Epinephrine is the mainstay of treatment for anaphylaxis. Corticosteroids should be administered in severe cases of envenomation, with the caution that steroids do little to improve symptoms acutely and no definitive evidence exists that corticosteroids reduce recurrent or prolonged anaphylaxis. [16]
H2 blockers such as ranitidine and cimetidine may be given intravenously. [17] Administration of one of these medications combined with diphenhydramine is superior to diphenhydramine alone. [1]
In cases of refractory anaphylaxis, glucagon may be helpful if concomitant beta-blockers are preventing adequate response to epinephrine treatment. [1]
Vasopressors such as epinephrine or dopamine can be used to provide vascular support.
Patients developing respiratory arrest require ventilatory support.
Blood products may be required in the event of disseminated intravascular coagulation (DIC).
Repeated doses of epinephrine may be indicated for severe cases.
In the event of cardiopulmonary arrest due to anaphylaxis, intravenous epinephrine should be administered as a first-line agent. [1]
Consider further inpatient care for all patients with life-threatening reactions. Observe for sufficient duration to ensure symptoms do not rebound after initial treatment. Rebound phenomena may occur up to 12 hours after sting. Respiratory and circulatory support may be needed if secondary organ damage has occurred.
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Western paper wasp (Mischocyttarus flavitarsis) building a nest. By Sanjay Acharya (self-made at Sunnyvale, California, USA). Courtesy of Wikimedia Commons.
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Yellow jacket. By Richard Bartz, Munich aka Makro Freak (Own work). Courtesy of Wikimedia Commons.
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Fire ant bites. In less than 10 seconds, an unwary scientist was stung over 250 times on one leg when he carelessly knelt on a collapsed fire ant mound. The sterile pustules developed to this stage in 3 days. US Department of Agriculture. Courtesy of Wikimedia Commons.
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Fire ants. US Department of Agriculture. Courtesy of Wikimedia Commons.
