Dear Ms. Thompson,

On occasion, patients attend hospital A & E departments or doctors' offices suffering form severe allergic reactions (anaphylaxis). This condition usually involves increasing upper airway obstruction and shock (inadequate circulation).

The intravenous antihistamines and corticosteroids usually administered are important but the intramuscular administration of epinephrine 1:1000 (adults: 0.3 to 0.5 ml, children: 0.2 to 0.4 ml) repeated as necessary at 15 to 20-minute intervals takes precedence.

This precedence refers to the rapid reduction of upper airway obstruction. This epinephrine, I understand, is not now being used on a regular basis in these patients. Clearly, other measures should be offered as necessary. The need for surgical tracheostomy (artificially produced airway) can usually be avoided with this regime.

Oral corticosteroids should be given to successfully treated patients for the next five days approximately to help prevent a delayed, recurrent attack of anaphylaxis.

Dr. A.W.W. Lawrence

Paediatrics and Allergy

Medical Associates Hospital

Kingston

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