Glucagon for Refractory Anaphylaxis

Parthvi, Rukma

doi:10.1097/mjt.0000000000000910

Cited by 12 publications

(8 citation statements)

References 3 publications

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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%

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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%

“…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…”

Section: Treatmentmentioning

confidence: 99%

Wilderness Medical Society Clinical Practice Guidelines on Anaphylaxis

Gaudio

Johnson²,

DiLorenzo

et al. 2022

Wilderness & Environmental Medicine

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“…Evidence did not support recommendations among different vasopressors [( Gamper et al, 2016 )], so dopamine, norepinephrine and vasopressin can be titrated with careful monitor [( Lieberman et al, 2005 ; Soar et al, 2008 ; Lieberman et al, 2010 ; Simons et al, 2011 ; Campbell et al, 2014 ; Ring et al, 2014 ; Lieberman et al, 2015 )]. Glucagon is pathophysiologically rational for anaphylaxis patients taking β-blockers but only case reports are available to support this [( Thomas and Crawford, 2005 ; Rukma, 2019 )].…”

Section: Resultsmentioning

confidence: 99%

A Clinical Practice Guideline for the Emergency Management of Anaphylaxis (2020)

Yin

et al. 2022

Front. Pharmacol.

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Background: For anaphylaxis, a life-threatening allergic reaction, the incidence rate was presented to have increased from the beginning of the 21st century. Underdiagnosis and undertreatment of anaphylaxis are public health concerns.Objective: This guideline aimed to provide high-quality and evidence-based recommendations for the emergency management of anaphylaxis.Method: The panel of health professionals from fifteen medical areas selected twenty-five clinical questions and formulated the recommendations with the supervision of four methodologists. We collected evidence by conducting systematic literature retrieval and using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach.Results: This guideline made twenty-five recommendations that covered the diagnosis, preparation, emergency treatment, and post-emergency management of anaphylaxis. We recommended the use of a set of adapted diagnostic criteria from the American National Institute of Allergy and Infectious Diseases and the Food Allergy and Anaphylaxis Network (NIAID/FAAN), and developed a severity grading system that classified anaphylaxis into four grades. We recommended epinephrine as the first-line treatment, with specific doses and routes of administration for different severity of anaphylaxis or different conditions. Proper dosage is critical in the administration of epinephrine, and the monitor is important in the IV administration. Though there was only very low or low-quality evidence supported the use of glucocorticoids and H1 antagonists, we still weakly recommended them as second-line medications. We could not make a well-directed recommendation regarding premedication for preventing anaphylaxis since it is difficult to weigh the concerns and potential effects.Conclusion: For the emergency management of anaphylaxis we conclude that:• NIAID/FAAN diagnostic criteria and the four-tier grading system should be used for the diagnosis• Prompt and proper administration of epinephrine is critical.

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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 12 publications

References 3 publications

Wilderness Medical Society Clinical Practice Guidelines on Anaphylaxis

Wilderness Medical Society Clinical Practice Guidelines on Anaphylaxis

A Clinical Practice Guideline for the Emergency Management of Anaphylaxis (2020)

Anaphylaxis in elderly people

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