In Anaphylaxis, Even When in Doubt, Administer Epinephrine

New recommendations by a panel of experts on emergency care calls for appropriate prompt treatment, including the use of epinephrine for all severe allergic reactions.

The panel, which was convened by the American College of Allergy, Asthma and Immunology (ACAAI; Arlington Heights, IL, USA), which included allergologists and emergency physicians, examined barriers to emergency care for anaphylaxis, and discussed ways to encourage appropriate prompt treatment, agreed that epinephrine should be given to patients at risk of an anaphylactic reaction based on a previous severe reaction or to those who have had a known or suspected exposure to their allergic trigger, with or without the development of symptoms.

Another crucial message highlighted by the panel was that anyone seen for anaphylaxis in the emergency room needs to be referred to an allergist for comprehensive follow-up care and guidance for severe allergic reactions. The panel also recommended that allergists and emergency physicians continue to work in partnership, that allergists be proactive in outreach to emergency care practitioners, and that easy-to-access educational programs and materials be developed for use by emergency medical systems and emergency department practitioners in the training environment and in practice. The recommendations were published on August 6, 2015, in Annals of Allergy, Asthma and Immunology.

“Our emergency medicine colleagues told us that if patients don't fit established guidelines for anaphylaxis, there may be a reluctance in the emergency room to treat with epinephrine,” said panel chair allergist Stanley Fineman, MD, past president of the ACAAI. “Because epinephrine is the first line of defense in treating anaphylaxis, the panel agreed it should be used, even if a patient's reaction may not meet all the established criteria. The consequences for not using epinephrine when it's needed are much more severe than using it when it might not be necessary.”

“We want emergency medical personnel, as well as people who have had, or are at risk for having severe allergic reactions to know there is no substitute for epinephrine as the most important tool for combatting anaphylaxis,” added panel member allergist Paul Dowling, MD, of Children's Mercy Hospitals and Clinics (Kansas City, MO, USA). “Antihistamines and corticosteroids should not be given instead of epinephrine because they don't work fast enough.”

Anaphylaxis is a severe allergic reaction that involves a number of body systems, and can be fatal within minutes. It can occur in people with allergies to certain foods, insect stings, medications, latex, or other allergens. All published US national anaphylaxis guidelines recommend epinephrine as the first choice treatment in an acute episode. The vast majority of deaths from anaphylaxis occur in individuals who do not receive epinephrine in a timely manner.

Related Links:
American College of Allergy, Asthma and Immunology
Children's Mercy Hospitals and Clinics