3.4.3 Allergic emergencies


In this section:

Anaphylaxis

Refer to Resuscitation Council (UK) guidelines:
Emergency treatment of anaphylactic reactions - Guidelines for healthcare providers - www.resus.org.uk/pages/reaction.pdf

Adrenaline 1:1000 (1mg/mL) 0.5 mg IM (= 500 micrograms = 0.5 mL of 1:1000) should be given, (give IM unless experienced with IV adrenaline). Further doses can be given at about 5-minute intervals according to the patient's response.
Adrenaline auto-injectors, pre-assembled syringe with a needle suitable for rapid (IM) administration, are available for patients at risk of anaphylaxis.

After initial resuscitation:

Chlorphenamine 10mg injected slowly intravenously or intramuscularly may be given after the adrenaline. In the community, intramuscular injection may be used.

Hydrocortisone injection 200mg injected slowly intravenously or intramuscularly, taking care to avoid inducing further hypotension. Its onset of action is delayed for several hours, but it may prevent further deterioration in severely affected patients. In the community, intramuscular injection may be used.

PAEDIATRIC NOTES - TREATMENT OF ALLERGIC EMERGENCIES

Refer to Resuscitation Council (UK) Emergency treatment of anaphylactic reactions - Guidelines for healthcare providers.

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Hereditary angioedema (HAE)

Specialist hospital prescribing only.

Icatibant acetate 30mg solution for injection in pre-filled syringe (Firazyr®) Black Triangle symbol indicating that the CHM and MHRA are intensively monitoring this product is used for the symptomatic treatment of acute attacks of HAE in adults (with C1-inhibitor deficiency). Use is contingent upon the continuing availability of the Patient Access Scheme in NHS Scotland.

C1-inhibitor (human) 500units powder and solvent for solution for injection (Cinryze®) Black Triangle symbol indicating that the CHM and MHRA are intensively monitoring this product is restricted to long-term prophylactic use in HAE patients (adults and adolescents with C1-inhibitor deficiency) who are unresponsive to maximal conventional approaches to managing long-term symptoms and who present repeatedly with recurrent, uncontrolled acute symptoms. Cinryze® Black Triangle symbol indicating that the CHM and MHRA are intensively monitoring this product therapy is restricted to use by the Immunology Department (prescribing, use, administration and supervision).

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