ANAPHYLAXIS GUIDELINE FROM AAAAI/ACAAI
Campbell RL, Li JT, Nicklas RA, Sadosty AT. Emergency department diagnosis and treatment of anaphylaxis: a practice parameter. Ann Allergy Asthma Immunol. 2014;113(6):599-608. doi: 10.1016/j.anai.2014.10.007.
The American Academy of Allergy, Asthma & Immunology and the American College of Allergy, Asthma, and Immunology guideline for emergency department diagnosis and treatment of anaphylaxis includes the following recommendations
• Carefully and immediately triage and monitor patients who have signs and symptoms of anaphylaxis in preparation for epinephrine administration.
• First-line treatment for patients experiencing anaphylaxis is epinephrine. It should be administered intramuscularly in the anterolateral thigh immediately after the diagnosis is made. Epinephrine can be administered every 5 to 15 minutes as needed to control symptoms.
• Do not substitute for epinephrine in the treatment of anaphylaxis. Antihistamines and corticosteroids can be administered in conjunction with epinephrine, not in place of it.
• Determine whether the patient has risk factors for severe and potentially fatal anaphylaxis, such as delayed administration of epinephrine, asthma, a history of biphasic reactions, or cardiovascular disease.
• For anaphylaxis patients with bronchospasms, administer a β-agonist.
• Patients should be observed for 4 to 8 hours (longer for those with a history of risk factors for severe anaphylaxis).
• Refer patients to an allergist–immunologist upon discharge.
COMMENTARY
Identification of anaphylaxis requires judgment. Abbreviated criteria for anaphylaxis include essentially two organ systems of involvement: skin manifestations of pruritus, flushing, hives, or angioedema; respiratory manifestations of wheezing or stridor; decreased blood pressure; and GI symptoms of vomiting, cramping abdominal pain, or diarrhea. Quick identification and treatment of anaphylaxis is important, as the median time to respiratory or cardiac arrest in food-induced anaphylaxis is only 30 minutes. All offices should stock epinephrine in an obvious place; you may consider use of a prefilled pen, so it is easy to find and to give the correct dose. —NS
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