Current Guidelines For Diagnosis And Management Of Anaphylaxis In The Emergency Department
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Current Guidelines For Diagnosis And Management Of Anaphylaxis In The Emergency Department

June 2011

Abstract

This edition of EM Practice Guidelines Update reviews 2 clinical guidelines addressing the diagnosis and management of anaphylaxis. Literature suggests that misdiagnosis and mismanagement or delayed management of acute anaphylaxis is prevalent, and this may be partly due to the controversy regarding the definition of anaphylaxis and the lack of randomized controlled trials to guide therapy. The emergency clinician can avoid a number of common pitfalls by focusing on several key recommendations around diagnosis, appropriate management, and disposition of patients with anaphylaxis.

Practice Guideline Impact

  • Intramuscular (IM) epinephrine is the mainstay of treatment for anaphylaxis. Antihistamines and corticosteroids are second-line treatments and should not delay epinephrine administration when it is indicated.
  • Cutaneous symptoms do not indicate the severity of the episode. Patients with other symptoms consistent with anaphylaxis deserve aggressive treatment even in the absence of cutaneous signs.
  • Patients diagnosed with anaphylaxis who are not high-risk should be discharged in the care of others, with an epinephrine auto-injector, given a demonstration on how to self-administer it, instructions on allergen avoidance, and referral to an allergist.
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