You have just given a 10-year-old boy an injection of pollen extract as prescribed by his allergist. You are about to move on to the next patient when the boy starts to complain about nausea and a funny feeling in his chest. You note that his face is flushed and his voice sounds muffled and strained. Which of the following is the first priority in managing this episode of anaphylaxis?

Anaphylaxis is a medical emergency that must be recognized and managed promptly. The onset of symptoms is usually dramatic. In the case presented, the change in voice suggests impending airway compromise, making airway stabilization your top priority. The other choices are all important in managing anaphylaxis and, in reality, may be occurring concurrently; of those listed, subcutaneous epinephrine would be the first medication used. Additional treatment can include plasma expanders, diphenhydramine, and cimetidine, as indicated by the clinical course of the patient. Additional treatment such as administration of corticosteroids should be started early, but the effect will be delayed. Mortality from anaphylaxis occurs as a result of upper airway edema and asphyxiation, severe bronchial obstruction causing respiratory failure, or cardiovascular collapse.