Managing anaphylaxis in dental practice

Anaphylaxis is a severe, immediate-type, generalised hypersensitivity reaction affecting multiple organ systems—it has a rapid onset and can be fatal. Anaphylaxis is characterised at its most severe by bronchospasm, upper airway obstruction and hypotension. Severe gastrointestinal symptoms may also occur.

Anaphylaxis can occur within minutes of parenteral or mucosal exposure to a drug, and approximately 30 minutes to hours after drug ingestion.

Instruct patients with a history of anaphylaxis to bring their adrenaline (epinephrine) autoinjector when attending for dental treatment.

In dental practice, follow the advice in Management of anaphylaxis in dental practice for first-aid management of patients with anaphylaxis.
Figure 1. Management of anaphylaxis in dental practice.

[NB1]

If anaphylaxis occurs:

  • Stop dental treatment.
  • Remove or stop administration of the allergen.
  • Lie the patient flat.
  • Give an intramuscular injection of adrenaline (epinephrine):

1 adrenaline (epinephrine) intramuscularly, via preloaded autoinjector, into the anterolateral thigh [NB2]

adult or child more than 20 kg: 300 micrograms

child 10 to 20 kg: 150 micrograms

OR

2 adrenaline (epinephrine) (adult and child) 10 micrograms/kg up to 500 micrograms (0.5 mL of 1:1000 solution) intramuscularly, into the anterolateral thigh.

  • Call 000—the patient must be taken to an emergency department.
  • Start supplemental oxygen and airway support if needed.
  • Be prepared to start CPR (for ‘Basic life support flow chart’, see Basic life support flow chart).
  • Repeat adrenaline (epinephrine) every 5 minutes until the patient responds, or assistance arrives.

Follow up:

  • Update records with details about the suspected allergen and the patient’s response.
  • Request a copy of the medical report of the allergic reaction.
Note:

CPR = cardiopulmonary resuscitation

NB1: A widely available and more detailed wall chart on the recognition and initial emergency management of anaphylactic reactions is available from Australian Prescriber here.

NB2: Preloaded autoinjectors contain 300 micrograms in 0.3 mL (for use in an adult or child more than 20 kg) and 150 micrograms in 0.3 mL (for use in a child 10 to 20 kg).