Initial Management

1. Continually assess and support ABCs as needed.

2. Acute severe anaphylactic reaction requires immediate discontinuation of allergen. Apply tourniquet proximal to antigenic site if secondary to IM and SQ injection. Remember to remove tourniquet once patient is stable.

3. Establish IV access.

4. Close monitoring in an intensive care setting for 12-24 hours is required for anaphylactic shock. Relapse of anaphylaxis can occur hours after initial presentation.

5. Further acute management is outlined in Figure I-2. Therapy should be guided by a board-certified allergist.

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