{
  "schema_version": 1,
  "kind": "condition",
  "id": "anaphylaxis",
  "name": "Anaphylaxis (Emergency Management)",
  "category": "acute",
  "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",
  "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",
  "verified_date": "2026-08",
  "treatments": [
    {
      "id": 153,
      "generic": "Adrenaline",
      "line": 1,
      "is_adjunct": false,
      "form": "injection",
      "strength_mg": null,
      "adult_dose": "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.",
      "adult_duration": "Emergency dose, repeat at 5 min PRN",
      "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.",
      "rationale": "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."
      ],
      "peds_mgkg_low": null,
      "peds_mgkg_high": null,
      "peds_max_mg": null,
      "peds_basis": null,
      "peds_unit": null,
      "peds_note": "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).",
      "peds_min_weight_kg": null,
      "peds_max_weight_kg": null,
      "peds_age_min_months": null,
      "peds_age_max_months": null,
      "peds_age_bands": [
        {
          "label": "Under 6 months",
          "age_min_months": 0,
          "age_max_months": 5,
          "dose_text": "100 to 150 mcg (0.1 to 0.15 mL) intramuscularly into the anterolateral thigh"
        },
        {
          "label": "6 months to 5 years",
          "age_min_months": 6,
          "age_max_months": 71,
          "dose_text": "150 mcg (0.15 mL) intramuscularly into the anterolateral thigh"
        },
        {
          "label": "6 to 11 years",
          "age_min_months": 72,
          "age_max_months": 143,
          "dose_text": "300 mcg (0.3 mL) intramuscularly into the anterolateral thigh"
        },
        {
          "label": "12 years and over",
          "age_min_months": 144,
          "age_max_months": 216,
          "dose_text": "500 mcg (0.5 mL) intramuscularly into the anterolateral thigh"
        }
      ],
      "peds_doses": null,
      "brands": [
        {
          "trade_name": "EPINEPHRINE-MEMPHIS 1 MG/ML 5 I.M./S.C. AMP.",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "MEMPHIS",
          "price_egp": 10.0,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": 1.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "ADRENAMAX 1 MG/1ML 10 AMPS.",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "CHEMIPHARM",
          "price_egp": 75.0,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": 1.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "EPINEPHRINE-MISR 0.25 MG/ML 25 AMP.",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "MISR",
          "price_egp": 187.5,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": 0.25,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "EPINEPHRINE-MISR 1 MG/ML 100 AMP.",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "MISR",
          "price_egp": 750.0,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": 1.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "ADRENALINE-CID 1 MG/1ML 100 I.M./S.C. AMP.",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "CID",
          "price_egp": 850.0,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": 1.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        }
      ],
      "condition_id": "anaphylaxis"
    },
    {
      "id": 154,
      "generic": "Hydrocortisone",
      "line": 2,
      "is_adjunct": true,
      "form": "injection",
      "strength_mg": 100.0,
      "adult_dose": "200 mg IV as the initial dose",
      "adult_duration": "Single emergency dose",
      "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.",
      "rationale": "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."
      ],
      "peds_mgkg_low": 4.0,
      "peds_mgkg_high": 4.0,
      "peds_max_mg": 100.0,
      "peds_basis": "dose",
      "peds_unit": "mg",
      "peds_note": "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.",
      "peds_min_weight_kg": null,
      "peds_max_weight_kg": null,
      "peds_age_min_months": null,
      "peds_age_max_months": null,
      "peds_age_bands": [
        {
          "label": "1 month to 11 years",
          "age_min_months": 1,
          "age_max_months": 143,
          "dose_text": "4 mg/kg IV, maximum 100 mg"
        },
        {
          "label": "12 years and over",
          "age_min_months": 144,
          "age_max_months": 216,
          "dose_text": "100 to 200 mg IV, as for an adult"
        }
      ],
      "peds_doses": [
        {
          "weight_kg": 10,
          "low_mg": 40,
          "high_mg": 40,
          "capped": false
        },
        {
          "weight_kg": 20,
          "low_mg": 80,
          "high_mg": 80,
          "capped": false
        },
        {
          "weight_kg": 30,
          "low_mg": 100,
          "high_mg": 100,
          "capped": true
        },
        {
          "weight_kg": 40,
          "low_mg": 100,
          "high_mg": 100,
          "capped": true
        }
      ],
      "brands": [
        {
          "trade_name": "SOLU-CORTEF 100MG/2ML VIAL",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "EIPICO > PFIZER",
          "price_egp": 16.0,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": 100.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "HYDROCORTISONE SODIUM SUCCINATE 100MG I.V./I.M.VIAL",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "EIPICO",
          "price_egp": 26.0,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": 100.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        }
      ],
      "condition_id": "anaphylaxis"
    }
  ]
}