Journal Mobile

M Whiteside, A Fletcher
Journal Issue: 
Volume 40: Issue 2: 2010




Anaphylaxis  is  the  quintessential  medical  emergency  where  prompt recognition and treatment is life-saving. In the UK the incidence is increasing year on year, and is most common in the sixth and seventh decades of life. More than half of cases are iatrogenic in nature, most of the rest are caused by venom (stings) and food substances. The clinical signs can be subtle, but an acute onset of skin or mucosal oedema with respiratory compromise or reduced blood pressure should alert the physician to the diagnosis. The management revolves around the use of adrenaline  after  an  initial  airway,  breathing  and  circulation  approach,  in  a  dose  of 0.5 mg  1:1,000  intramuscularly,  repeated  five  minutes  later  if  there  has  been  no response. Any  delay  in  treatment  is  associated  with  increased  risk  of  adverse outcome.  Steroids  and  antihistamines  are  often  given,  although  there  is  no convincing evidence of their effect in the acute setting. Where diagnostic uncertainty arises, serum tryptase levels can confirm or refute the diagnosis.