Dawaa Reference

acute

Anaphylaxis (Emergency Management)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources5 sources

MSF Essential Drugs 2024 (hydrocortisone injectable monograph): "Child one month to 11 years: 4 mg/kg (max. 100 mg); Child 12 years and over and adult: 100 to 200 mg". The Resuscitation Council UK May 2021 drug dose table is not held in this corpus. · Egyptian National Drug Formulary - Cardiovascular 2024 · Resuscitation Council UK Anaphylaxis Guidelines 2021 · EAACI Anaphylaxis Guidelines 2021 · Resuscitation Council UK, Emergency treatment of anaphylaxis, May 2021, section 5.5 and the drug dose table

Verified against4 documents
  • MSF Essential Drugs 2024 (hydrocortisone injectable monograph): "Child one month to 11 years: 4 mg/kg (max. 100 mg); Child 12 years and over and adult: 100 to 200 mg". The Resuscitation Council UK May 2021 drug dose table is not held in this corpus.
  • Egyptian National Drug Formulary - Cardiovascular 2024
  • Resuscitation Council UK Anaphylaxis Guidelines 2021
  • Resuscitation Council UK, Emergency treatment of anaphylaxis, May 2021, section 5.5 and the drug dose table

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (6)

  • Skin flushing, itching, and hives are common but may appear only after respiratory symptoms start, especially with oral exposures [itching · urticaria]
  • Other breathing symptoms include a hoarse voice, wheeze, and stridor [hoarseness · stridor · wheeze]
  • Reactions typically develop quickly, usually within an hour of exposure
  • Symptoms can return in a second wave hours later even after the first reaction resolves, peaking 8 to 11 hours after the original episode
  • Abdominal pain, cramping, vomiting, low muscle tone, fainting, or loss of bladder or bowel control can occur from poor organ perfusion [abdominal pain · muscle cramps · syncope · vomiting]
  • Gastrointestinal complaints occur in roughly a quarter to a third of patients

Signs — what you find (1)

  • The blood-pressure criterion is a systolic reading under 90 mmHg or a drop of more than 30 percent from the patient's baseline

Tests (3)

  • Diagnosis is made clinically; lab testing is not required to diagnose or treat
  • Serum histamine is not useful because it rises only briefly and is often missed by the time it is drawn
  • Serum tryptase can help confirm an anaphylactic episode after the fact since it stays elevated for hours, though it is not very sensitive

If not this — what else fits (12)

  • Angioedema can mimic anaphylaxis and is on the differential
  • Anxiety or panic can present similarly and should be considered
  • Cardiac arrhythmias are part of the differential for acute reactions
  • An asthma exacerbation can be mistaken for anaphylaxis
  • Carcinoid syndrome, with its flushing, is a differential to consider
  • Epiglottitis is a differential, particularly with airway symptoms
  • A foreign body obstructing the airway is on the differential
  • Gastroenteritis is considered when GI symptoms predominate
  • Mastocytosis is a differential diagnosis to consider
  • Myocardial ischemia or infarction should be considered in the differential
  • A vasovagal episode can mimic some features and is on the differential
  • Vocal cord dysfunction is a differential, especially with breathing difficulty

SourceStatPearls "Anaphylaxis" - disease-level clinical article

Presentation findings are traced to the source above.

1

ADRENALINE

1st line

Forminjection

Adult dose and duration

0.5 mg (0.5 mL of 1:1000 / 1 mg/mL solution) INTRAMUSCULARLY into mid-outer thigh. Repeat every 5 minutes PRN if no improvement. - Emergency dose, repeat at 5 min PRN

Paediatric dose

(Intramuscular 1:1000 (1 mg/mL) adrenaline into anterolateral thigh: Age <6 months: 100-150 mcg (0.1-0.15 mL); Age 6 months - 5 years: 150 mcg (0.15 mL); Age 6-11 years: 300 mcg (0.3 mL); Age 12+ years: 500 mcg (0.5 mL).)

Dose by age
Under 6 months:100 to 150 mcg (0.1 to 0.15 mL) intramuscularly into the anterolateral thigh
6 months to 5 years:150 mcg (0.15 mL) intramuscularly into the anterolateral thigh
6 to 11 years:300 mcg (0.3 mL) intramuscularly into the anterolateral thigh
12 years and over:500 mcg (0.5 mL) intramuscularly into the anterolateral thigh
Dose source

Egyptian National Drug Formulary - Cardiovascular 2024 (adrenaline monograph), Anaphylaxis and other severe immediate hypersensitivity reactions: adult "IM: 0.3 or 0.5 mg (use 0.5 mg in patients >50 kg) using the 1 mg/mL solution given in the anterolateral thigh; may repeat every ~5 to 15 minutes if no response", and the paediatric IM bands 100-150 micrograms up to 6 months, 150 micrograms 6 months-5 years, 300 micrograms 6-11 years, 500 micrograms 12-17 years. The Resuscitation Council UK Anaphylaxis Guidelines 2021 are not held in this corpus.

