International consensus on (ICON) anaphylaxis
Emergency treatment of anaphylaxis: concise clinical guidance
"Anaphylaxis is a serious systemic hypersensitivity reaction that is
usually rapid in onset and may cause death. It is characterised by the
rapid development of airway and/or breathing and/or circulation
problems. Intramuscular adrenaline is the most important treatment,
although, even in healthcare settings, many patients do not receive this
intervention contrary to guidelines. The Resuscitation Council UK
published an updated guideline in 2021 with some significant changes in
recognition, management, observation and follow-up of patients with
anaphylaxis. This is a concise version of the updated guideline."
Lessons for management of anaphylaxis from a study of fatal reactions
"The unpredictability of anaphylactic reactions and the need for
immediate, often improvised treatment will make controlled trials
impracticable; other means must therefore be used to determine optimal
management. This study aimed to investigate the circumstances leading to fatal anaphylaxis.
Immediate recognition of anaphylaxis, early use of adrenaline,
inhaled beta agonists and other measures are crucial for successful
treatment. Nevertheless, a few reactions will be fatal whatever
treatment is given; optimal management of anaphylaxis is therefore
avoidance of the cause whenever this is possible. Predictable
cross-reactivity between the cause of the fatal reaction and that of
previous reactions had been overlooked. Adrenaline overdose caused at
least three deaths and must be avoided."
Food-induced anaphylaxis
"In the UK register of fatal anaphylactic reactions, all food-induced
fatalities have been accompanied by respiratory problems with
respiratory arrest. Atopic individuals with bronchial asthma and prior
allergic reactions to the same food are at a particularly high risk. Not
only peanuts, seafood and milk can induce severe, potentially lethal,
anaphylaxis, but indeed a wide spectrum of foods, according to the
different patterns of food sensitivity in different countries. Foods
with "hidden" allergens and meals at restaurants are particularly
dangerous for patients with food allergies. Similarly, schools, public
places and restaurants are the major places of risk. However, the main
factor contributing to a fatal outcome is the fact that the victims did
not carry their emergency kit with adrenaline (epinephrine) with them.
Therefore, we suggest that the pharmaceutical industry should
reintroduce an adrenaline inhaler that is more effective, especially in
asthmatic reactions."
A guide for the management of post vaccination allergy and anaphylaxis in a pharmacy clinic
"Vaccination falls within the scope of practice of a pharmacist and the
coronavirus disease 2019 pandemic has seen an increase in pharmacies
providing vaccination services. These vaccines are not without risk of
allergic reactions and anaphylaxis. The available guidelines for the
management of anaphylaxis include the administration of intravenous (IV)
fluids. However, IV administration does not fall within the scope of
practice of a pharmacist. A gap was identified in the availability of
guidelines for the management of anaphylaxis without the use of IV fluid
administration."
Presentations of Anaphylaxis
NOT THE VACCINE, BUT ANAPHYLAXIS TO THE COVID-19 VIRUS ITSELF
A patient developed systemic allergic symptoms including fatigue, rash, rhinitis, and lip swelling after exposure to the COVID 19 virus (most likely omicron variant). She had a history of chronic idiopathic urticaria and dermatographism, so her mast cells may have already been disordered. Her symptoms lasted for 4 days, during which time she required a continuous IV benadryl infusion as well as remdesivir, Solu-Medrol, loratadine, and famotidine. Testing showed that she had an elevated level of IL10.
