Anaphylaxis management for GPs: recognition, adrenaline first, devices, and follow-up
An allergy and immunology specialist walks through clinical diagnosis, Australian epidemiology, why posture and early IM adrenaline matter, and what is new with intranasal adrenaline — with ASCIA action plans and specialist referral in the follow-up pack.
- Allergy / immunology specialist — private practice + academic appointments
- Combines private clinical work with research and training. Regular examiner roles (policy/exam positions as introduced) and academic appointments at Griffith University and the University of Queensland. Otter did not clearly capture the surname — this summary does not invent a name and attributes the talk by specialty and appointments only.
GP-facing summary of one Gold Coast CPD seminar on Saturday 30 May 2026 (Otter title: “Anaphylaxis Management Seminar”; otter id 3nf1OFvsgnmcJ8kQOSGSQR93PeQ). About 18 minutes (~1102 s). It is not personal medical advice and not a substitute for ASCIA action plans, product information, TGA/PBS rules, or the patient in front of you.
Otter.ai garbles many clinical terms (anaphylaxis, hypotension, urticaria, EpiPen/Anapen, alpha-gal, biphasic). Where the recording is unclear, this write-up cleans the clinical term rather than inventing doses, mortality rates, or guideline claims the speaker did not make.
Clinical definition and age patterns
The working definition used in the seminar: anaphylaxis is an acute-onset, life-threatening allergic reaction that causes cardiovascular and/or respiratory compromise. It is a clinical diagnosis — recognise it promptly and treat; you do not need a laboratory test in the acute moment.
Gastrointestinal features can count toward the diagnosis in selected contexts, especially insect venom and alpha-gal syndrome (mammalian red-meat allergy after multiple tick bites). Examples from the talk: after a bee sting, abdominal pain, vomiting and fainting is anaphylaxis; after a steak in someone with alpha-gal, vomiting, fainting and collapse with prominent GI symptoms can likewise be anaphylactic.
A brief historical aside in the talk: the term anaphylaxis (“against protection”) came from early 1900s animal work on immunisation/envenomation where repeated antigen exposure caused swelling and collapse rather than immunity — clinicians later recognised the same clinical picture in people.
Triggers and timing
Main trigger groups highlighted:
- Food — commonest presentations, especially in children; nuts carry higher risk among foods
- Drugs — antibiotics, anaesthetics, NSAIDs prominent in adults
- Insect stings — bees/wasps; under-recognised fatal burden in young adult males
- Food-dependent exercise-induced anaphylaxis (FDEIA) — needs both food and exercise; one alone may not reproduce the reaction
- Immunisations and rarer causes (exercise-induced, latex, radiocontrast) as framed
Most patients present within about 30 minutes to 2 hours of allergen exposure. Onset can be faster with food or insect sting; with exercise-related syndromes features may appear later.
The multisystem myth
Updated thinking in the talk: the old idea that you must have three or more systems involved before calling it anaphylaxis is not correct. A child who has eaten a food and has urticaria plus wheeze has anaphylaxis and needs treatment. Acute respiratory distress, stridor and hoarse voice are common in children; cardiovascular collapse more so in adults; abdominal features as discussed for insect and alpha-gal.
Australian epidemiology
Lifetime prevalence of anaphylaxis in Australia was framed as up to about 2%. Presentations are rising with population growth, but overall rates appear relatively stable. Deaths remain uncommon: ABS figures cited for 1997–2013 recorded about 304 deaths (~20 per year historically). Many deaths were coded as unspecified or comorbidities made the algorithm unclear.
| Pattern (from the talk) | What GPs should notice |
|---|---|
| Food admissions | Very high in infancy (new foods); second peak in early teens (peers, alcohol, nuts, not carrying the pen) |
| Food vs mortality | Food is common in presentations but accounted for a smaller share of deaths (~6% as framed); children often do better once triggers are identified |
| Drug allergy | Admissions and mortality climb with age; antibiotics, anaesthetics, NSAIDs key; drugs also ~6% of deaths as framed but under-recognised in community pharmacy settings |
| Insect stings | ~20% of deaths; young adult males who “wing it” without carrying adrenaline are particularly underserved |
Fatal risk factors and posture
Patients who need extra caution: severe underlying allergy with ongoing exposure; older age; asthma and cardiovascular disease; delayed or omitted adrenaline; and upright posture after a reaction.
About 20% of out-of-hospital deaths in Australia (as framed) occurred when people changed to a more upright posture after a reaction — they felt better, sat up, stood, walked, then collapsed and were hard to salvage. Prefer lie flat. Sitting may be needed if breathing is the dominant problem, but otherwise keep them flat even when they feel better. This is part of ASCIA action-plan teaching.
Food-fatality summaries in the talk: children often with nuts, incomplete device carriage, and poorly controlled asthma; adults more shellfish, non-carriage of devices, and cardiovascular disease. Delayed adrenaline is associated with fatality, biphasic reactions, more hospital admissions, repeat adrenaline, and abnormal vitals.
Acute management: flat → adrenaline → help
- Lie the person flat (or sit if breathing is the limiting problem)
- Give intramuscular adrenaline promptly
- Call for help
- Repeat adrenaline in about five minutes if needed — partial response is a reason to redose
Devices: pens and intranasal adrenaline
Familiar IM auto-injectors discussed: EpiPen (e.g. 150 / 300 microgram strengths as framed) and Anapen (including higher adult strengths; some stock issues noted for particular strengths in the talk). Teach patients the simple sequence: place, hold, push — and print ASCIA how-to sheets.
Intranasal adrenaline (TGA-approved update)
Intranasal adrenaline is TGA-approved and available in Australia — a nasal spray cartridge, framed as repurposing technology familiar from naloxone nasal sprays. Doses discussed: about 1 mg or 2 mg. Suitable for adults and children aged 4 and older weighing more than 15 kg. Cost mentioned around $194 (PBS status not yet expected to cover it immediately as framed). Longer shelf life than pens was highlighted as a practical advantage for shared decision-making.
Pharmacokinetic data were described as strong; oral-challenge experience suggested rapid symptom resolution (median framed around minutes). Consider for patients who will not carry pens, needle anxiety, or who want an alternative — still a shared decision. For patients never previously prescribed adrenaline, first-time prescribing should be in consultation with a specialist. Switching already-prescribed patients after education is framed as something GPs can do after discussion.
Monitoring, prescribing, education, referral
- Hospital monitoring after anaphylaxis — biphasic reactions in up to about 20%; comorbidities worsen biphasic outcomes
- Prescribe an adrenaline device plus an ASCIA action plan (drug-allergy-only contexts may differ for device need as noted)
- PBS initial device may need authority / specialist risk assessment; ongoing scripts and Anapen options discussed as available to GPs
- Educate on allergen avoidance, device use, posture, and carriage — especially young men with venom allergy
- Refer to identify cause, review plans, consider venom immunotherapy, drug-allergy workup, and food challenges when the picture is unclear
Take-home messages
- Anaphylaxis is a clinical diagnosis — respiratory and/or cardiovascular compromise; GI counts in insect and alpha-gal contexts
- You do not need three systems; food + urticaria + wheeze in a child is enough
- Children → respiratory; adults → cardiovascular; food in infancy/teens; drugs with age; insect ~20% of deaths in underserved young men
- Lie flat → IM adrenaline → call help → repeat in 5 minutes; antihistamines/steroids never instead of adrenaline
- Watch posture after treatment — upright change linked to ~20% of out-of-hospital deaths
- Prescribe device + ASCIA plan; consider intranasal adrenaline with shared decision; specialist input for first-time prescribing; refer for immunotherapy and workup
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