This is an allergic reaction to drugs, food, stings, etc., in a sensitized individual.

Clinical Features

  • Extensive skin rash
  • Pruritus
  • Urticaria
  • Respiratory distress that may be accompanied by a wheeze or a stridor (due to laryngeal oedema or bronchospasm)
  • Hypotension.


Parents and care givers are advised to take health care facility as soon as possible any child with extensive skin rash or difficulty in breathing.

Follow the ABC of resuscitation. In addition do the following:

  • Adrenaline: give IM 0.01ml/kg of 1:1,000 solution; or 0.1ml/kg of 1:10,000 solution. Can be repeated every 15 minutes for 3 doses.
  • Aminophylline 5mg/kg IV over 20 minutes if there is wheezing.
  • Nebulized bronchodilators, e.g., salbutamol.
  • Antihistamine: Chlorpheniramine 0.1mg/kg IV slowly. Then continue IM/SC 8 hourly for 24–48 hours,
  • Hydrocortisone 4mg/kg IV is of secondary value but useful to prevent delayed recurrences.

Subsequent management:

  • Patients with mild to moderate reaction, e.g., urticaria or mild bronchospasm, should be observed for at least 6 hours because attacks may recur after full recovery.
  • Admit those with severe reactions e.g. poor circulation, severe bronchospasm.
  • Continue intravenous fluid replacement, and closely monitor pulse, BP and urinary output.
  • Avoid offending agents. Inform parent/child the cause of reaction so as to know and to avoid the offending agent in future.