🚨 Men's Health

Anaphylaxis — Emergency Management (Nigeria)

Severe, life-threatening allergic reaction — recognise it, give adrenaline, call for help

Anaphylaxis is a severe, potentially fatal allergic reaction that develops within minutes of exposure to a trigger. It is a medical emergency requiring immediate adrenaline (epinephrine) injection. In Nigeria, anaphylaxis is underrecognised and undertreated — many patients receive antihistamines and steroids but not the life-saving adrenaline. Common triggers in Nigeria include drugs (penicillin, NSAIDs), insect stings (bees, wasps), foods (groundnuts, shellfish), and contrast dyes used in radiology. Every doctor, nurse, and first aider must know how to recognise and treat anaphylaxis.

Signs and Symptoms

✓ Skin: urticaria (hives), flushing, angioedema (swelling of face, lips, tongue, throat)

✓ Respiratory: stridor, wheeze, hoarseness, difficulty breathing — DANGER SIGN

✓ Cardiovascular: rapid pulse, low blood pressure, dizziness, collapse

✓ Gastrointestinal: nausea, vomiting, abdominal cramps, diarrhoea

✓ Neurological: feeling of impending doom, confusion, loss of consciousness

✓ Anaphylaxis is present if: skin/mucosal changes PLUS respiratory difficulty OR hypotension

✓ Or: two or more systems involved rapidly after allergen exposure

Risk Factors

Previous anaphylaxis — the highest risk factor for future anaphylaxis
Asthma — significantly worsens respiratory anaphylaxis severity
Mastocytosis — a mast cell disorder
Beta-blocker use — impairs adrenaline response and masks early symptoms
ACE inhibitor use — increases risk of angioedema
Exercise-triggered anaphylaxis — food plus exercise combination
Delayed or inadequate access to adrenaline — increases fatality risk

When to Seek Help

Emergency — act within minutesAny suspected anaphylaxis — give adrenaline immediately, do not wait for all features to develop

EmergencyAngioedema of the tongue or throat with stridor — airway is compromised

Urgent — 6–12 hours observationAfter adrenaline is given — biphasic anaphylaxis (second wave) can occur up to 8 hours later

Routine follow-upAfter any anaphylaxis episode — allergy assessment, adrenaline auto-injector prescription, patient education

Refer to allergistVenom allergy — bee or wasp sting anaphylaxis — venom immunotherapy can prevent future reactions

Tests & Diagnosis

🧪 Serum mast cell tryptase

Taken within 1–4 hours of onset — elevated tryptase confirms mast cell activation (anaphylaxis). Useful for retrospective diagnosis. Not always available in Nigerian hospitals but awareness is increasing

🧪 Specific IgE testing

After the acute episode — identify the trigger allergen

🧪 Skin prick testing

4–6 weeks after anaphylaxis — to confirm and identify the trigger allergen

🧪 24-hour urinary methylhistamine

Alternative mast cell marker — less commonly used

Treatment Options

STEP 1 — Call for help, assess ABC

Shout for help. Assess airway, breathing, circulation. Note time of onset

STEP 2 — Give adrenaline (epinephrine) IMMEDIATELY

Adrenaline 0.5 mg IM (0.5 ml of 1:1000 adrenaline) into the outer thigh (through clothing if needed). In children: 0.15 mg if 15–30 kg, 0.3 mg if 30 kg+. This is the ONLY life-saving treatment. Give it first, before anything else

STEP 3 — Position the patient

If breathing: sit upright to ease breathing. If unconscious or shocked: lie flat with legs elevated. Pregnant women: tilt to left. DO NOT sit up suddenly if shocked — causes cardiac arrest

STEP 4 — Call emergency services / transfer to hospital

Anaphylaxis requires hospital assessment even if adrenaline resolves symptoms immediately — biphasic reaction risk

STEP 5 — Repeat adrenaline if no improvement in 5 minutes

Give second adrenaline dose. Adrenaline can be repeated every 5 minutes. Most patients respond to 1–2 doses

STEP 6 — Adjunct treatments (SECONDARY to adrenaline)

Oxygen (high flow). IV fluids for hypotension (500 ml–1L normal saline rapidly). IV chlorphenamine 10 mg (antihistamine). IV hydrocortisone 200 mg. Salbutamol nebuliser for bronchospasm. These are adjuncts — adrenaline remains first priority

DO NOT delay adrenaline to give antihistamine first

Antihistamines take 30–60 minutes to work and do not prevent airway closure or cardiovascular collapse. They are adjuncts, not primary treatment. Giving antihistamine instead of adrenaline costs lives

After the acute episode

Monitor for minimum 6–12 hours for biphasic reaction. Discharge with: 2 adrenaline auto-injectors, written anaphylaxis action plan, allergy referral, medic-alert bracelet consideration

Adrenaline auto-injectors in Nigeria

Epipen (0.3 mg) and Emerade (0.3 mg, 0.5 mg) — available at major Nigerian pharmacies and allergy clinics. Some hospitals stock 1:1000 adrenaline ampoules — staff should be trained to draw up and give IM doses

Frequently Asked Questions

What is the difference between a severe allergic reaction and anaphylaxis?

Anaphylaxis specifically involves multiple body systems (skin PLUS respiratory or cardiovascular) developing rapidly. A severe allergic reaction affecting only the skin (large hives, swelling) without breathing difficulty or low blood pressure is serious but not anaphylaxis. The treatment differs — anaphylaxis requires adrenaline, severe urticaria requires antihistamines and steroids.

Can antihistamines treat anaphylaxis?

No. Antihistamines are NOT the primary treatment for anaphylaxis. They take 30–60 minutes to work and cannot prevent airway closure or cardiovascular collapse. Adrenaline is the only effective immediate treatment. Antihistamines are given after adrenaline as an adjunct to treat hives and itch.

How do I use an adrenaline auto-injector?

1. Remove the blue safety cap. 2. Press the orange tip firmly against the outer thigh (through clothing). 3. Hold in place for 10 seconds. 4. Remove and massage the site for 10 seconds. 5. Call for emergency help and note the time. A second dose can be given 5–15 minutes later if needed. Store at room temperature — not refrigerated.

What if adrenaline is not available?

This is a real problem in Nigeria where adrenaline auto-injectors are not always accessible. 1:1000 adrenaline ampoules should be available in all Nigerian clinical settings. Hospitals should have written anaphylaxis protocols. In the absence of adrenaline, give oxygen, lay flat, IV fluids for shock, and transfer urgently. But every effort must be made to give adrenaline — it is the only life-saving treatment.