Anaphylaxis in the emergency department: a paediatric perspective

Abstract

Correct management of anaphylactic manifestations in the emergency department is crucial to prevent mortality and future episodes, in particular for paediatric patients. We make here recommendations based on a critical review of the evidence for the management of anaphylaxis in emergency department with particular emphasis on children. Available information suggests that anaphylaxis must be promptly recognized keeping in mind the airway patency, breathing (ventilation and respiration), circulation and mental status and treated. The first treatment is epinephrine. After successful treatment of an anaphylactic episode, attention must be paid at prevention of early recurrences (biphasic anaphylaxis) and assessment of causes. Patients should not be discharged before prescribing self-injectable epinephrine and explain how and in under what circumstances it must be injected; giving an action plan to be communicated to their communities; inform the school about the possible occurrence of reactions and the appropriate avoidance and rescue measures; and consider the necessity of a Medic-Alert identification. As gross differences have been described in the awareness of the disease and its management between allergists and nonallergists, allergists should interact with emergency doctors to improve education in this area.