What is the recommended action for suspected anaphylaxis during flight?

• A. Monitor only
• B. Administer antihistamines and continue flight
• C. Rely on on-board oxygen without epinephrine
• D. Administer epinephrine, call for medical support, and monitor

Answer: (D)

Suspected anaphylaxis is a medical emergency that requires prompt administration of epinephrine as the first-line treatment, along with calling for medical support and continuous monitoring. Epinephrine reverses the life-threatening features of anaphylaxis—airway swelling, bronchospasm, and drop in blood pressure—so delaying it in favor of other measures can be fatal. Antihistamines and oxygen can help but do not rapidly counteract the airway and circulatory collapse, so they are not sufficient on their own. On a flight, the safest course is to give epinephrine if available, activate medical support, and monitor the patient closely, arranging for further care on landing. If an epinephrine auto-injector is available, use it according to age/weight guidelines and be prepared to repeat doses if symptoms persist.