Management of anaphylaxis in the emergency setting

Abstract

Anaphylaxis is a life-threatening emergency that appears to be increasing in frequency. It affects males and females of all ages and ethnic groups. The most common triggers include foods, drugs and venom from stinging insects, although any of a number of other triggers may also be implicated. Death, when it occurs, tends to be due to respiratory and/or cardiovascular compromise, but most of these fatalities can be prevented by appropriate avoidance measures and emergency management. The management of anaphylaxis is hampered by scientific and clinical uncertainty.

Anaphylaxis: mechanisms and management

“…Delayed administration of epinephrine is a risk factor for severe and biphasic reactions and a fatal outcome [10,98,157,163,172]. A clinician should not wait for overt signs of distributive shock or cardiovascular compromise to administer epinephrine [173][174][175][176][177][178][179]. Due to the fact that patients who have fatal anaphylaxis tend to have a delay in epinephrine administration from the time of allergen exposure, it is recommended that epinephrine be given as soon as possible [16].…”

GRADE system: new paradigm

“…Based on modeling studies that provide estimates of the magnitude of effect that is very unlikely to be explained by bias [39,40], the GRADE system defines a large effect as a RR of more than 2.0 or less than 0.5 (based on consistent evidence from at least two studies, with no plausible confounders) and a very large effect as a RR of more than 5.0 or less than 0.2 (based on direct evidence with no major threats to validity). For example, the extremely large and consistent effect [41] of epinephrine injections in anaphylactic shock leaves us convinced of the benefits of the intervention. Moreover, the GRADE approach can be particularly useful applied in cases in which carrying out RCTs is impossible.…”

Oral immunotherapy for the treatment of peanut allergy: systematic review of six case series studies

“…It is in this respect important to appreciate that, whilst all food allergies have the potential to induce anaphylaxis, some foods are more likely than others to cause potentially lifethreatening reactions. 3 Among anaphylactic reactions attributed to foods, 23-47% are triggered by peanut protein. 4 It has been suggested that ingestion of peanuts by mothers during pregnancy or while lactating could be a potential risk factor for the development of peanut allergy, but the evidence for this is weak.…”