Recognition Of Anaphylaxis Research Articles

Rare and Fatal Complication: A Case of Ketorolac-Induced Anaphylaxis Leading to Cardiac Arrest and Hypoxic-Ischemic Brain Injury in a Young Adult

Background: Anaphylaxis is a severe, life-threatening allergic reaction that can lead to cardiac arrest and hypoxic-ischemic brain injury (HIBI). Ketorolac, a nonsteroidal anti-inflammatory drug (NSAID) commonly used for postoperative pain management, has been rarely associated with anaphylaxis. Case presentation: We present the case of a 32-year-old woman who developed anaphylaxis and subsequent cardiac arrest following intravenous administration of ketorolac after an appendectomy. Despite successful resuscitation, the patient suffered from HIBI and remained in a persistent vegetative state. Conclusion: This report highlights the potential for fatal complications associated with ketorolac administration and emphasizes the importance of prompt recognition and management of anaphylaxis in the perioperative setting. This case underscores the need for heightened vigilance regarding potential anaphylactic reactions to ketorolac, even in patients with no prior history of drug allergies. Early recognition and aggressive management of anaphylaxis are crucial to minimize the risk of severe complications like cardiac arrest and HIBI.

Anaphylaxis diagnosis and management

Background: Anaphylaxis is an acute, generalized, potentially life-threatening, severe allergic reaction. It is critical to recognize the signs and symptoms of anaphylaxis as early as possible and initiate immediate treatment. Epinephrine is the drug of choice to treat anaphylaxis.Current Concepts: The World Allergy Organization (WAO) revised and updated its diagnostic criteria for anaphylaxis in 2020. Previous criteria were proposed by the 2005 United States National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network Symposium, which were subsequently adopted by the WAO in 2011 and have contributed greatly to improving the diagnosis and treatment of anaphylaxis. The updated diagnostic criteria were adopted by the European Academy of Allergy and Clinical Immunology and began to be implemented in 2021.Discussion and Conclusion: The two diagnostic criteria share the common goal of immediate recognition of anaphylaxis allowing prompt patient treatment. The updated WAO Diagnostic Criteria for Anaphylaxis 2024 have been simplified to cover more clinical situations potentially involving anaphylaxis. Physicians should be aware of anaphylaxis diagnosis and management procedures so that they are prepared to save patient lives.

Knowledge and Awareness of Anaphylaxis and Anaphylactic Shock Among the General Population of the Western Region of Saudi Arabia.

Introduction Anaphylactic shock is a severe and acute life-threatening condition triggered by exposure to common allergens. Despite the increasing incidence of anaphylaxis worldwide, there is still a lack of awareness and understanding of anaphylaxis and its proper management. Methods A descriptive survey design was used to evaluate the knowledge and awareness of anaphylactic shock among the general population in the western region of Saudi Arabia through an online questionnaire distributed from January 2024 to June 2024. The validated questionnaire included demographic information and 18 knowledge-based questions on anaphylaxis. Results The data was collected from 501 participants in the western region of Saudi Arabia. Among them, 290 (58%) were female, and 211 (42%) were male. The largest age group was between 41 and 50 years, comprising 121 participants (24.1%). Additionally, most participants, 298 (59.4%), held a bachelor's degree. A total of 207 participants (41.3%) reported either experiencing anaphylaxis or knowing someone who had. Furthermore, 123 participants (24.5%) underwent tests for anaphylaxis or anaphylactic shock, with 88 (17.5%) having a blood test and 35 (7%) having a skin prick test. In terms of knowledge about anaphylaxis, 266 participants (53%) were able to accurately identify multiple symptoms, while 195 (38.9%) were uncertain about the proper diagnostic methods. Moreover, only 92 (18.4%) recognized epinephrine as the first-line treatment, and 125 (25%) knew the correct administration route (intramuscular). 216 participants (43.1%) were aware of the need to visit the ER after using epinephrine. Furthermore, the survey findings indicated that 318 participants (63.5%) acknowledged the dangerous nature of anaphylaxis, with 258 (51.5%) believing that it could be fatal. However, 228 (45.5%) remained unsure about the risk of anaphylaxis-associated organ failure. Conclusion The study highlighted the need for targeted public awareness campaigns to improve understanding and ensure early recognition and correct management of anaphylaxis.

