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Guidelines: Be Quick on the Trigger with Epinephrine to Treat Anaphylaxis

ROCHESTER, MN – Emergency physicians need to be quick on the trigger when administering epinephrine to patients presenting with symptoms of a severe allergic reaction, according to new guidelines.

In fact, according to the guidelines published recently in the Annals of Allergy, Asthma and Immunology, there is little reason to delay epinephrine when anaphylaxis is suspected.

"Since emergency department physicians are often the first to see patients who are suffering from anaphylaxis, it's especially important that they not only correctly diagnose the problem, but understand that epinephrine should be administered as soon as possible," said lead author Ronna L. Campbell, MD, PhD, an emergency physician at the Mayo Clinic in Rochester, MN.

The recommendations, which emphasize there is no substitute for epinephrine in treatment of anaphylaxis, also include:

• Immediately triaging and monitoring patients with signs and symptoms of anaphylaxis in preparation of epinephrine administration.

• Administering epinephrine intramuscularly in the anterolateral thigh immediately after the diagnosis is made. The drug can be administered every 5 to 15 minutes as needed to control symptoms.

• Administering antihistamines and corticosteroids in conjunction with epinephrine, not instead of it.

• Determining whether the patient has risk factors for severe and potentially fatal anaphylaxis, such as delayed administration of epinephrine, asthma, a history of biphasic reactions, or cardiovascular disease.

• Administering β-agonist for anaphylaxis patients with bronchospasms.

• Observing patients 4 to 8 hours or even longer for those with a history of risk factors for severe anaphylaxis.

• Referring patients to see an allergist-immunologist upon discharge.

Stanley Fineman, MD, past president of the American College of Allergy, Asthma and Immunology, noted that “the collaboration between emergency department personnel and allergists is vital," and said that ED physicians and allergists participated in a roundtable discussion on the topic at the group’s recent Annual Scientific Meeting.

“We discussed how, together, we can get the word out about the importance of rapid epinephrine administration for those suffering from anaphylaxis,” Fineman recounted. “It's a message we want to get out to everyone dealing with severe allergies."