Anaphylaxis

Reference material only. This article is general reference information, not clinical, medical or legal advice. It does not replace your clinic's own written emergency protocols, your clinical judgement, up-to-date professional guidance, or the emergency services. In an emergency, call 999 without delay. Every clinic remains responsible for its own emergency preparedness, training, equipment and drugs, and for acting within each practitioner's scope of competence and insurance.

Anaphylaxis is a severe, life-threatening, generalised hypersensitivity reaction. It can follow any injectable, topical or oral agent used in clinic, including local anaesthetic and hyaluronidase. It is managed the same way whatever the trigger.

Recognising it

Suspect anaphylaxis with sudden onset and rapid progression of Airway, Breathing or Circulation problems, usually with skin changes:

• Airway: throat or tongue swelling, hoarse voice, stridor, difficulty swallowing.
• Breathing: wheeze, breathlessness, fatigue, cyanosis, low oxygen saturations.
• Circulation: pale, clammy, dizziness, collapse, fast heart rate, low blood pressure.
• Skin: flushing, widespread urticaria (hives), angio-oedema. Skin changes alone are not anaphylaxis.

Immediate actions

• Call for help and dial 999, stating "anaphylaxis".
• Remove the trigger where possible and lie the patient flat (sit up if breathing is the main problem; left lateral if pregnant).
• Give intramuscular adrenaline into the anterolateral thigh at the dose in the current UK Resuscitation Council anaphylaxis algorithm, and repeat after 5 minutes if there is no improvement.
• Give high-flow oxygen if available and monitor the patient closely.

Be ready before it happens

Every clinic giving injectables should hold in-date adrenaline, know the current dosing, and train the whole team to the Resuscitation Council algorithm. Keep an anaphylaxis pack checked and accessible. Anyone who has received adrenaline needs hospital assessment because of the risk of a biphasic (delayed second) reaction, even if they appear to recover.

Afterwards

Document times, doses and observations. Report the reaction, review the likely trigger, and ensure the patient has clear follow-up and allergy advice before any future treatment.