Updated guidelines issued for management of anaphylaxis

In a practice parameter update published online Dec. 17 in the Annals of Allergy, Asthma & Immunology, new guidelines are presented for the diagnosis and management of anaphylaxis.

David B. K. Golden, M.D.C.M., from the Johns Hopkins School of Medicine in Baltimore, and colleagues focused on seven areas with new evidence to update recommendations for the diagnosis of anaphylaxis in pediatric and adult patients.

The authors note that diagnostic criteria for anaphylaxis have been revised. For diagnosis of anaphylaxis and identification of underlying mast cell disorders, measurement of serum tryptase is important. Age-specific symptoms may differ for infants and toddlers versus older children and adults; no correlation has been seen for patient age with reaction severity. Anaphylaxis is unlikely to be the initial reaction to first exposure to an allergen. Specific measures for prevention and treatment of anaphylaxis are required for different community settings. Optimal prescribing and use of epinephrine autoinjector devices requires specific counseling and patient and caregiver training, including whether and when to call emergency medical services. Immediate activation of emergency medical services may not be required if the patient experiences a prompt, complete, and durable response to rapid use of epinephrine. For adult patients with severe insect sting anaphylaxis or recurrent idiopathic anaphylaxis, evaluation for mastocytosis, including a bone marrow biopsy, should be considered.

"These guidelines translate recent advances in the understanding of severe allergic reactions to help all health care professionals provide individualized care to each patient at the right time, in the right place, every time," Golden said in a statement.

Several authors disclosed financial ties to the pharmaceutical industry.

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