Study: Use Epinephrine Even With Unconfirmed Anaphylaxis

Allergists and emergency care providers should not delay use of epinephrine in patients experiencing potential anaphylaxis even if there is not significant proof that the patient is experiencing an allergic reaction.

“An expert panel of allergists and emergency physicians was convened by the American College of Allergy, Asthma and Immunology in November 2014 to discuss current knowledge about anaphylaxis, identify opportunities for emergency practitioners and allergists to partner to address barriers to care, and recommend strategies to improve medical management of anaphylaxis along the continuum of care: from emergency medical systems and emergency department practitioners for acute management through appropriate outpatient follow-up with allergists to confirm diagnosis, identify triggers, and plan long-term care,” wrote the study’s authors.
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The panel experts identified the making of an accurate diagnosis as a specific barrier to treating patients with anaphylaxis. Other barriers they highlighted were inadequate follow-up by patients and few epinephrine administrations by health care providers during acute management.

To combat these barriers, the panel recommended that emergency physicians and allergists should not hesitate to use epinephrine for possible anaphylaxis, as the drug is safe in appropriate doses and there are no contraindications for its use with anaphylaxis.

"It is not necessary for the [National Institute of Allergy and Infectious Disease and the Food Allergy and Anaphylaxis Network] criteria to be met to administer epinephrine," they wrote.

Further, the panel recommended the development of easy-to-access educational programs for use by emergency department practitioners and emergency medical systems.

The complete study published in the August issue of Annals of Allergy, Asthma and Immunology.

-Michelle Canales Butcher

Reference:

Fineman SM, Bowman SH, Campbell RL. Addressing barriers to emergency anaphylaxis care: from emergency medical services to emergency department to outpatient follow-up. Ann Allergy, Asthma, Immunol. 2015 August [epub ahead of print] doi: dx.doi.org/10.1016/j.celrep.2015.07.008.