Glucagon for Refractory Anaphylaxis

Parthvi, Rukma

doi:10.1097/00045391-900000000-98512

Cited by 4 publications

(4 citation statements)

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“…20,26,35,95,110 For patients on β blockers, a few case reports have suggested that glucagon may be beneficial in refractory anaphylaxis. 111,112 Recommendations: Epinephrine may be given every 5 to 15 min IM to treat refractory anaphylaxis, along with the secondary treatments of antihistamines and corticosteroids, as well as inhaled β agonists for patients with bronchospasm (1C). For hypotension after epinephrine administration, IV crystalloids may be given with additional doses of IM epinephrine (1C).…”

Section: Refractory Anaphylaxismentioning

confidence: 99%

Wilderness Medical Society Clinical Practice Guidelines on Anaphylaxis

Gaudio

Johnson²,

DiLorenzo

et al. 2022

Wilderness & Environmental Medicine

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The Wilderness Medical Society convened a panel to review the literature and develop evidence-based clinical practice guidelines on the treatment of anaphylaxis, with an emphasis on a field-based perspective. The review also included literature regarding the definition, epidemiology, clinical manifestations, and prevention of anaphylaxis. The increasing prevalence of food allergies in the United States raises concern for a corresponding rise in the incidence of anaphylaxis. Intramuscular epinephrine is the primary treatment for anaphylaxis and should be administered before adjunctive treatments such as antihistamines, corticosteroids, and inhaled β agonists. For outdoor schools and organizations, selecting a method to administer epinephrine in the field is based on considerations of cost, safety, and first responder training, as well as federal guidelines and state-specific laws.

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Section: Refractory Anaphylaxismentioning

confidence: 99%

Wilderness Medical Society Clinical Practice Guidelines on Anaphylaxis

Gaudio

Johnson²,

DiLorenzo

et al. 2022

Wilderness & Environmental Medicine

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“…We found that in contrast to previous studies on different allergic diseases, lower NLRs, not higher NLRs, were associated with refractory anaphylaxis refractory to treatment, even after adjusting for possible covariates. Our findings are valuable because refractory anaphylaxis may require additional treatment measures other than epinephrine, such as vasopressors [12], methylene blue [13], or glucagon [14], and early recognition of refractory anaphylaxis may help emergency physicians to make decisions on additional medications F I G U R E 1. Flow chart of the study design.…”

Section: Discussionmentioning

confidence: 98%

The association between neutrophil-to-lymphocyte ratio and anaphylaxis refractory to epinephrine treatment

2021

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Objectives: Anaphylaxis refractory to epinephrine treatment is a potentially fatal condition requiring additional medications. Neutrophil-to lymphocyte ratio (NLR) is commonly used to predict severity in allergic diseases. The aim of this study was to determine the association between NLR and refractory anaphylaxis. Methods: This was a retrospective, observational study of 126 adult anaphylaxis patients arriving at the emergency department between January 2015 and December 2019. Patients were placed into refractory anaphylaxis, if they required more than two 0.3 mg injections of intramuscular epinephrine for symptom resolution, and non-refractory anaphylaxis groups. NLRs were determined at the time of arrival at the hospital and were compared between groups. Results: Thirty-two (25.4%) patients were categorized as refractory anaphylaxis cases. NLR was significantly lower in the refractory anaphylaxis than in the non-refractory anaphylaxis group (P < 0.001). In the multivariate logistic regression analysis model, NLR was inversely associated with the occurrence of refractory anaphylaxis (adjusted odds ratio 0.33, 95% confidence interval 0.13-0.81, P = 0.016). The area under the receiver operating characteristic curve of NLR for prediction of refractory anaphylaxis was 0.717 (P < 0.001). The optimal cut-off value of NLR was < 0.68 using the Youden index, with 50.0% sensitivity and 80.9% specificity. Conclusions: NLR was independently and inversely associated with the occurrence of refractory anaphylaxis among anaphylactic patients. Therefore, NLR has the potential to be used as an easy and inexpensive test to predict refractory anaphylaxis in patients.

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“…The therapeutic effect of adrenaline may be blunted by ß-blockers. In this situation, if adrenaline is not effective, glucagon can be administered intravenously, as it has a mechanism of action independent of the ß-receptors [45,46]…”

Section: Other Treatmentsmentioning

confidence: 99%

Anaphylaxis in elderly people

Ventura

Boni²,

Taborda-Barata

et al. 2022

Current Opinion in Allergy &Amp; Clinical Immunology

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Purpose of reviewAnaphylaxis is common in old-age adults but is insufficiently understood by physicians, and may be underdiagnosed. This review discusses the specificities of anaphylaxis in this age group and stresses the importance of adrenaline in its management.Recent findingsData from the European Anaphylaxis Registry on elderly patients is a major finding. Other findings include the prevention of possible anaphylactic reactions in coronavirus disease 2019 vaccination as well as some new epidemiologic data.SummaryThe most common risk factors are hymenoptera venom and food and drug allergy. Cardiovascular symptoms are the most important ones to reverse in old-age adults, especially due to the multiple comorbidities. Anaphylaxis in old-age adults has a more severe outcome than in younger ones. Polypharmacy is a specific factor to be considered. The Airway, Breathing, Circulation, Disability, Exposure (ABCDE) algorithm is applicable in all clinical emergencies for immediate assessment and treatment, and should be considered for all patients. Adrenaline is the mainstay of the management of the condition. There are no absolute contraindications to the prescription of self-injectable adrenaline in elderly individuals at risk of anaphylaxis.

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Glucagon for Refractory Anaphylaxis

Cited by 4 publications

References 0 publications

Wilderness Medical Society Clinical Practice Guidelines on Anaphylaxis

Wilderness Medical Society Clinical Practice Guidelines on Anaphylaxis

The association between neutrophil-to-lymphocyte ratio and anaphylaxis refractory to epinephrine treatment

Anaphylaxis in elderly people

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