Diagnosis and treatment of anaphylaxis: there is an urgent needs to implement the use of guidelines

Abstract

Anaphylaxis is a severe, life-threatening generalized or systemic hypersensitivity reaction that requires rapid and adequate care. This study aimed to obtain an integrated view of the level of physicians' knowledge related with treatment of anaphylaxis in studies published within the last 5 years. Sixteen studies were found and four points were identified as of the great interest to the authors: (1) emergency pharmacological treatment, (2) epinephrine auto-injectors prescription, (3) knowledge of the main signs of anaphylaxis, and (4) admission of the patient to verify biphasic reactions. Concern about the use of intramuscular adrenaline as the first choice in relation with anaphylaxis was evident in most studies, rather than its use in the comparison dial, and especially low in a study that included data from Brazil, in which the frequency of its use was 23.8%. An adrenaline autoinjector is highly recommended among specialists for patients at risk of anaphylaxis, however, its use is still infrequent among non-specialists and in countries that this agent is not available. Intervention studies have shown improved medical knowledge of anaphylaxis following disclosure of the information contained in the international guidelines. The analysis of these studies reinforces the need to disseminate international guidelines for diagnosis and treatment of anaphylaxis, as well as providing an adrenaline autoinjector, to improve management and to prevent a fatal outcome.

Chloropyramine and Ranitidine as a combination of H1 and H2- antihistamines in the additive therapy of anaphylaxis

“…There is little evidence to support the routine use of an H2-antihistamine (e.g.,ranitidine, cimetidine) for the initial treatment of an anaphylactic reaction [26]. Need to promote international guidelines on diagnosis and management of anaphylaxis among non-specialists as well as to provide adrenaline auto-injector in countries in which this device is not available in order to prevent fatal outcomes [33]. In the future, a multricentic, placebo-controlled study should be conducted among patients with anaphylaxis that was immediately assessed and treated with adrenalin, propper positioning, added oxigen and intravenous fluids before the treatment with the second line drugs such are H2-antihistamines or placebo [15].…”

Anaphylaxis following prick‐by‐prick testing with peanut

“…Adrenaline is the drug of choice in anaphylaxis treatment, and antihistamines, steroids, salbutamol, and other medications are additive treatments to be considered after adrenaline administration. A repeated challenge in the treatment of anaphylaxis is the late recognition of anaphylaxis and the low adherence to the guidelines concerning adrenaline administration, and the importance of having adrenaline available while testing cannot be stressed enough 11 …”

Anaphylaxis: knowledge among oral and maxillofacial surgeons

“…According to Muraro et al (2014), there are absolute indications for the prescription of self-injectable adrenaline, such as previous anaphylaxis with foods, exercise-induced anaphylaxis and idiopathic anaphylaxis. Ribeiro, et al (2017) report that the use of autoinjectors is high in the United States. The infrequent prescription and unawareness of selfinjectable adrenaline may be due to the non-availability in the domestic market of some countries and the cost of importation.…”