Managing Anaphylaxis Behind the Counter

Anaphylaxis is the emergency community pharmacy is most likely to encounter, particularly in stores offering vaccination services. It can develop within minutes, and the single factor most associated with a poor outcome is delayed adrenaline.

Recognising it

Anaphylaxis is any acute allergic reaction with signs of airway, breathing or circulation involvement. Watch for difficult or noisy breathing, swelling of the tongue or throat, a hoarse voice, wheeze or persistent cough, persistent dizziness or collapse, and pallor or floppiness in a young child. Hives and swelling are common but are not required for the diagnosis. Any of the serious signs above means treat it as anaphylaxis, even if the skin looks normal.

Give adrenaline immediately

Adrenaline is the first line treatment and there is no situation in suspected anaphylaxis where withholding it is safer than giving it. Administer the autoinjector into the outer mid thigh, through clothing if necessary, and hold it in place for the time specified by the device. Note the time you gave it.

Position matters more than people realise

Lay the person flat, or allow them to sit with legs extended if breathing is difficult. Do not stand them up or walk them anywhere, including to a treatment room or a car. Sudden movement to an upright posture in anaphylaxis has been associated with fatal deterioration. If they are pregnant, lay them on their left side. If they are unresponsive and breathing, place them in the recovery position.

Call 000 and prepare for a second dose

Call an ambulance every time, even if the person improves quickly, because a biphasic reaction can occur hours later. If there is no improvement after five minutes, give a further dose of adrenaline. Keep the used device to hand over to the paramedics.

Afterwards

The patient must be transported to hospital for observation. Document what was given and when, and review your store's own protocol and adrenaline stock afterwards so that the next response is faster.

Practise the physical sequence

Knowing the pharmacology is not the same as having handled a trainer device under pressure. Our Provide First Aid course covers anaphylaxis recognition and autoinjector technique alongside CPR and the rest of the syllabus. Find a session near you.