Emergency treatment of anaphylaxis: concise clinical guidance

Abstract

There are approximately 20-30 deaths reported each year due to anaphylaxis in the UK, but this may be a significant underestimate; approximately 10 anaphylaxis deaths each year are due to foods, and another 10 due to perioperative anaphylaxis. 6 The most common triggers are food, drugs and venom. 4 Food is the most common trigger in young people: teenagers and adults up to the age of 30 years appear to be at greatest risk of fatal food-induced reactions. 4,5 In contrast, the rate of druginduced anaphylaxis is highest in the elderly, probably due to the combination of comorbidities (such as cardiovascular disease) and polypharmacy (including beta-blockers and angiotensinconverting-enzyme (ACE) inhibitors). 4,7 The diagnosis is supported if there is exposure to a known trigger, however, in up to 30% of cases, there may be no obvious trigger ('idiopathic' or 'spontaneous' anaphylaxis). The characteristics of anaphylaxis to the most common causes are shown in Table 1. 1,8 Anaphylaxis is a clinical diagnosis that lies along a spectrum of severity of allergic symptoms (Fig 1 ), and no symptom is entirely specific for the diagnosis.

A Case of Usefulness of Auto-Injectable Adrenaline as a Prophylactic Countermeasure Against Bee Sting for Forestry Workers

“…Forestry workers in Italy have also been reported to have a generic risk of experiencing wasp (hymenoptera) sting anaphylaxis (Ricciardi et al, 2018). A history of large, local reactions was a strong risk factor for developing a systemic reaction, thus representing a red flag for future anaphylaxis and meriting prescription of an adrenaline auto-injector (Whyte et al, 2022). As the immediate injection of adrenaline was vital for patients suffering from anaphylaxis, this advance effort from Japan involving prescription of auto-injectable adrenaline as a prophylactic countermeasure against bee sting among forestry workers based on a positive allergy test for bee sting may be used as grounds to help protect forestry workers around the world.…”

“…Anaphylaxis is described as a sudden-onset, immediate reaction that carries a risk of death. Fatalities can occur due to asphyxiation from laryngeal or oropharyngeal swelling, collapse from hypotensive shock, cardiac arrest, or acute severe bronchoconstriction that causes respiratory failure and arrest (Watts & Marie Ditto, 2019; Whyte et al, 2022). According to reports from the Ministry of Agriculture, Forestry and Fisheries, or Forestry and Timber Manufacturing Safety & Health Association in Japan, over 10 fatal bee sting accidents occur per year all over Japan, and over 200 bee sting accidents including 0–3 fatal accident occurred each year in the forestry field in Japan until 2006 (Forestry and Timber Manufacturing Safety & Health Association, 2022a; Ministry of Agriculture, Forestry and Fisheries, n.d.-b).…”

“…Employees are to arrange for workers with bee or wasp allergies to contact local medical facilities for the prescription of auto-injectable adrenaline. Adrenaline is a sympathomimetic catecholamine that increases blood pressure by inducing vascular smooth muscle contraction, an increased heart rate, bronchodilation, and mydriasis, and it is used as first-line management for anaphylaxis (Muraro et al, 2022; Watts & Marie Ditto, 2019; Whyte et al, 2022). Workers who are prescribed this medication then learn how to use the auto-injectable adrenaline from their health care provider.…”

Managing “Hidden” Allergens in the Perioperative Setting

“…The term anaphylaxis refers to the overall clinical presentation of “the most severe form of immediate hypersensitivity reaction” 5 (p100) from a variety of mechanisms of action (eg, immunologic response, idiopathic) 6 . Although some of the current clinical guidance indicates that the severity of anaphylactic reactions varies and provides a grading scale, 7 additional guidelines do not specify a scale, 8 indicate a lack of consensus on the scale, 7,8 or state that anaphylaxis occurs on a continuum without specific levels 9 . Generally, less severe reactions are not life‐threatening 7 .…”

Impacting outcomes in acute care

“…Recommendations about monitoring of glycated haemoglobin at admission in cases of new-onset hyperglycaemia are worthy of prospective study.Another important manuscript in this edition, from Whyte et al, is a summary of the revised guideline from the Resuscitation Council UK on the emergency management of anaphylaxis. 4 There are notable updates on recognition, management, observation and follow-up of patients with anaphylaxis. There are updates on the respective roles of corticosteroids and antihistamines, and important summaries of changes to the recommended duration of observation for patients who have experienced anaphylaxis.…”