Anaphylaxis

Follows the current ASCIA Acute Management of Anaphylaxis Guideline (2024) — 2026 versions of ASCIA Action Plans for Anaphylaxis (general and device-specific versions) are now available.

Overview

Anaphylaxis is an acute cause of wheeze/bronchospasm and a medical emergency.

Definition (either of):

• Any acute-onset hypotension, bronchospasm, or upper airway obstruction where anaphylaxis is considered possible — even without typical skin features, or
• Any acute-onset illness with typical skin features (urticarial rash, erythema/flushing, and/or angioedema) plus involvement of the respiratory or cardiovascular systems, or persistent severe gastrointestinal symptoms.

Treatment

• IM adrenaline 10 mcg/kg up to 500 mcg (0.5 mL of 1:1000 adrenaline), repeated at 5-minute intervals if needed.
• Supportive measures: oxygen, airway support.
• IV fluids (20 mL/kg) if hypotensive.
• Salbutamol 8–12 puffs via spacer or 5 mg nebulised for persistent wheeze.
• Consider nebulised adrenaline for upper airway obstruction.