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Panel recommends epinephrine use even if severe allergic reaction is in doubt
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A panel of allergists and emergency physicians has recommended the use of epinephrine as a first-line defense against anaphylaxis, even if a patient is not showing signs of a severe allergic reaction.
A delay in epinephrine use could be hazardous and lead to even more severe anaphylaxis, according to the recommendations.
Stanley M. Fineman
“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,” Stanley M. Fineman, MD, an adjunct associate professor in the department of pediatrics at Emory University School of Medicine, said in a press release. “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.”
The American College of Allergy, Asthma and Immunology in November 2014 gathered Fineman and colleagues to discuss current knowledge of anaphylaxis, and to recommend strategies to improve medical management of anaphylaxis.
Epinephrine should also be given to patients at risk for an anaphylactic reaction, whether they had a previous severe reaction or even if they had exposure to an allergic trigger without the development of anaphylaxis symptoms.
Anyone seen in the ED for anaphylaxis should be referred to an allergist to schedule a follow-up visit, according to the panel.
The panelists also recommended that antihistamines and glucocorticoids should never be used as a substitute to epinephrine, but rather should be used after epinephrine has already been administered.
“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,” panelist Paul J. Dowling, MD, director of allergy/immunology training program at Children's Mercy Hospitals and Clinics in Kansas City, said in the release. “Antihistamines and corticosteroids should not be given instead of epinephrine because they don’t work fast enough.” – by Ryan McDonald
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Neil Kao, MD
I'm happy to read about specialties collaborating on the diagnosis and treatment of diseases common between them. Hopefully, as the conference proceedings are disseminated, this will produce better practices and outcomes all around.
After reading [the recommendations], I had a combination of some facts reinforced, learning of new facts and ideas about changes I want to make to my own practice.
The public and health care providers of all levels and specialties should be educated on what allergists try to do when they see patients with this suspected diagnosis. Allergists should have three goals: confirm that an anaphylactic event occurred, try to identify all contributing factors to this event, and work with patients to have a plan that tries to avoid the triggers and have a detailed action plan if an event should occur.
A sizable minority of patients that have had an anaphylactic event come to me without being referred by any physician. Many of these patients do not have an autoinjecting epinephrine device or an action plan. Every provider should be counseled as to the importance of these for every one of these patients.
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