PROTOCOL FOR TREATMENT OF ANAPHYLACTIC REACTIONS

All personnel administering biologic products or serum should be prepared to recognize

and treat anaphylaxis.

 Mild symptoms of pruritus, erythema, urticaria and angioedema should be treated with
epinephrine injected intramuscularly or subcutaneously, followed by diphenhydramine,
hydroxyzine or other anti-histamine given orally or parenterally. Epinephrine
administration may be repeated every 5-15 minutes. If the patient’s condition improves
with this management and remains stable, a long-acting epinephrine injection may be
given and an oral anti-histamine prescribed for the next 24 hours.

Treatment of more severe or potentially life-threatening severe anaphylaxis involving severe

bronchospasm, laryngeal edema, shock and cardiovascular collapse necessitates additional
therapy. Maintenance of the airway and oxygen administration should be instituted promptly.
IV epinephrine may be indicated. Rapid IV infusion of physiologic saline to maintain blood
pressure must be instituted to compensate for the loss of circulating blood volume that may
occur. Patients manifesting with severe anaphylaxis should be immediately brought to a
hospital setting for treatment and additional management.EPINEPHRINE IN THE
TREATMENT OF ANAPHYLAXIS
Subcutaneous or Intramuscular administration
Epinephrine 1:1000 (aqueous) in 1mg/ml ampoule: 0.01ml/kg per dose repeated every
10-20 minutes.
 Infants : 0.05-0.1ml
 Children : 0.1-0.3ml
 Adolescents : 0.3-0.5ml
Intravenous administration
Epinephrine 1:1000 (aqueous): 0.1ml/kg diluted to 1:10,000 with physiologic saline.
 Dose may be repeated every 10-20 minutes. A continuous infusion should be
started if repeated doses are required. One milligram (1 ml) of 1:1000 dilution of
epinephrine added to 250ml of 5% dextrose in water, resulting in a concentration
on 4ug/ml, is infused initially at a rate of 0.1 ug/kg per minute and increased
gradually to 1.5 ug/kg per minute to maintain blood pressure.
DIPHENHYDRAMINE IN THE TREATMENT OF ANAPHYLAXIS
Oral, IM or IV (50mg/ml)
1-2 mg/kg every 4-6 hours (100 mg maximum single dose)

All patients showing signs and symptoms of anaphylaxis, regardless of severity, should
be observed for several hours. A period of observation of 4 hours would be reasonable for mild
episodes and perhaps as long as 24 hours for severe episodes.