Association Between Early Patient Characteristics and IgE-Mediated Allergy in the Perioperative Setting

BackgroundEarly recognition of perioperative anaphylaxis, a life-threatening, usually immunoglobulin E [IgE]-mediated, immediate hypersensitivity, is essential, but bedside diagnosis is not always straightforward as clinical presentation may vary. ObjectivesTo describe early characteristics of perioperative immediate hypersensitivity (POH), with a special attention on cutaneous phenotypes, and identify risk factors for IgE-mediated allergy. MethodsWe retrospectively analyzed data from adults with suspected POH who were investigated in two academic medical centers. Multivariable logistic regression was conducted to evaluate associations between patient, clinical, and paraclinical characteristics and IgE-mediated allergy. ResultsOut of 145 patients enrolled, 99 (68.3%) and 46 (31.7%) were respectively categorized in the IgE-mediated allergy and non-allergy groups. Cutaneous vasoconstriction phenotype (pallor, piloerection, thelerethism, sweating ± cyanosis) occurring within minutes (or even one minute) of drug-exposure, was strongly associated with IgE-mediated allergy (adjusted odds ratio [aOR]: 28.02, 95% confidence interval [CI]: 4.41-305.18). IgE-mediated allergy was always life-threatening in this setting. Other early factors associated with allergy were low end-tidal carbon dioxide (ETco2) ≤25mmHg (aOR: 5.45, 95%CI: 2.39-26.45), low mean arterial pressure (MAP) ≤60mmHg (aOR: 3.82, 95%CI: 1.28-17.31), and early cutaneous vasodilation (erythema, urticaria and/or angioedema) (aOR: 2.78, 95%CI: 0.73-20.54). Late cutaneous vasodilation following restoration of hemodynamics corroborated the diagnosis of allergy (aOR: 23.67, 95%CI: 4.94-205.09). The best-fit model including three readily available variables (cutaneous phenotype involving the three modalities [reference lack of cutaneous signs], low MAP and low ETco2) had an AUC of 0.91. ConclusionsCutaneous vasoconstriction phenotype is associated with the strongest risk of life-threatening allergy and may thus be regarded as pathognomonic of perioperative IgE-mediated anaphylaxis.

Clinical governance implications of a Victorian coronial finding regarding contrast-related anaphylaxis for health services and private providers of radiology services.

What is known about the topic? Anaphylaxis is a rare but inherent risk of treatments and investigational agents. What does this paper add? Using a recent coronial finding in Victoria, this letter explores clinical governance responsibilities of health services and private providers of radiology services with respect to anaphylaxis recognition and management. What are the implications for practitioners? There is a strong case for health service and corporate governance teams (for stand-alone clinics) to ensure that all staff have recent, adequate training to recognise and initiate treatment of anaphylaxis. Reliance on an ambulance response is not enough.

The Ability of First Aid Providers to Recognize Anaphylaxis: A Scoping Review.

Early recognition of anaphylaxis is critical to early treatment and often occurs in the first aid setting. However, the ability of first aid providers to recognize anaphylaxis is unknown. We sought to examine the evidence regarding first aid providers' ability to recognize anaphylaxis. Our scoping review was performed as part of the International Liaison Committee on Resuscitation (ILCOR) continuous evidence evaluation processes to update the 2020 ILCOR Consensus on Science with Treatment Recommendations. We searched Medline, Embase, Cochrane, and the gray literature from 2010 to September 2022. The population included adults and children experiencing anaphylaxis with a description of any specific symptom to a first aid provider. Recognition of anaphylaxis was the primary outcome. Two investigators (DM and PC) reviewed abstracts and extractedand assessed the data. Discrepancies between the reviewers were resolved by discussion and consensus with the ILCOR First Aid Task Force. Out of 957 hits, 17 studies met inclusion criteria: one review and meta-analysis, two experimental studies, and 14 observational studies. We did not identify any studies that directly addressed our PICOST (Population, Intervention, Control, Outcomes, Study Design, and Timeframe) as none were performed in the first aid setting. Articles included individuals who may be first aid providers as patients and parents (n=5), teachers, students or school staff (n=8), caregivers and patients (n= 2) or nannies (n=1). All included studies were conducted in high-income countries. Our scoping review found that signs and symptoms of anaphylaxis were not specific and did not allow for easy identification by the first aid provider. Studies focused on education (n=10) and protocols (n=2) and found that both could have a positive impact on anaphylaxis recognition and management. While we did not identify any clinical studies that directly addressed the ability of first aid providers to identify anaphylaxis, future studies examining education methods and action plans may help improve the identification of anaphylaxis by first aid providers.

