Epinephrine for First-aid Management of Anaphylaxis

Abstract

Anaphylaxis is a severe, generalized allergic or hypersensitivity reaction that is rapid in onset and may cause death. Epinephrine (adrenaline) can be life-saving when administered as rapidly as possible once anaphylaxis is recognized. This clinical report from the American Academy of Pediatrics is an update of the 2007 clinical report on this topic. It provides information to help clinicians identify patients at risk of anaphylaxis and new information about epinephrine and epinephrine autoinjectors (EAs). The report also highlights the importance of patient and family education about the recognition and management of anaphylaxis in the community. Key points emphasized include the following: (1) validated clinical criteria are available to facilitate prompt diagnosis of anaphylaxis; (2) prompt intramuscular epinephrine injection in the mid-outer thigh reduces hospitalizations, morbidity, and mortality; (3) prescribing EAs facilitates timely epinephrine injection in community settings for patients with a history of anaphylaxis and, if specifi c circumstances warrant, for some high-risk patients who have not previously experienced anaphylaxis; (4) prescribing epinephrine for infants and young children weighing <15 kg, especially those who weigh 7.5 kg and under, currently presents a dilemma, because the lowest dose available in EAs, 0.15 mg, is a high dose for many infants and some young children; (5) effective management of anaphylaxis in the community requires a comprehensive approach involving children, families, preschools, schools, camps, and sports organizations; and (6) prevention of anaphylaxis recurrences involves confi rmation of the trigger, discussion of specifi c allergen avoidance, allergen immunotherapy (eg, with stinging insect venom, if relevant), and a written, personalized anaphylaxis emergency action plan; and (7) the management of anaphylaxis also involves education of children and supervising adults about anaphylaxis recognition and fi rst-aid treatment.

Capturing anaphylaxis through medical records

“…26 Although no gold standard testing exists for anaphylaxis, tryptase, a major mast cell and basophil protease, released in serum after degranulation, is a highly specific biomarker of anaphylaxis. 27 In a recent study of 19,836 cases of drug-induced anaphylaxis, less than 0.8% had a tryptase level checked within 1 week of the anaphylactic event. 28 National guidelines 1,29 state that intramuscular epinephrine is the preferred acute treatment of anaphylaxis, and outpatient anaphylaxis management includes prescribing and obtaining an epinephrine autoinjector.…”

Anaphylaxis diagnosis and management in the Emergency Department of a tertiary hospital in the Philippines

“…In July 2005, the National Institute of Allergy and Infectious Disease and the Food Allergy and Anaphylaxis Network (NIAID/FAAN) created a universally accepted definition and criteria for diagnosis and guidelines on the management of anaphylaxis [1]. These clinical criteria for the diagnosis of anaphylaxis have been validated in ED studies in children, teenagers, and adults as having high sensitivity (96.7%), reasonable specificity (82.4%), and a high negative predictive value (98%) [1,4,5].…”

Advances in the approach to the patient with food allergy

“…Lastly, the Section on Allergy and Immunology of the American Academy of Pediatrics published 2 educational articles targeting pediatricians: one on epinephrine as first-aid management for anaphylaxis and the other focused on guidance for completing a written allergy and anaphylaxis emergency plan. 56,57 Addressing the psychological, behavioral, and educational components of food allergy management directly affects patients and families and establishes an evidence-based foundation for development of further innovative approaches.…”