Position of patient in anaphylaxis with upper airway swelling or bronchospasm

Q: 44 years old patient went into anaphylaxis after receiving ciprofloxacin infusion. Patient developed upper airway swelling and bronchospasm. The next step should be to put the patient in the Trendelenburg position to counter hypotensive shock.

A) True

B) False

Answer: B

Although classic teaching in anaphylaxis is to keep the patient in a flat, semirecumbent position or even the Trendelenburg position to counteract the expected hypotension from anaphylaxis, if there is prominent upper airway swelling or bronchospasm, it is recommended to elevate the patient's head or even make the patient lean forward until the airway can be secured. This positioning helps minimize airway edema due to gravity.

Raising the legs instead of the Trendelenburg position is always preferred.

# anaphylaxis

#hemodynamic

#airway

Further readings:

1. Australasian Society of Clinical Immunology and Allergy guidelines on anaphylaxis -https://www.allergy.org.au/hp/papers/acute-management-of-anaphylaxis-guidelines (last accessed September 2, 2025)

2. Pumphrey RS. Fatal posture in anaphylactic shock. J Allergy Clin Immunol 2003; 112:451.

3. Geerts BF, van den Bergh L, Stijnen T, et al. Comprehensive review: is it better to use the Trendelenburg position or passive leg raising for the initial treatment of hypovolemia? J Clin Anesth 2012; 24:668.