The diagnosis and management of anaphylaxis: An updated practice parameter

Second symposium on the definition and management of anaphylaxis: Summary report—Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium

“…It was acknowledged that no criteria will provide 100% sensitivity and specificity, but it was believed that the criteria proposed are likely to capture more than 95% of cases of anaphylaxis. Because the majority of anaphylactic reactions include skin symptoms, [5][6][7][8][9][10] which are noted in more than 80% of cases when carefully assessed, it was judged that at least 80% of anaphylactic reactions should be identified by criterion 1, even when the allergic status of the patient and potential cause of the reaction might be unknown. However, cutaneous symptoms might be absent in up to 20% of anaphylactic reactions in children with food allergy or insect sting allergy.…”

“…In general, participants at the Second NIAID/FAAN Anaphylaxis Symposium support the therapeutic approach outlined in recently published guidelines. 5 A summary of these guidelines is provided below, along with a more detailed discussion of the recommended route of parenteral epinephrine, positioning during treatment of anaphylaxis, and suggested observation periods after treatment of an anaphylactic episode.…”

“…5 Aqueous epinephrine, 0.01 mg/kg (maximum dose, 0.5 mg) administered intramuscularly every 5 to 15 minutes as necessary, is the recommended dosage for controlling symptoms and maintaining blood pressure. 15,16 The 5-minute interval between injections can be liberalized to permit more frequent injections if deemed necessary by the clinician.…”

“…10,20 Detailed procedures for the preparation and administration of epinephrine infusions have been published. 5 It is important to recognize the potential for lethal arrhythmias when administering intravenous epinephrine, and therefore continuous cardiac monitoring is recommended. Continuous low-dose epinephrine infusions might represent the safest and most effective form of intravenous delivery because the dose can be titrated to the desired effect and can avoid the potential for accidental administration of large boluses of epinephrine.…”

“…5 In this report the Task Force defined anaphylaxis as ''as a condition caused by an IgE-mediated reaction'' and noted that such reactions ''are often life-threatening and almost always unanticipated.'' The purpose of the practice parameter was to provide ''the practicing physician with an evidence-based approach to the diagnosis and management of anaphylactic reactions.''…”