Guideline for Acute Therapy and Management of Anaphylaxis

Abstract

Anaphylaxis is the most severe form of an immediate-type allergy that can be fatal. Because of the often dramatic start and clinical course of these responses, clinicians and patients must have practical understanding of how to manage them. There must be a distinction made between acute therapy modalities and general management suggestions for patients who have experienced an allergic reaction. Acute care includes general procedures such as positioning, inserting an intravenous catheter, calling for assistance, ensuring the patient's comfort, and administering medication. Depending on the severity of the clinical symptomatology, the acute therapy modalities are chosen. First and foremost, anaphylaxis must be diagnosed early and a variety of differential diagnoses must be considered. The diagnosis is entirely clinical, and laboratory testing are of no use in an emergency. In pharmacologic treatment, epinephrine is the most important anti-anaphylactic medication. It should be administered intramuscularly first, with intravenous administration being attempted only in the most severe cases or in the case of surgical operations. Furthermore, glucocorticosteroids are used to avoid long-term or biphasic anaphylaxis; nevertheless, they are ineffective in the acute scenario. Auto injectors for epinephrine can be used by the patient. In mild anaphylactic reactions, histamine H1-antagonists are useful; if possible, they should be given intravenously. In anaphylactic treatment, volume replenishment is critical. In the beginning, crystalloids can be utilized, but in cases of severe shock, colloid volume replacements must be employed. Patients experiencing an anaphylactic reaction should be monitored for 4-10 hours, depending on the severity of their symptoms. It is critical to be aware of or recognize high-risk patients, such as those with severe uncontrolled asthma or those who are on -adrenergic blockade. Inhaled under-agonists can also be used for laryngeal edema when bronchial symptoms are the focus. Prior to the administration of potentially anaphylaxis-inducing medications (e.g. radiographic contrast media), the use of combination H1- and H2-antagonists has been advocated for prophylaxis. Patients who have survived an anaphylactic reaction must be extensively investigated, and an allergy diagnosis must be made based on the eliciting agent and pathogenic mechanism. In the case of IgE-mediated anaphylaxis, allergen-specific immunotherapy is available for some allergens and can be beneficial, as in the instance of insect venom anaphylaxis. Patients should also be educated on the nature of anaphylaxis, the main eliciting agents, and the principles of behavior and coping with the condition, including how to use epinephrine autoinjectors and antianaphylactic medications. There have been produced educational programs for anaphylaxis.