Anaphylaxis (Immediate-Type) — Management Pathway

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

🎓 Want to practice? Do a case challenge with this pathway → (get a case, choose management step by step, scored).

Full pathway

1. [Decision] Does it meet anaphylaxis criteria?
   Does it meet the diagnostic criteria for anaphylaxis? (Meets any one: 1) acute skin/mucosal symptoms within minutes–hours (urticaria, flushing, lip/tongue swelling) + one of (respiratory involvement, hypotension/end-organ dysfunction, severe GI symptoms); 2) acute hypotension, bronchospasm or laryngeal involvement after exposure to a known or highly likely allergen (even without skin findings).)
   • Meets it (or high suspicion) → Give intramuscular epinephrine now
   • Does not meet it / minor local reaction → Not anaphylaxis / minor reaction
2. [End] Give intramuscular epinephrine now
   Give IM epinephrine immediately: 0.01 mg/kg (1:1000; adult max 0.5 mg, child max 0.3 mg) into the anterolateral thigh, repeatable every 5–15 min. Also: remove the allergen, ABC, lie flat with legs raised (left lateral if pregnant), high-flow oxygen, large-bore IV access, rapid crystalloid for hypotension; add inhaled β2 agonist for bronchospasm; use glucagon if on beta-blockers and not responding. Antihistamines / corticosteroids are second-line and must not delay or replace epinephrine. (Note: Watch for a biphasic reaction (may recur hours later); for recurrent or refractory hypotension use IV epinephrine (continuous monitoring) and escalate support.)
3. [End] Not anaphylaxis / minor reaction
   Not anaphylaxis or a minor local reaction: symptomatic treatment and observation; treat as anaphylaxis the moment systemic symptoms appear. Identify and avoid the trigger.

Source guidelines & references

• World Allergy Organization (WAO) 2020 anaphylaxis guidance. World Allergy Organ J 2020 · source ↗
• AAAAI/ACAAI anaphylaxis practice parameter 2020

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

Other pathways