Key messages

• Factors influencing treatment include the location of the reaction, the rate of progression, the underlying state of the patient, the clinical manifestations, and the mechanism of the reaction.

• Multisystem anaphylaxis with urticaria, asthma, edema, and cardiovascular collapse leads to an obvious diagnosis. However, if symptoms are restricted to a single system such as angio-edema or cardiovascular collapse, the diagnosis may be difficult or not considered.

• The cardinal signs that anaphylaxis is likely to be severe are rapid onset, dyspnea, stridor, facial swelling, and/or hypotension.

• Sympathomimetic drugs are the primary pharmacological agents used in anaphylactic shock. All vasoconstrictor sympathomimetics produce some improvement. The agent of choice is epinephrine (adrenaline).

• In severe anaphylaxis with cardiovascular collapse or pulmonary edema there is a significant volume deficit. Colloid is more efficient in severe cases, since four to eight times the volume of crystalloid is necessary.

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