Question is regarding dexamethasone in anaphylaxis. 
 
Scenario of a 50s M stung by a bee, known anaphylaxis reactions in past, no epi pen called EMS. Pt had angioedema, hives, and signs of bronchoconstriction. Pt treated with epi, followed by benadryl and some salbutamol for his bronchoconstriction. Pt has a history of asthma. Causative factor of bronchoconstriction likely being from anaphylaxic reaction to the bee sting, which the bronchoconstriction quickly resolved with epi, benadryl and salbutamol. Could this pt benefit from dexamethasone? Is this part of the expectation if you have anaphylaxis and the pt also has bronchostriction, with indications as described in protocol, that we should follow the protocol including dexamethasone? 
 
And while I'm on the topic, thoughts on dexamethasone in anaphylaxis in general, often steroids are given in hospital, could dexamethasone be beneficial? 

Dexamethasone in the setting of anaphylaxis is not recommended. A different type of steroid may be considered in hospital. However, that should be up to the discretion of the treating physician. There has been some recent evidence suggesting that administration of steroids in anaphylaxis may be associated with poorer outcomes. This has not directly been studied. It has caused some practitioners to question utilizing steroids in the setting of anaphylaxis. 

Bronchoconstriction from anaphylaxis (even if there is a mixed picture with asthma history) is best treated with epinephrine. In the setting of anaphylaxis and bronchoconstriction, SWORBHP Medical Council would not suggest administering dexamethasone. 

Airway/Breathing,Bronchoconstriction,Moderate to Severe Allergic Reaction

allergy, Anaphylaxis, Bronchoconstriction, Dexamethasone, Rebound anaphylaxis, Steroids

Dodd A, Hughes A, Sargant N, Whyte AF, Soar J, Turner PJ. Evidence update for the treatment of anaphylaxis. Resuscitation. 2021 Apr 23;163:86-96. doi: 10.1016/j.resuscitation.2021.04.010. Epub ahead of print. PMID: 33895231; PMCID: PMC8139870.