Management of Anaphylaxis Refractory to Standard First Line Therapy

Anaphylaxis is a common yet often under-recognized and undertreated phenomenon. Experts have defined the term various ways but all agree that the standard of care is rapid treatment with epinephrine upon diagnosis of anaphylaxis. However, some cases of anaphylaxis are either partially or unresponsive to standard doses of epinephrine, a phenomenon referred to as refractory anaphylaxis. The epidemiology, risk factors, preventative measures, and treatments (both traditionally accepted second-line therapies and more controversial novel therapies) of refractory anaphylaxis are discussed in this chapter.