Anaphylaxis is a potentially life-threatening systemic allergic reaction. The primary goal of treatment is to immediately relieve acute symptoms such as airway obstruction and hypotension, and to prevent subsequent recurrences. The main treatment is epinephrine injection, which rapidly constricts blood vessels, relieves bronchospasm, and inhibits the release of allergic mediators. It is currently the only first-line treatment proven to significantly reduce mortality.
Treatment should follow the principle that “time is life.” Patients or witnesses should administer epinephrine within 15 minutes of symptom onset and seek medical attention immediately. Subsequent treatment may include antihistamines, corticosteroids, and monitoring vital signs to prevent recurrence.
The main treatment consists of acute management and long-term management. Acute management centers on intramuscular injection of epinephrine, which functions by:
Long-term management involves allergen avoidance, self-epinephrine emergency education, and carrying preloaded epinephrine auto-injectors (such as EpiPen) to reduce the risk of recurrence.
Applicable to patients with diagnosed anaphylactic shock, presenting symptoms such as difficulty breathing, throat swelling, hypotension, and widespread skin rash. Common triggers include:
This treatment is not suitable for non-allergic hypotension or non-systemic allergic reactions. It should be used based on a physician’s assessment of symptom severity.
In the acute phase, 0.01-0.3 mg of epinephrine should be administered via intramuscular injection into the outer thigh, with repeat doses (every 5-15 minutes) until symptoms improve. Pediatric doses are calculated based on weight, but in emergencies, the initial dose should be administered first, then adjusted accordingly.
For long-term management, patients must carry preloaded auto-injectors and store them at room temperature. After use, immediate medical attention is required, and at least 4 hours of hospitalization for observation is recommended to prevent rebound phenomena.
Epinephrine can significantly improve blood pressure and respiration within 3-5 minutes, reducing mortality by over 90%. Its advantages include:
Long-term management strategies can reduce recurrence by more than 70%.
Possible side effects include tachycardia, dizziness, and headache, which are usually temporary and reversible. Serious risks include:
Contraindications: Caution should be exercised in patients with hypovolemic shock without medical evaluation and in those with severe coronary artery disease. Confirm that symptoms are indeed caused by allergy before use, to avoid misapplication for other similar symptoms (such as panic attacks).
Those carrying auto-injectors should regularly check the expiration date and receive proper training annually. Asthma patients should inform their doctor, as dosage adjustments may be necessary.
Concurrent use with β-blockers (e.g., metoprolol) may exacerbate cardiovascular side effects, as epinephrine may not counteract the blockade. Use of monoamine oxidase inhibitors should be disclosed to the physician, as it may increase blood pressure fluctuations.
Multicenter studies show that timely use of epinephrine reduces mortality from 6.7% to 1.2%. A 2019 systematic review indicates that patients who did not receive epinephrine had a hospitalization rate 3.2 times higher than those who did. However, delaying administration beyond 30 minutes significantly diminishes efficacy.
Long-term follow-up demonstrates that combining allergen immunotherapy (such as peanut SLIT therapy) can reduce recurrence rates by up to 40%, but epinephrine remains the first-line emergency response.
If epinephrine is contraindicated, consider:
However, it is emphasized that these alternatives are not first choices and should only be used under specific medical conditions.
Yes. Even if symptoms improve after epinephrine administration, immediate hospital evaluation is essential. Anaphylaxis can recur, and medical personnel need to assess whether additional medication or monitoring is required to prevent secondary episodes.
How can I confirm that my medication is effective when carrying an epinephrine auto-injector long-term?Regularly check the solution’s color for cloudiness, inspect the container for cracks, and note the expiration date. Environmental temperature also affects efficacy; avoid storing the injector in high or low temperatures (such as in a car or freezer). Expired medication should be replaced immediately to ensure safety during emergencies.
What activities should patients avoid in daily life after treatment for anaphylactic shock?Patients should avoid known allergens, such as specific foods or medications. Additionally, vigorous exercise, hot environments, or emotional stress may trigger symptoms. It is recommended to develop a safe activity plan under medical guidance and carry a medical alert card detailing allergy history.
What are the possible side effects of epinephrine injections, and how should they be managed?Common side effects include palpitations, tremors, or dizziness, which usually resolve within minutes to hours. If severe discomfort such as chest pain or difficulty breathing occurs, seek medical attention immediately. Confirm that the patient has no history of cardiovascular disease before use to reduce risks.
What should be considered when vaccinating patients with a history of anaphylactic shock?Inform healthcare providers of allergy history and current medications before vaccination. Some vaccines (e.g., tetanus) may contain allergens such as calcium modulators, requiring administration under medical supervision. Observe for 30 minutes post-vaccination to ensure no acute reactions occur before leaving.
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