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Review
. 2024 Dec 9;20(Suppl 3):62.
doi: 10.1186/s13223-024-00926-3.

Anaphylaxis

Elissa M Abrams  1   2 , Waleed Alqurashi  3 , David A Fischer  4 , Timothy K Vander Leek  5 , Anne K Ellis  6
Affiliations
Review

Anaphylaxis

Elissa M Abrams et al. Allergy Asthma Clin Immunol. .

Abstract

Anaphylaxis is an acute, potentially fatal systemic hypersensitivity reaction with varied mechanisms and clinical presentations. Although prompt recognition and treatment of anaphylaxis are imperative, both patients and healthcare professionals often fail to recognize and diagnose its early signs. Clinical manifestations vary widely, however, the most common signs are cutaneous symptoms, including urticaria and angioedema. Immediate intramuscular administration of epinephrine into the anterolateral thigh is first-line therapy, and is always safe even if the diagnosis is uncertain. The mainstays of long-term management include specialist assessment, allergen avoidance measures, and the provision of an epinephrine auto-injector with an individualized anaphylaxis emergency plan. This article provides an overview of the causes, clinical features, diagnosis, and acute as well as long-term management of anaphylaxis.

Keywords: Acute management; Anaphylaxis; Anaphylaxis emergency plan; Diagnosis; Epinephrine; Long-term management.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Ethics approval and consent to participate are not applicable to this review article. Consent for publication: Not applicable. Competing interests: Dr Elissa M. Abrams is an employee of Public Health Agency of Canada (PHAC); views expressed are her own and not those of PHAC. She is Section Head for Anaphylaxis/Food Allergy, and a Member of the Canadian Society of Allergy and Clinical Immunology (CSACI). Dr. Waleed Alqurashi has received grant funding from the Canadian Institute for Health Research. Dr. David A. Fischer is a previous President of the Canadian Society of Allergy & Clinical Immunology (CSACI). He has received consulting fees and honoraria for continuing education from AstraZeneca, GSK, Bausch Health, Valeo, AbbVie, Takeda, ALK, Pfizer, Aralez, Merck, Novartis, Sanofi, Pediapharm and Teva Pharmaceuticals. Dr. Timothy K. Vander Leek has participated in advisory boards and has received consulting fees and honoraria from Aralez/Miravo, Bausch Health, and Covis Pharma. Dr. Anne K. Ellis has participated in advisory boards for ALK-Abello, AstraZeneca, Bausch Health, LEO Pharma, Miravo, Merck, Novartis, has been a speaker for ALK-Abello, AstraZeneca, Bausch, Miravo, Medexus, Mylan, Novartis, Pfizer, Sanofi, StallergenesGreer and Regeneron. Her institution has received research grants from ALK Abello, Aralez, AstraZeneca, Bayer LLC, Medexus, Novartis, Sanofi and Regeneron. She has also served as an independent consultant to Bayer LLC, Pharming, and Regeneron. About this supplement: This article has been published as part of Allergy, Asthma & Clinical Immunology, Volume 20 Supplement 03, 2024: Practical Guide for Allergy and Immunology in Canada 2024. The full contents of the supplement are available at https://aacijournal.biomedcentral.com/articles/supplements/volume-20-supplement-3 .

Figures

Fig. 1
Fig. 1
Simplified algorithm for the acute management of anaphylaxis. *Should be administered if there is no improvement after intramuscular epinephrine by a physician trained in the use of IV epinephrine with capacity for continuous blood pressure and cardiac monitoring. **At home management, without EMS activation, is appropriate in the following stringent set of circumstances: (1) patient/caregiver comfort level with the recognition and management of anaphylaxis, in particular the prompt and correct use of epinephrine auto-injector; (2) immediate access to at least two, in date, weight-appropriate dose of epinephrine autoinjectors; (3) absence of risk factors for a biphasic reaction: a prior biphasic reaction, a moderate-to- severe reaction, delayed use of epinephrine (> 60 min) or requirement of more than one dose of epinephrine; (4) absence of risk factors for severe anaphylaxis outcomes: cardiovascular disease, asthma (especially active or poorly controlled), mastocytosis; (5) symptom resolution with one dose of epinephrine administration; (6) patient/caregiver preference IV: intravenous; IM: intramuscular; EMS: emergency medical services
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References

    1. Turner PJ, Worm M, Ansotegui IJ, El-Gamal Y, Rivas MF, Fineman S, et al. WAO Anaphylaxis Committee. Time to revisit the definition and clinical criteria for anaphylaxis? World Allergy Organ J. 2019;12(10):100066. - PMC - PubMed
    1. Turner PJ, DunnGalvin A, Hourihane JO. The emperor has no symptoms: the risks of a blanket approach to using epinephrine autoinjectors for all allergic reactions. J Allergy Clin Immunol Pract. 2016;4(6):1143–6. - PMC - PubMed
    1. Jerschow E, Lin RY, Scaperotti MM, McGinn AP. Fatal anaphylaxis in the United States 1999–2010: temporal patterns and demographic associations. J Allergy Clin Immunol. 2014;134(6):1318–e13287. - PMC - PubMed
    1. Ma LL, Danoff TM, Borish L. Case Fatality and Population Mortality Associated with anaphylaxis in the United States. J Allergy Clin Immunol. 2014;133(4):1075–83. - PMC - PubMed
    1. Turner PJ, Jerschow E, Umasunthar T, Lin R, Campbell DE, Boyle RJ. Fatal anaphylaxis: Mortality Rate and Risk factors. J Allergy Clin Immunol Pract. 2017;5(5):1169–78. - PMC - PubMed

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