Life-Threatening Allergy – An Homage to Von Pirquet
Management of Anaphylaxis
F. Estelle R. Simons, MD, FRCPC
University of Manitoba
Winnipeg, Manitoba, Canada
Dr. Estelle Simons is a Professor in the Department of Pediatrics & Child Health and the Department of Immunology in the Faculty of Medicine at the University of Manitoba. She served as the 2005-2006 President of the American Academy of Allergy, Asthma, and Immunology. She is a member of the Board of Directors of the World Allergy Organization. She is a past-President of the Canadian Society of Allergy & Clinical Immunology. She has authored or co-authored more than 400 original peer-reviewed publications and has edited and co-edited several textbooks, including Middleton’s Allergy Principles & Practice, Sixth Edition (2003).
Physicians play a critically important role in the acute management of anaphylaxis. This role involves: assessing the patient’s airway, breathing, circulation, and mentation, injecting epinephrine, maintaining the airway, placing the patient supine, and administering oxygen and large volumes of intravenous fluids. Additional measures may be needed. Allergy/immunology specialists should also be cognizant of their responsibilities in the long-term management of individuals who have experienced anaphylaxis. Their unique role involves risk assessment: verification of the trigger by obtaining a comprehensive history of the anaphylaxis episode and performing relevant investigations, as well as determining co-morbidities and concomitant medications. Risk assessment should be followed by long-term, personalized, trigger-specific, risk-reduction strategies. These may include: allergen avoidance for prevention of food-, medication-, or latex-induced anaphylaxis, immunotherapy for prevention of venom-induced anaphylaxis, and prophylactic medications for idiopathic anaphylaxis .Despite vigilant avoidance of the trigger and good compliancewith treatment, at-risk individuals may experience anaphylaxis again. They therefore need to be trained to use self-injectable epinephrine, reminded that they cannot depend on an oral antihistamine or an asthma puffer in anaphylaxis, and equipped with accurate medical identification and an Anaphylaxis Emergency Action Plan. Anaphylaxis education should be provided for individuals at risk, their families and caregivers, healthcare professionals, and the general public.
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Sampson HA, Munoz-Furlong A, Campbell RL, et al. Second symposium on the definition and management of anaphylaxis: Summary report B Second National Institute of Allergy and Infec-tious Disease/Food Allergy and Anaphylaxis Network symposium. J Allergy Clin Immunol 2006;117:391-397.
Joint Task Force on Practice Parameters, American Academy of Allergy, Asthma, and Immunology, American College of Allergy,Asthma, and Immunology, Joint Council of Allergy Asthma and Immunology. The diagnosis and management of anaphylaxis: an updated practice parameter. J Allergy Clin Immunol 2005;115(Suppl.):S483-S523.