Why

Adrenergic agonist that reverses the airway swelling, bronchospasm, and vasodilation of anaphylaxis; the only drug that treats the reaction itself, which is why it must be given immediately into muscle rather than delayed for other measures.

Cautions
  • TIME-CRITICAL EMERGENCY: Give IM adrenaline IMMEDIATELY upon recognizing anaphylaxis (airway, breathing, or circulation compromise).
  • Administer INTRAMUSCULARLY into mid-outer thigh (vastus lateralis); DO NOT give IV adrenaline in primary care (high risk of fatal arrhythmia).
  • Position patient flat with legs elevated (or sitting up if breathlessness dominates); DO NOT allow patient to stand or walk abruptly.
  • Call emergency services (123 in Egypt) immediately for urgent transport to emergency department.
Egyptian brands
Egyptian brandManufacturerIndicative price
EPINEPHRINE-MEMPHIS 1 MG/ML 5 I.M./S.C. AMP.MEMPHIS10.00 EGP
ADRENAMAX 1 MG/1ML 10 AMPS.CHEMIPHARM75.00 EGP
EPINEPHRINE-MISR 0.25 MG/ML 25 AMP.MISR187.50 EGP
EPINEPHRINE-MISR 1 MG/ML 100 AMP.MISR750.00 EGP
ADRENALINE-CID 1 MG/1ML 100 I.M./S.C. AMP.CID850.00 EGP
2

HYDROCORTISONE

add-on - not a substitute

Strength100 mg

Forminjection

Adult dose and duration

200 mg IV as the initial dose - Single emergency dose

Paediatric dose

4 mg/kg/dose [child max 100 mg]

(Child one month to 11 years: 4 mg/kg IV, maximum 100 mg. Child 12 years and over: 100 to 200 mg, as for an adult.)

Dose by age
1 month to 11 years:4 mg/kg IV, maximum 100 mg
12 years and over:100 to 200 mg IV, as for an adult
Dose by weight
3kg12 mg/dose
4kg16 mg/dose
5kg20 mg/dose
6kg24 mg/dose
7kg28 mg/dose
8kg32 mg/dose
9kg36 mg/dose
10kg40 mg/dose
11kg44 mg/dose
12kg48 mg/dose
13kg52 mg/dose
14kg56 mg/dose
15kg60 mg/dose
16kg64 mg/dose
17kg68 mg/dose
18kg72 mg/dose
19kg76 mg/dose
20kg80 mg/dose
21kg84 mg/dose
22kg88 mg/dose
23kg92 mg/dose
24kg96 mg/dose
25kg100 mg/dose
26kg100 mg/dose (capped)
27kg100 mg/dose (capped)
28kg100 mg/dose (capped)
29kg100 mg/dose (capped)
30kg100 mg/dose (capped)
31kg100 mg/dose (capped)
32kg100 mg/dose (capped)
33kg100 mg/dose (capped)
34kg100 mg/dose (capped)
35kg100 mg/dose (capped)
36kg100 mg/dose (capped)
37kg100 mg/dose (capped)
38kg100 mg/dose (capped)
39kg100 mg/dose (capped)
40kg100 mg/dose (capped)
41kg100 mg/dose (capped)
42kg100 mg/dose (capped)
43kg100 mg/dose (capped)
44kg100 mg/dose (capped)
45kg100 mg/dose (capped)
46kg100 mg/dose (capped)
47kg100 mg/dose (capped)
48kg100 mg/dose (capped)
49kg100 mg/dose (capped)
50kg100 mg/dose (capped)
Dose source

MSF Essential Drugs 2024 (hydrocortisone injectable monograph): "Child one month to 11 years: 4 mg/kg (max. 100 mg); Child 12 years and over and adult: 100 to 200 mg". The Resuscitation Council UK May 2021 drug dose table is not held in this corpus.

Why

Not part of the emergency treatment any more. The 2021 guideline is explicit: corticosteroids are no longer advised for the routine emergency treatment of anaphylaxis. Consider one after initial resuscitation, for a refractory reaction or ongoing asthma or shock - and never in place of adrenaline.

Cautions
  • There is a signal of harm, not just absence of benefit: early steroid use is associated with a higher rate of intensive care admission even after adjusting for how sick the patient was. Very low-certainty evidence, but it is the reason the routine recommendation was withdrawn.
  • Never prioritise this over adrenaline, fluids, or an adrenaline infusion. If reaching for hydrocortisone delays any of those, do not reach for it.
  • Corticosteroids have a delayed onset of action (4-6 hours) and must NEVER be used as first-line substitute for adrenaline.
  • Adjunctive therapy only; emergency hospital observation for at least 6-12 hours is required.
Egyptian brands
Egyptian brandManufacturerIndicative price
SOLU-CORTEF 100MG/2ML VIALEIPICO > PFIZER16.00 EGP
HYDROCORTISONE SODIUM SUCCINATE 100MG I.V./I.M.VIALEIPICO26.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.