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Anaphylaxis — ABIM Board MCQ

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HardRheumatology/Allergy/ImmunologyAnaphylaxisABIM Board

A 58-year-old man taking carvedilol for cardiomyopathy develops anaphylaxis after a wasp sting. He receives two correctly administered intramuscular epinephrine doses, oxygen, and rapid isotonic fluid but remains hypotensive and bronchospastic. An epinephrine infusion is being prepared. Which adjunct is most appropriate for beta-blocker-associated refractory anaphylaxis?

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Correct answer: C — Give intravenous glucagon with cardiac and glucose monitoring

The best answer is “Give intravenous glucagon with cardiac and glucose monitoring”. Glucagon increases intracellular cyclic AMP independently of beta-adrenergic receptors and can improve refractory hypotension or bronchospasm in beta-blocked patients. It is an adjunct, not a replacement for continued epinephrine, fluids, airway management, and vasopressor support. Nausea, vomiting, hyperglycemia, and hemodynamic effects require monitoring.

Reference: 2023 Anaphylaxis Practice Parameter Update: https://www.aaaai.org/Aaaai/media/Media-Library-PDFs/Allergist%20Resources/Statements%20and%20Practice%20Parameters/Anaphylaxis-Practice-Paramaters-2023.pdf