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Anaphylaxis Care in the ED

Anaphylaxis Care in the ED

Guidelines and updated emergency medicine (EM) practice parameters have been issued for the management of anaphylaxis in the ED, but research indicates that significant knowledge and practice gaps persist. In July 2011, a round-table meeting called Anaphylaxis in Emergency Medicine was conducted, consisting of a multidisciplinary group of experts who reviewed the current guidelines and how they are applied in different emergency medical settings in the United States. The experts agreed that the root cause for many treatment gaps for anaphylaxis was the lack of a practical definition of anaphylaxis as it relates to EM. “There is concern that EM professionals may not be using current guidelines and practice parameters fully,” explains Richard Nowak, MD, who chaired the Anaphylaxis in Emergency Medicine roundtable panel. “This results from not having a consensus in published guidelines on the definition of anaphylaxis. Another key factor is that there are differences in signs and symptoms of how anaphylaxis presents in EDs, compared with those occurring in allergists’ offices.” A Practical Definition of Anaphylaxis In 2013, Dr. Nowak and colleagues published an article in the Journal of Emergency Medicine that customized anaphylaxis guidelines for EM. Articulating a simple standardized practical definition of anaphylaxis and describing characteristic findings in the clinical criteria for identifying it were an important emphasis (Table 1). The working definition was modified, building upon definitions suggested by other groups, so that it is clinically more relevant to emergency providers. Dr. Nowak and colleagues also developed consensus statements that encouraged practical application of guidelines when managing anaphylaxis (Table 2). “These statements expand the discussion on how to diagnose and manage anaphylaxis in...
A Look at Anaphylaxis in America

A Look at Anaphylaxis in America

Anaphylaxis is an acute, life-threating condition that typically requires an ED visit, a prescription for medication, and physician follow-up. However, data regarding the prevalence of anaphylaxis in the United States are limited and vary widely. To help shed light on the state of anaphylaxis, Robert A. Wood, MD, and colleagues conducted random telephone surveys among the general U.S. adult population between July and November 2011. Results were published in the Journal of Allergy and Clinical Immunology. Using a stringent definition, the research team found that 1.6% of survey respondents “very likely” had anaphylaxis and that 5.1% had “probable” anaphylaxis. “Anaphylaxis is clearly a common condition, perhaps more than what has been estimated in prior surveys,” says Dr. Wood. “Furthermore, anaphylaxis is common among all age groups. It has been previously thought to be a pediatric problem, but our surveys focused entirely on adults. Healthcare providers will encounter anaphylaxis on a regular basis, and therefore should be inquiring about it while taking initial or integral medical histories.” Key Findings Beyond determining the prevalence of anaphylaxis, the researchers sought to gather information on the symptoms and triggers of anaphylactic reactions as well as how patients reacted to episodes in terms of accessing healthcare and using medications. After conducting a survey of the general population (public survey), a second survey was conducted targeting a higher-risk population of subjects with a history of allergic reactions (patient survey). “The symptoms typically thought to accompany anaphylaxis, such as skin reactions and respiratory issues, were indeed the most common among both groups,” says Dr. Wood (Figure). “Other common symptoms involved the gastrointestinal, cardiovascular, and neurologic systems....
Rapid Desensitization for Chemotherapy Allergies

Rapid Desensitization for Chemotherapy Allergies

Chemotherapy in the 21st century is only now beginning to evolve from its early, traumatic treatments. We are still using the potent toxins that kill every dividing cell and make patients physically sick and bereft of the normal protections that help to prevent infections and subsequent malignancies. However, in the past few years, we have seen the emergence of elegant, less traumatic, and more targeted cancer therapies such as tyrosine kinase inhibitors and monoclonal antibodies. These agents have had a profound effect on extending overall survival while also having fewer adverse treatment effects that have historically been seen with chemotherapy. Allergies May Develop In addition to the terrible burden of cancer, patients can become allergic to their chemotherapy. This happens with some frequency with both older and newer treatments. Older treatments — carboplatin, for example — can cause allergic reactions so often that oncologists will need to perform skin testing routinely to check for the onset of allergies. The newer monoclonal antibodies can also cause serious and life-threatening reactions. These factors can complicate treatment for patients and clinicians alike. For board-certified allergists, much time is spent helping patients tolerate the treatments and therapies that they need but which cause them to have allergic reactions. When managing allergies, the desensitization process involves giving the actual allergen substance. This includes giving antibiotics to desensitize patients who are allergic to antibiotics. In some cases, it may mean giving stinging insect venoms to desensitize patients who are allergic to stings from bees, wasps, hornets, and fire ants. In other cases, clinicians may need to administer inhalant allergens (eg, cat, dog, dust mite, and...
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