# Anaphylaxis (Emergency Management) - Category: acute - Review status: reviewed (every claim checked against a document named on this page) - 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 date: 2026-08 ## Verified against - 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 ## Treatment metadata - Adrenaline — injection - Hydrocortisone — 100 mg — injection ## Complete treatment card ```text ANAPHYLAXIS (EMERGENCY MANAGEMENT) 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 Review status: REVIEWED against 4 sources listed above (2026-08) 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 Source StatPearls "Anaphylaxis" - disease-level clinical article Status traced to the source above 1. ADRENALINE [1st line] Adult 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 Peds 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 (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).) 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. Caution 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. Egypt EPINEPHRINE-MEMPHIS 1 MG/ML 5 I.M./S.C. AMP. MEMPHIS 10.00 EGP ADRENAMAX 1 MG/1ML 10 AMPS. CHEMIPHARM 75.00 EGP EPINEPHRINE-MISR 0.25 MG/ML 25 AMP. MISR 187.50 EGP EPINEPHRINE-MISR 1 MG/ML 100 AMP. MISR 750.00 EGP ADRENALINE-CID 1 MG/1ML 100 I.M./S.C. AMP. CID 850.00 EGP 2. HYDROCORTISONE [add-on - not a substitute] Adult 200 mg IV as the initial dose - Single emergency dose Peds 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.) 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 3kg -> 12 mg/dose 4kg -> 16 mg/dose 5kg -> 20 mg/dose 6kg -> 24 mg/dose 7kg -> 28 mg/dose 8kg -> 32 mg/dose 9kg -> 36 mg/dose 10kg -> 40 mg/dose 11kg -> 44 mg/dose 12kg -> 48 mg/dose 13kg -> 52 mg/dose 14kg -> 56 mg/dose 15kg -> 60 mg/dose 16kg -> 64 mg/dose 17kg -> 68 mg/dose 18kg -> 72 mg/dose 19kg -> 76 mg/dose 20kg -> 80 mg/dose 21kg -> 84 mg/dose 22kg -> 88 mg/dose 23kg -> 92 mg/dose 24kg -> 96 mg/dose 25kg -> 100 mg/dose 26kg -> 100 mg/dose (capped) 27kg -> 100 mg/dose (capped) 28kg -> 100 mg/dose (capped) 29kg -> 100 mg/dose (capped) 30kg -> 100 mg/dose (capped) 31kg -> 100 mg/dose (capped) 32kg -> 100 mg/dose (capped) 33kg -> 100 mg/dose (capped) 34kg -> 100 mg/dose (capped) 35kg -> 100 mg/dose (capped) 36kg -> 100 mg/dose (capped) 37kg -> 100 mg/dose (capped) 38kg -> 100 mg/dose (capped) 39kg -> 100 mg/dose (capped) 40kg -> 100 mg/dose (capped) 41kg -> 100 mg/dose (capped) 42kg -> 100 mg/dose (capped) 43kg -> 100 mg/dose (capped) 44kg -> 100 mg/dose (capped) 45kg -> 100 mg/dose (capped) 46kg -> 100 mg/dose (capped) 47kg -> 100 mg/dose (capped) 48kg -> 100 mg/dose (capped) 49kg -> 100 mg/dose (capped) 50kg -> 100 mg/dose (capped) 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. Caution 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. Egypt SOLU-CORTEF 100MG/2ML VIAL EIPICO > PFIZER 16.00 EGP HYDROCORTISONE SODIUM SUCCINATE 100MG I.V./I.M.VIAL EIPICO 26.00 EGP Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)