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In this episode, Sam Ashoo, MD, and TR Eckler, MD, discuss the July 2022 Emergency Medicine Practice article on the Management of Allergic Reactions and Anaphylaxis in the Emergency Department.
Intro
- The number of ED visits and hospitalizations
- Studies show up to 57% of anaphylactic reactions are not recognized, and epinephrine is not administered in up to 80% of cases.
Criteria
- 2006 Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network (NIAID/FAAN)
- WAO revised the criteria in 2020
- Delphi group and Brown et al
Pathophysiology
Epidemiology
- Most common causes in children and adults
- More than half of deaths from anaphylaxis occur within the first hour of symptom onset
Prehospital Care
- Give epi, H1 blockers
- Mainstay = recognition
ED Care
- Airway
- Epinephrine
- Decontamination
- H1 and H2 blockers
- Corticosteroids
- Biphasic reactions
- Glucagon
Special Cases
- Alpha-gal
- Scombroid
- Kounis syndrome
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