Anaphylaxis—a practice parameter update 2015

Lieberman, Phillip; Nicklas, Richard A.; Randolph, Christopher; Oppenheimer, John; Bernstein, David I.; Bernstein, Jonathan A.; Ellis, Anne K.; Golden, David B.K.; Greenberger, Paul A.; Kemp, Steven; Khan, David A.; Ledford, Dennis K.; Lieberman, Jay; Metcalfe, Dean D.; Nowak‐Węgrzyn, Anna; Sicherer, Scott H.; Wallace, Dana; Blessing-Moore, Joann; Lang, David M.; Portnoy, Jay M.; Schuller, Diane E.; Spector, Sheldon L.; Tilles, Stephen A.

doi:10.1016/j.anai.2015.07.019

Cited by 410 publications

(422 citation statements)

References 450 publications

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“…1 -3 Epinephrine is the primary initial treatment of anaphylaxis. [1][2][3] This clinical report from the American Academy of Pediatrics (AAP) updates and amplifies the previous report on this topic. 4 …”

Section: Introductionmentioning

confidence: 93%

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Epinephrine for First-aid Management of Anaphylaxis

2017

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Anaphylaxis is a severe, generalized allergic or hypersensitivity reaction that is rapid in onset and may cause death. Epinephrine (adrenaline) can be life-saving when administered as rapidly as possible once anaphylaxis is recognized. This clinical report from the American Academy of Pediatrics is an update of the 2007 clinical report on this topic. It provides information to help clinicians identify patients at risk of anaphylaxis and new information about epinephrine and epinephrine autoinjectors (EAs). The report also highlights the importance of patient and family education about the recognition and management of anaphylaxis in the community. Key points emphasized include the following: (1) validated clinical criteria are available to facilitate prompt diagnosis of anaphylaxis; (2) prompt intramuscular epinephrine injection in the mid-outer thigh reduces hospitalizations, morbidity, and mortality; (3) prescribing EAs facilitates timely epinephrine injection in community settings for patients with a history of anaphylaxis and, if specifi c circumstances warrant, for some high-risk patients who have not previously experienced anaphylaxis; (4) prescribing epinephrine for infants and young children weighing <15 kg, especially those who weigh 7.5 kg and under, currently presents a dilemma, because the lowest dose available in EAs, 0.15 mg, is a high dose for many infants and some young children; (5) effective management of anaphylaxis in the community requires a comprehensive approach involving children, families, preschools, schools, camps, and sports organizations; and (6) prevention of anaphylaxis recurrences involves confi rmation of the trigger, discussion of specifi c allergen avoidance, allergen immunotherapy (eg, with stinging insect venom, if relevant), and a written, personalized anaphylaxis emergency action plan; and (7) the management of anaphylaxis also involves education of children and supervising adults about anaphylaxis recognition and fi rst-aid treatment.

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Section: Introductionmentioning

confidence: 93%

“…1,2,8 It may be helpful for families to know they are seeking additional medical care not because of the use of the EA, a safe treatment, but rather to assess and monitor the anaphylactic episode.…”

Section: Using Easmentioning

confidence: 99%

Epinephrine for First-aid Management of Anaphylaxis

2017

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“…Um estudo canadense avaliou 1212 prescrições de adrenalina autoinjetável, das quais 30,1% dos pacientes não adquiriram a medicação no prazo de 90 dias da prescrição 22 . É fundamental, aos pacientes que já tiveram anafilaxia, portar a adrenalina autoinjetável, pois a reação pode evoluir rapidamente em poucos minutos, e o acesso a um serviço de saúde pode ser inviável em curto período de tempo 23 . Em nosso país a venda de adrenalina autoinjetável não estava liberada no momento do estudo, devendo ser importada.…”

Section: Discussionunclassified

Conhecimento de pediatras que atuam em urgências e emergências sobre tratamento da anafilaxia

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Fernandes

2018

ABCS Health Sci.

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resumo introdução: Anafilaxia é uma reação sistêmica grave, aguda e potencialmente fatal. Apresenta vários desencadeantes e mecanismos diferentes, entretanto, o tratamento agudo é igual em todos os casos. objetivo: Avaliar o conhecimento sobre tratamento da anafilaxia e choque anafilático (CA) de pediatras que atuam em setor de emergência pediátrica. métodos: Estudo transversal através da aplicação de questionário de múltiplas escolhas com 10 perguntas sobre tratamento da anafilaxia e CA. Foram convidados todos os pediatras do Pronto Socorro de um Hospital Público Pediátrico. resultados: Cinquenta entre 51 pediatras concordaram em participar do estudo. A média de acertos foi 6,32 com mediana de 7 (mínimo 2 e máximo 10). Houve reconhecimento adequado dos pediatras sobre a droga de escolha para iniciar o tratamento da anafilaxia e CA em 96% e 92%, respectivamente. Sobre a via de administração da adrenalina, a adequação das respostas foi de 64%. Em relação à dose de adrenalina, 70% identificaram corretamente, porém, o conhecimento sobre a dose máxima foi de 44%. Ao perguntar o intervalo para repetir a adrenalina, 38% responderam corretamente. Perguntou-se sobre terapias adjuvantes no tratamento do CA com 74% de acerto. Sobre a droga que previne a reação anafilática bifásica, 60% responderam corretamente. Quanto ao tempo de observação, 54% responderam o período adequado. O acerto sobre apresentações disponíveis de adrenalina autoinjetável foi de 40%. Conclusão: Houve dificuldade principalmente em reconhecer dose máxima, dose de adrenalina autoinjetável e tempo necessário para ser repetida, o que aumenta o risco de superdosagem e seus efeitos adversos.Palavras-chave: anafilaxia; epinefrina; pediatria; tratamento de emergência. AbstrACt introduction:Anaphylaxis is a severe, acute and potentially fatal systemic reaction. It presents several triggers and different mechanisms, however, the acute treatment is the same in all the cases. objective: To evaluate the knowledge about treatment of anaphylaxis and anaphylactic shock (AS) of pediatricians who works in the pediatric emergency sector. methods: Cross-sectional study through the use of a multiplechoice questionnaire with 10 questions about the treatment of anaphylaxis and AS. All the emergency room pediatricians of a general pediatric hospital were invited. results: Fifty of fifty-one pediatricians agreed to take part of the study. The mean of right answers was 6.32 and median of 7 (minimum 2 and maximum 10). There was an appropriate recognition about the drug of choice to initiate the treatment of anaphylaxis and AS in 96% and 92%, respectively. On the route of adrenaline administration, the adequacy of the answers was 64%. Regarding to adrenaline dose 70% were right, however the recognition of the maximum dose was 44%. When asked about the interval to repeat the adrenaline, 38% responded correctly. About adjuvant therapies to treat AS the score was 74% and 60% when questioned about the drug that prevents biphasic anaphylactic reaction. In relation to the observation...

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“…6 In addition, those patients with a history of anaphylaxis are strongly indicated for an adrenaline auto-injector. 4,5 However, epinephrine auto-injectors are unavailable or unaffordable in some developing countries. We have recently demonstrated the stability and the sterility of an epinephrine prefilled syringe for use as an alternative treatment for those patients suffering from anaphylaxis.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3] Guidelines for treatment of anaphylaxis have recommended to inject epinephrine intramuscularly at anterolateral thigh. 4,5 Since it can provide the early onset and higher blood level of epinephrine than injection via subcutaneous or intramuscular at deltoid. 6 In addition, those patients with a history of anaphylaxis are strongly indicated for an adrenaline auto-injector.…”

Section: Introductionmentioning

confidence: 99%