Therapeutic target
Stabilization of circulatory conditions
Therapy recommendation for anaphylactic shock
- Removal of the triggering substance (if possible) and placement of an i.v. line (administration of full electrolyte solution, VEL).
- Severity I and II * (mild to marked general reactions):
- General therapy: antihistamines (e.g., dimetindene, i.v.); in acute therapy and prophylaxis.
- In bronchospasmolysis (decongestion of bronchial muscles by drugs):
- SS-Sympathomimetics, inhalative (eg, salbutamol; if necessary, additively theophylline (in refractory bronchospasm) 5 mg/kg bw i.v.;
- Glucocorticoids: 250 mg prednisolone, i.v. (play a minor role in acute therapy because of delayed onset).
- In severe hypotension: cafedrine-theodrenaline 200/10 mg.
- Severity III and IV * (severe general reactions, shock, circulatory arrest).
- Secure airway proactively, but not generally prophylactically!
- Generous volume therapy with VEL; caveat: do not use hydroxyethyl starch (HES); is nephrotoxic (“damaging to the kidney“).
- Epinephrine (first-line agent)
- Patient not requiring resuscitation: i.m. Administration (if necessary, repeat after five to ten minutes).
- In severe or impending shock: Adreanaline administration diluted intravenously under pulse and blood pressure control:
- Non-resuscitated patient: i.m. application of epinephrine (0.01 mg/kg bw = 0.01 ml/kg bw of 1:1000 solution) into the outer thigh; in the absence of onset of action, i.m. application may be repeated every 5-10 min, depending on the side effects
- Impending cardiovascular failure: i. v. continuous infusion (0.01 to a maximum of 1 µg/kg bw min titration after effect)
- Cardiovascular arrest: i.v. administration during resuscitation (0.01 mg/kg bw 1: 10,000 solution (epinephrine diluted 1:10) → 0.1 ml/kg bw epinephrine 1: 10,000 (epinephrine diluted 1:10)).
- Glucocorticoids: 500-1,000 mg prednisolone, i.v. (especially in severe bronchospasm or delayed progressive symptoms).
- If necessary, antihistamines and theophylline supplemental.
- Oxygen administration and generous indication of mechanical ventilation.
- If cardiopulmonary resuscitation is required: cardiac compressive massage and ventilation in a 30:2 ratio; apply an automatic defibrillator so that defibrillation can be performed in the event of ventricular fibrillation
- Prompt allergological diagnostics
* Severity scale for classification of anaphylactic reactions (see classification below).
