Emergency anaphylaxis care guidelines: Epinephrine early and often

By Rob Goodier

Epinephrine should be the first line of treatment for anaphylaxis and patients should take it home to treat future attacks, according to new guidelines from a joint task force representing three allergy treatment organizations.

"Epinephrine is a safe and effective medication and should be administered early to prevent progression of the symptoms and to decrease the risk of fatal anaphylaxis," Dr. Ronna Campbell, an emergency physician at Mayo Clinic in Rochester, Minnesota, and lead author of the guidelines, told Reuters Health by email.

The guidelines were published online December 2 in the Annals of Allergy, Asthma and Immunology. Members of the task force included representatives from the American Academy of Allergy, Asthma and Immunology; the American College of Allergy, Asthma and Immunology; and the Joint Council of Allergy, Asthma and Immunology.

"It is imperative that emergency physicians educate patients on the risk of future anaphylactic reactions and help to mitigate these risks by ensuring that patients are prescribed self-injectable epinephrine and know how to administer it," Dr. Campbell said.

The guidelines drive home the point that epinephrine is essential, and there is no firm contraindication for its use in anaphylaxis. It is also important to recognize that anaphylaxis can quickly explode from mild to severe involving more than one organ system, according to the new report.

Among the recommendations, diagnosis of anaphylaxis should be based on history and an examination, but its presentation varies broadly and diagnosis should not rely on signs of shock alone.

Epinephrine should be administered immediately after diagnosis, the task force says, and oxygen should be given as needed; neither antihistamines nor corticosteroids should be used instead of epinephrine.

After treatment, the guidelines recommend measuring serum tryptase to help rule out other conditions that might be causing the symptoms. In case there is no response to epinephrine injections, intravenous epinephrine should be given and the patient should be monitored.

At discharge, the patient should be referred to an allergist-immunologist and given injectable epinephrine for use at home.

"Ongoing collaborations between emergency physicians and allergists will continue to enhance the care of patients suffering from severe allergies," Dr. Campbell said.

SOURCE: http://bit.ly/1zTYMXh

Ann Allergy Asthma Immunol 2014.

(c) Copyright Thomson Reuters 2014. Click For Restrictions - http://about.reuters.com/fulllegal.asp