Safety of mRNA vaccination for COVID‐19 in children with polyethylene glycol (PEG)‐asparaginase allergy

Safety of <scp>mRNA</scp> vaccination for <scp>COVID</scp>‐19 in children with polyethylene glycol (<scp>PEG</scp>)‐asparaginase allergy

Canada’s First Joint Oncology-Allergy Clinic: Successful Desensitization to Trastuzumab Following Severe Anaphylactic Reaction in Which Epinephrine Was Inappropriately Withheld

Recognition of anaphylaxis and differentiation from other infusion reactions in an oncology setting is imperative; epinephrine is the recommended treatment for anaphylaxis and should be administered immediately to patients in whom anaphylaxis is suspected. Trastuzumab has a potentially tremendous oncological benefit, and when hypersensitivity reactions occur, rechallenge with desensitization protocols has become more common. Oncology presents a unique situation in which repeat drug exposure after a serious adverse reaction is often warranted due to the mortality risk of untreated cancer-allergists can assist with both symptom assessment and risk mitigation. This case showcases successful desensitization in a 43-year-old female with locally advanced HER2-positive breast cancer following a severe anaphylactic reaction to trastuzumab, in which epinephrine was not administered. We report the establishment of the Medical Oncology and Allergy Clinic: Canada's first multidisciplinary clinic aimed at expediting the assessment and management of oncology patients with adverse drug reactions (including chemotherapy, contrast media, antimicrobials) and those with primary and acquired immunodeficiency. We propose this multidisciplinary clinic model as a treatment framework moving forward, with the goal of continuing first-line therapies in cancer patients who develop drug-hypersensitivity (i.e., through desensitization). This case highlights the unmet need for a multidisciplinary approach to the management of oncology patients who experience hypersensitivity reactions.

Preparedness and Knowledge Level of Family Physicians Regarding Anaphylaxis Diagnosis and Management

Objective: Anaphylaxis is under-recognized and undertreated by physicians, indicating critical knowledge gaps. This study aimed to assess the knowledge levels of anaphylaxis among family physicians (FPs) as they are the primary first-line healthcare providers and identify the factors influencing their knowledge levels. Materials and Methods: A cross-sectional study using an internet-based Google Forms questionnaire was conducted among voluntary FPs in Sivas, Turkey. Demographic features, including age, years in practice, career position, and knowledge related to the diagnosis and management of anaphylaxis in children were assessed. Results: A total of 149 FPs participated in the survey (34 [24.3%] general practitioners [GPs], 20 [14.3%] contracted family physicians [CFPs], 74 [52.9%] residents in training [RITs], and 12 [8.6%] specialists). The number of participants who correctly answered all questions regarding diagnosis, acute treatment, and epinephrine auto-injector use was 11 (7.9%), 52 (37.4%), and 27 (19.3%), respectively. In diagnosing anaphylaxis, 100 (72.5%) participants were unaware that anaphylaxis can occur without skin manifestations, and only 48 (34.8%) identified gastrointestinal symptoms as a possible anaphylaxis presentation. RITs (11, 14.9%) and specialists (2, 16.7%) had better performance on the questionnaire, with higher proportions of participants who answered all questions correctly, compared to GPs (2, 5.9%) and CFPs (1, 5.0%). Attendance at an educational activity in the last year was the only independent factor associated with answering all questionnaire items correctly. Conclusion: There is a need to improve anaphylaxis recognition and management among all FPs regardless of their career position and work experience, underlining the importance of regular and updated educational interventions.

