Is It Really Anaphylaxis?
Epinephrine should be administered for true anaphylaxis, but not for other sorts of distress such as panic attacks or hives without airway or circulation problems. If a patient is truly experiencing anaphylaxis, the following criteria should be present:
Sudden onset of symptoms that progress rapidly, usually over a period of no more than a few minutes
Life-threatening airway, breathing, or circulation problems (the acronym ABC can be used as a mnemonic)
Skin and/or mucus membrane symptoms, such as rash, hives (urticaria), flushing, swelling
Gastrointestinal symptoms such as cramping and vomiting may or may not be present in anaphylaxis. Exposure to a known allergen in the patient indicates a strong likelihood that a severe reaction really is anaphylaxis.
ABC symptoms alone are not enough to diagnose anaphylaxis. Epinephrine treatment is only appropriate if the other two criteria are present, indicating that anaphylaxis is the true cause of the problem. A confounding factor is that in both anaphylaxis and a panic attack, the patient may experience a sense of great anxiety or impending doom.