Allergy, Anaphylaxis, and Adrenaline

Dental patients can react to medicines, latex, chlorhexidine, dental materials, food, or unknown triggers. Mild allergy typically causes rash, itching, rhinitis, conjunctivitis, or mild bronchospasm. Anaphylaxis is a life-threatening systemic reaction with airway, breathing, or circulation compromise.

Red flags for anaphylaxis

• Swelling of tongue, throat, lips, or voice change.
• Wheeze, stridor, shortness of breath, or respiratory distress.
• Collapse, faintness, pallor, clamminess, confusion, or weak pulse.
• Rapid progression after exposure to a possible trigger.
• Abdominal pain, vomiting, diarrhoea, or a sense of impending doom with other features.

RCUK guidance emphasises intramuscular adrenaline as the primary treatment for anaphylaxis. SDCEP dental emergency guidance recommends adrenaline 1:1000 intramuscular injection and oxygen, with a repeat adrenaline dose after 5 minutes if needed. Antihistamines are for mild allergy or later supportive care; they must not delay adrenaline in suspected anaphylaxis.

Adrenaline and dental nurse role

In suspected anaphylaxis, airway, breathing or circulation signs matter more than the skin. Adrenaline should not wait behind antihistamine.