema, and it was a further 5 minutes before I reached the hospital. I ran straight to the first casualty officer I saw, and told him that the child in my arms had an acute anaphylaxis and we were quickly escorted to a cubicle.

    Here is where the problems started, and the following events have prompted me to write this letter. You will, of course, bear in mind that I was highly charged at this point in time. My daughter and I were left alone in the cubicle. Small delay. I shouted for oxygen, hoping to prompt some action (without being a pain in the neck). Small delay. I shouted for adrenaline (by this time not afraid to be a pain in the neck). No adrenaline forthcoming. Casualty …

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