Supportive care with nebulized therapy, vasopressors, antihistamines, or corticosteroids may be beneficial for specific symptoms but are not replacements for epinephrine and should be administered only after epinephrine.⁸ Patients should be observed after acute treatment to monitor for biphasic reactions or possible recurrence as the epinephrine wears off.²² Because the initial clinical presentation cannot reliably predict biphasic or protracted anaphylaxis, observation periods must be individualized.⁸

Conclusion

In order to manage the growing population of allergic individuals in the United States, physicians and office staff must maintain a well-established plan, clinical proficiency, and the proper equipment in treating anaphylaxis.

Education may be the most important tool for patients at risk for anaphylaxis, and developing a written action plan is essential for all patients who have experienced anaphylaxis.^7,8 The proper use of self-administered epinephrine is an essential component of patient education. Patients should be counseled to store epinephrine auto-injectors properly (avoiding temperature extremes) and to be cognizant of the expiration date.²²

Other key components include education regarding allergen avoidance, including hidden allergens and cross-reactivities as well as developing an anaphylaxis action plan.^7,8,22 To that end, patients with a history of anaphylaxis should be considered for referral to an allergy/immunology specialist for evaluation and long-term management.⁸

Dr. Lanier is a clinical professor of pediatrics at the University of North Texas Health Science Center in Fort Worth, Texas. This article is sponsored by Mylan Specialty, L.P.

Editor’s Note: Emergency physician Marc Finder has long advised his patients to store an epinephrine auto-injector in the silverware drawer. That way, in an emergency in which the patient has to tell someone to go fetch it, it’s easy to find. “A house typically has only one (easily located) kitchen,” says Dr. Finder, “and a kitchen typically has one (easily identified) silverware drawer.”

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