An update on allergic emergencies

Abstract

Purpose of review To provide an updated framework of management for allergic emergencies. Recent findings The most frequent causes of anaphylaxis include medications, foods, and stinging insects. Early and appropriate administration of epinephrine is critical to managing anaphylaxis. Although epinephrine is well tolerated and there is no absolute contraindication to using epinephrine in first-aid management of anaphylaxis, many patients at risk for anaphylaxis still fail to carry and use the medication prior to seeking emergency care. Outcomes of allergic emergencies can be improved by educational efforts that focus on adherence to emergency plans, as well as asthma controller treatments in patients with persistent asthma. Though venom immunotherapy is known to decrease the risk for stinging insect anaphylaxis, the role of emerging strategies for food allergen immunotherapy in reducing cases of anaphylaxis requires further study. Summary Fatalities resulting from anaphylaxis and asthma are rare. Patient education serves an important role in preparing for unexpected emergencies, instituting prompt and appropriate treatment, and incorporating effective strategies into the lives of children and families.

Reply to “Subcutaneous terbutaline as an alternative to aerosolized albuterol”

“…1 In the setting of acute severe asthma, it is important to ensure availability of emergency medical services and/or additional intensive care resources that may be required for patient management, including supplemental oxygen, aggressive bronchodilator therapies (both intramuscular and intravenous beta-agonists, anticholinergics, and other smooth muscle inhibitors including magnesium sulfate), anti-inflammatory medications including early administration of corticosteroids, and supportive measures such as noninvasive positive pressure ventilation and helium-oxygen gas mixtures. 4 Terbutaline is a beta-agonist that preferentially stimulates beta-2 receptors in the bronchi to a greater degree than beta-1 receptors in the heart. Although terbutaline is effective at a dose of 0.5 mg (0.5 mL) subcutaneously in adult patients presenting with acute severe asthma, it is also notable that epinephrine at a dose of 0.5 mg (0.5 mL) has been shown to have similar benefit with a comparable adverse effect profile.…”