Hydrocortisone anaphylaxis

Give hydrocortisone, 5 mg/kg or approximately 250 mg IV (prednisone 20 mg orally can be given in mild cases) to reduce the risk of recurring or protracted anaphylaxis. These doses can be repeated every 6 hours as required. 

It is usual to give a sedating antihistamine, for example chlorphenamine 10 mg by intramuscular or slow intravenous injection, because of the relatively short half-life of epinephrine (adrenaline), and because of the active role of histamine in anaphylaxis. In addition, the inflammatory reaction can be moderated by the administration of a corticosteroid, such as hydrocortisone 200 mg by intramuscular or slow intravenous injection. Corticosteroids may take several hours to act, but can be of some help in so-called biphasic anaphylactic reactions. 

A number of other agents may be required for the treatment of anaphylactic reactions. Corticosteroids (hydrocortisone sodium succinate intravenously) are recommended to reduce the risk of late-phase reactions. Aminophylline may be used as adjunctive therapy for bronchospasm. Histamine (Hi) receptor blockers (such as diphenhydramine) may be administered to reduce some of the symptoms associated with anaphylaxis however, these agents are not effective as primary therapy. 

An 8-month-old boy developed similar symptoms after two doses of the same brand of Shen ling bai zhu san. The skin lesion also included bullae, which was easily ruptured. He made a gradual recovery treatment with hydrocortisone, ceftriaxone, calamine lotion, a sedative, and medications for anaphylaxis. 

A 43-year-old woman was admitted to hospital with the sudden onset of tongue and periorbital swelling. She had commenced a course of oral flucloxacillin for cellulitis of the left hand. Regular medications included propranolol, lansoprazole, and fexofenadine. She had no known traditional risk factors for coronary artery disease. A diagnosis of anaphylaxis was made probably due to flucloxacillin. She was first treated with intravenous hydrocortisone and chlorphenamine. Despite this treatment, she became profoundly hypotensive. This prompted the intramuscular administration of 0.5mg adrenaline (0.5mL 1 1000 solution). There was inadequate clinical response to the first dose, and so, a second 0.5 mL dose was administered. This resulted in normalization of blood pressure... 

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