A Conceptual Framework for Instructional Design of a High Acuity and Low Occurrence Event - Simulation Based Education Training of Residents, Medical Students, and Nurses in Anaphylaxis Utilizing Curated Educational Theories.

The broad goal of this educational curriculum is utilization and optimization of Simulation-Based Education (SBE) in the training of residents, medical students, and nursing staff involved in the rapid and timely recognition of Anaphylaxis and its optimized treatment. A critical gap in Anaphylaxis Diagnosis, Management, and Treatment (ADAM) has been well established across medical disciplines. It is imperative to include all members of the healthcare team, as nurses and pharmacists play key roles in anaphylaxis recognition and care. Nurses and pharmacists are proficiently trained in the initial assessment of acute patient complaints, status, and in proper dosing/administration considerations. Anaphylaxis is a High Acuity and Low Occurrence (HALO) event. Delayed recognition and administration of epinephrine-autoinjector (EAI) is a patient safety concern. Suboptimal technique and expertise in this regard is common. Literature abounds with reports of physician trainee doubts and uncertainties in the recognition and optimized management of Anaphylaxis. Importantly, Anaphylaxis is frequently misdiagnosed in hospital emergency departments. SBE methodologies are ideal for instructing HALO experiences. The framework of the "Zone of Simulation Matrix" supports the utilization of a simulation experience in this instance. Learning will be effective, enhanced, and made durable by embedding numerous specifically curated educational theories. Given the paucity in training of residents and nursing staff in Anaphylaxis, such instruction is imperative. Of note, a special emphasis in this curricular framework is the debriefing experience. Considerations will be given to the psychological safety of the trainees and the importance of the heterogeneity of prior experiences. Precise diagnosis minimizes mortality. In the hospital setting, nurses are the first responders to critical HALO events, and there is a lack of awareness of ADAM by nursing students.

Evaluating the Food Allergy Passport: A Novel Food Allergy Clinical Support Tool

The prevalence of pediatric food allergy (FA) has increased in the past 2 decades. The previous literature suggests that FA presents burdens, both economically and psychosocially, to children and their caregivers, especially families in lower-income strata. Using data from a previously published needs assessment, the Food Allergy Management in Low-Income Youth study, the FA Passport and Workbook tools were developed to address identified needs. This study evaluated the utility of the FA Passport in helping families insured by Medicaid to manage FA better and improve quality of life. Families insured through Illinois Medicaid were recruited from two Chicago-based allergy clinics. Caregivers of children with FA completed a pretest evaluating knowledge, attitudes, beliefs, and practices regarding FA management. A clinician guided caregivers through the FA Passport. The caregivers then completed a posttest immediately afterward and again 3 months later. Changes were evaluated from baseline responses and direct feedback was elicited about the tool. The FA Passport successfully improved caregiver-reported confidence with epinephrine autoinjector use (from 69% to 93%), caregiver anaphylaxis recognition (from 66% to 73%), and reported quality of life, and it nearly doubled caregiver comfort regarding leaving the child in the care of others (from 40% to 75.7%). Caregivers rated the FA Passport tool as extremely helpful overall (9.4 out of 10). The FA Passport is a novel FA clinical support tool that addresses barriers to proper FA management described in previous studies. It proved effective at improving caregiver comfort with regarding leaving the food-allergic children with other caregivers, increasing FA knowledge, and improving the quality of life in families affected by FA.

Management Of Anaphylaxıs In Pedıatrıc Populatıon.

