Allergic Reactions and Anaphylaxis

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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