> For the complete documentation index, see [llms.txt](https://handbook.teddwa.xyz/llms.txt). Markdown versions of documentation pages are available by appending `.md` to page URLs; this page is available as [Markdown](https://handbook.teddwa.xyz/airway-problems/airway-swelling-and-anaphylaxis.md).

# Airway swelling and anaphylaxis

Recognize progressive swelling, give epinephrine, and prepare for airway failure.

### Identify anaphylaxis

Suspect anaphylaxis after a likely exposure with airway swelling, hoarseness, stridor, wheeze, widespread hives, flushing, vomiting, hypotension, or collapse.

Look for tongue, lip, face, or neck swelling. Ask about known allergens, previous reactions, and the time of exposure.

### Immediate actions

1. Remove or stop the trigger when safe.
2. Position the patient for breathing comfort. Keep a hypotensive patient supine when tolerated.
3. Apply high concentration oxygen and continuous oxygen saturation monitoring.
4. Give intramuscular epinephrine promptly for suspected anaphylaxis.

Do not delay epinephrine for antihistamines, steroids, or IV access.

### ALS treatment

Establish IV or IO access. Give isotonic crystalloid for hypotension or poor perfusion.

Use nebulized albuterol for bronchospasm. Give an H1 antihistamine for hives or itching after epinephrine. Consider corticosteroids for persistent symptoms.

Prepare early for advanced airway management when there is progressive stridor, voice change, tongue swelling, severe work of breathing, or deteriorating consciousness.

### Transport

All patients treated with epinephrine need emergency evaluation. Continuously reassess airway patency, breath sounds, blood pressure, oxygen saturation, mental status, and response to treatment.


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