Wilderness Medical Society Clinical Practice Guidelines on Anaphylaxis

Abstract

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.

Symjepi Epinephrine Injection Device Deconstruction and Residual Medication Retrieval in an Austere Environment

“…They are also convenient to use in the austere setting because they are self-contained, do not require advanced medical knowledge to use, and are reliable. 6,7 However, there are nonmedical considerations, as outdoor recreationalists are often limited to the amount of space, weight of materials, and tools that they can carry with them. The addition of multiple devices may sometimes be seen as an inconvenience; therefore, many outdoor enthusiasts will forgo carrying an additional autoinjector, feeling that the risk-to-benefit ratio is low.…”

“…It is widely recommended that urgent medical attention is obtained and early administration of epinephrine is provided in the treatment of anaphylaxis. 7 Outdoor enthusiasts with known allergic reactions are encouraged to carry sufficient medication with them on any type of outdoor expedition. 7 However, it is also important to be resourceful and improvise as a wilderness medicine provider.…”

“…7 Outdoor enthusiasts with known allergic reactions are encouraged to carry sufficient medication with them on any type of outdoor expedition. 7 However, it is also important to be resourceful and improvise as a wilderness medicine provider. Understanding how to access and administer additional doses of medication may provide lifesaving medical treatment for a patient with anaphylaxis.…”

“…Conditions, including cardiac arrhythmias, stroke, and myocardial infarction, among others, after the administration of epinephrine, have been reported in the literature. 7 Although these are usually associated with elderly patients or those with preexisting medical conditions that put them at risk, the provider must be aware and ready to identify these emergencies. Administering multiple doses of the medication may increase this risk to the patient.…”