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Anaphylaxis — CCFP MCQ

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HardEmergency presentations in communityAnaphylaxisCCFP

A 10-year-old develops wheeze, lip swelling, and generalized urticaria 10 minutes after eating a cookie containing peanuts. Blood pressure is 88/54 mmHg, oxygen saturation 93%, and the child is anxious. What is the most appropriate next step in management?

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Correct answer: E — Give intramuscular epinephrine immediately and activate emergency response

The answer is **C**. This child has anaphylaxis with hemodynamic compromise (hypotension). Intramuscular epinephrine is the only intervention that rapidly reverses airway edema and shock by restoring vasoconstriction and cardiac contractility. It must be given immediately without delay. Current Canadian evidence explicitly states that antihistamines and corticosteroids should not delay epinephrine administration. Salbutamol alone is inadequate for a hypotensive patient. Prednisone and allergy testing have no role in acute management. Simultaneous activation of emergency response ensures the child receives transport, continuous monitoring, IV access, and further therapy if refractory to the first dose.

Reference: CMAJ 2025;197(38):E1270. 'Management of anaphylaxis.' Jeimy S, et al. https://www.cmaj.ca/content/197/38/E1270