1. Purpose & Scope

This protocol outlines the recognition and management of anaphylaxis and severe allergic reactions following dermal filler, botulinum toxin, skin care products, or any in-clinic exposure. It applies to all staff and covers immediate emergency response, escalation, and aftercare.

2. Governance & References

This protocol aligns with Ahpra Guidelines for Non-Surgical Cosmetic Procedures (2025), ASCIA Anaphylaxis Guidelines (2022), and Australian Resuscitation Council Guidelines. All staff must complete annual CPR & anaphylaxis training.

3. Recognition of Allergic Reactions

Mild–moderate reaction:

• Localised skin: hives, flushing, angioedema.
• GI symptoms: abdominal pain, nausea.

Anaphylaxis (life-threatening):

• Sudden onset, rapid progression.
• Skin: widespread urticaria, angioedema, flushing.
• Respiratory: wheeze, stridor, dyspnoea.
• Cardiovascular: hypotension, collapse, syncope.
• GI: persistent severe abdominal pain, vomiting.

Always treat if in doubt as anaphylaxis.

4. Immediate Management of Anaphylaxis

Step 1 – Call for help:

• Activate clinic emergency response.
• Call 000 (ambulance) immediately.

Step 2 – Position patient:

• Lay flat; elevate legs if tolerated.
• If breathing difficulty: allow sitting with legs extended.
• Do not suddenly stand.

Step 3 – Adrenaline (first-line, no delay):

• Adrenaline 1:1000 (1 mg/mL) IM injection
  • Adults: 0.5 mL IM (500 micrograms) into mid-lateral thigh.
  • Repeat every 5 minutes if no improvement.
• EpiPen® 0.3 mg autoinjector may be used if available.

Step 4 – Supportive therapy:

• High-flow oxygen if available.
• Airway support (basic airway manoeuvres).
• IV access: give normal saline for hypotension.
• Nebulised salbutamol for persistent wheeze.

Step 5 – Adjunct medications (only after adrenaline given):

• Antihistamine (oral/IV): e.g., cetirizine or promethazine.
• Corticosteroid: e.g., dexamethasone or prednisolone.

Step 6 – Monitor:

• Vital signs every 5 min.
• Prepare for CPR if deterioration.

5. Post-Emergency Care

• Transfer to hospital emergency department for observation (minimum 4–6 hrs; 24 hrs if severe or biphasic).
• Provide incident summary to paramedics.
• Document reaction, suspected agent, lot number, timeline, treatments given.
• Notify TGA if reaction linked to cosmetic medicine product.
• Schedule follow-up for patient debrief and allergy referral.

6. Clinic Readiness

Anaphylaxis Kit:

• Adrenaline 1:1000 ampoules + syringes/needles.
• EpiPen® autoinjectors (expiry checked monthly).
• Oxygen + mask.
• Salbutamol puffer + spacer.
• Antihistamine tablets.
• Corticosteroid tablets.
• BP cuff, stethoscope, pulse oximeter.
• Emergency protocol wall chart (ASCIA).

Staff training:

• Annual CPR & anaphylaxis update.
• Quarterly simulation drills.

7. Documentation

• Emergency event form: onset, symptoms, agent, interventions, response, outcome.
• Record in patient notes with photos if applicable.
• File incident report for audit and Ahpra compliance.

References

1. ASCIA 2022, Acute management of anaphylaxis guidelines, Australasian Society of Clinical Immunology and Allergy, viewed 3 Oct 2025
2. Ahpra 2025, Guidelines for non-surgical cosmetic procedures, Australian Health Practitioner Regulation Agency, viewed 3 Oct 2025
3. Australian Resuscitation Council (ARC) 2023, Guideline 9.2.7 – Anaphylaxis, viewed 3 Oct 2025
4. Therapeutic Goods Administration (TGA) 2024, Reporting adverse events involving medicines and vaccines, viewed 3 Oct 2025