Table 6

Special consideration in acute and long term management of anaphylaxis12 28 52 54 62 63

GroupSpecial considerations
Infants

  • Unable to report symptoms

  • Some symptoms are physiological: flushing, spitting food after feeding, etc

  • Correct epinephrine dose should be calculated

ChildrenConsider developmental delay/behavioural problems
TeenagersRisk taking behaviour (non-compliance with prescribed treatment and avoidance due to denial or peer pressure)
Elderly

  • Consider comorbidities especially involving cardiovascular system

  • β-blockers and ACE inhibitors commonly used

  • Memory impairment precludes recognition of life threatening symptoms; physical impairment (severe rheumatoid arthritis, hearing/vision impairment) hinders epinephrine (auto-injector) administration

PregnancyMother's health is the priority; use epinephrine as in non-pregnant patient; position on left side to relieve inferior vena cava compression by gravid uterus; regular fetal monitoring; consider emergency caesarian section
All age groupsSubstance/alcohol abuse—interferes with avoidance measures; impairs recognition of life threatening symptoms and appropriate self management