In a suspected anaphylactic reaction, what is the sequence of immediate actions?

• A. Administer intramuscular epinephrine immediately; secure airway; call for emergency help; provide oxygen.
• B. Wait to see if symptoms worsen before giving epinephrine.
• C. Give oral antihistamines first.
• D. Provide oxygen only.

Answer: (A)

In a suspected anaphylactic reaction, the immediate priority is to administer epinephrine intramuscularly right away. Epinephrine tackles the life-threatening features of anaphylaxis by relaxing bronchial smooth muscle to relieve wheeze and bronchospasm, reducing airway swelling, and constricting blood vessels to raise blood pressure and improve organ perfusion. Because the reaction can deteriorate quickly, quickly calling for emergency help is essential and the patient should be monitored and, if needed, have airway support prepared. After epinephrine is given, securing or preparing to secure the airway is prudent because swelling can progress and compromise breathing. Oxygen should be provided if there is hypoxia or significant breathing difficulty, but it does not treat the underlying reaction on its own, so it accompanies the epinephrine rather than delaying it. Delaying epinephrine or choosing only antihistamines or oxygen without epinephrine fails to address the critical pathophysiology and increases risk of severe outcomes.