Although an increase in the incidence of childhood anaphylaxis has been reported, it remains underdiagnosed. Foods are the most common triggers for anaphylaxis, particularly cow's milk, hen's egg, and nuts. Other common causes of anaphylaxis in children and adolescents include venom and drugs. The skin is the most commonly affected organ, but approximately 10% of patients with anaphylaxis may present without skin symptoms, which can lead to misdiagnosis. Recognition of anaphylaxis is a great challenge in children, possibly due to a lack of vigilance among patients, caregivers, and healthcare professionals, but also in part due to discrepancies in the clinical definition of anaphylaxis. In addition, anaphylaxis in infants often poses a distinct challenge because the wide spectrum of clinical manifestations and the inability of infants to describe their symptoms may hinder prompt diagnosis and treatment. Given the rapid onset of anaphylaxis and its unpredictable severity, rapid assessment and appropriate treatment are critical. Although the morbidity and mortality associated with anaphylaxis are potentially preventable with the timely administration of life-saving epinephrine, anaphylaxis is still undertreated worldwide. Long-term management of pediatric anaphylaxis is a patient-centered, multidimensional approach that focuses on the recognition of anaphylaxis, the use of epinephrine auto-injectors, and prevention of recurrences. Therefore, close communication and collaboration between the child, caregivers, healthcare professionals, and schools is the cornerstone of long-term care. This paper is designed to provide a comprehensive overview of current perspectives and concepts related to anaphylaxis in the pediatric population in light of recent guidelines and literature.

Variation in diagnosis and management of allergic reactions among emergency medicine and allergy immunology providers

Background: Children with anaphylaxis often emergently present for treatment. Providers' adherence to the principles of optimal management according to the most recent national guidelines is unknown. Objective: To assess the variation in management approaches for allergic reactions and anaphylaxis between allergy/immunology (AI) and emergency medicine (EM) providers. Methods: This was a cross-sectional survey study of AI and EM providers in the University of Colorado affiliated hospitals and Colorado Asthma and Allergy Society. The survey consisted of six cases of patients with allergic reactions, with four cases that represented patients with anaphylaxis that resolved by the time of discharge. For each vignette, the participants were asked about preferred initial therapy, adjunctive therapies, monitoring, outpatient prescription medications, and discharge instructions provided. Survey derivation and validation was accomplished by a multidisciplinary team of experts by using a modified Delphi process. Results: A total of 413 clinicians were contacted, of whom 194, (47%) responded, including 69 pediatric EM, 50 general EM, and 49 AI providers, and 26 did not identify a provider type. There were no statistically significant differences in correct recognition of anaphylaxis between the AI and EM providers. For each case, statistically significant differences were noted in the use of corticosteroids during and after resolution of anaphylaxis: AI providers reported giving fewer prescriptions than did the EM providers for corticosteroids in all cases of anaphylaxis (p < 0.001). The AI providers were less likely to prescribe scheduled antihistamines than were the EM providers in half of the cases (p < 0.02). Conclusion: Across the specialties, there were high rates of recognition of epinephrine as first-line treatment for anaphylaxis. The majority of the EM providers prescribed scheduled corticosteroids and antihistamines after resolution of anaphylaxis, whereas most of the AI providers did not prescribe scheduled corticosteroids. Analysis of the current data suggests against the routine use of corticosteroids in the management of anaphylaxis, particularly continued use after resolution of symptoms. AI involvement in the creation of EM and hospital protocols for allergic reactions could improve overall care.

Children at risk of anaphylaxis: A mixed-studies systematic review of parents' experiences and information needs.

To explore parents' self-reported experiences and information needs regarding recognition and management of pediatric anaphylaxis. We searched Ovid Medline, Ovid PsychInfo, CINAHL Plus, the Cochrane Library, and grey literature to identify primary studies in English or French published since 2000. We used a mixed-method appraisal tool and convergent integrated approach to assess quality and synthesize data, respectively. 43 studies were included (22 quantitative, 19 qualitative, and 2 mixed-method); 77% of studies had high methodological quality. Parents' experiences were categorized as: recognizing an anaphylactic reaction; managing and responding to a reaction; emotional impact of caring for a child at risk of anaphylaxis; and interaction with the health system and healthcare providers. Parents' information needs were categorized into themes relating to: gaps in knowledge and information; type of information desired; information sources; and information delivery format. Negative emotional experiences and a general lack of information were commonly reported by parents of included studies. Provision of relevant and comprehensible information may help parents to make informed decisions and manage reactions promptly. The findings of this review are guiding the development of an innovative knowledge translation tool (KT) as part of a larger initiative of developing a suite of parent-focused KT tools for acute childhood conditions.

Bridging Knowledge Gaps in Anaphylaxis Management Through a Video-Based Educational Tool.

Introduction: We aimed to develop and test the effectiveness of an education tool to help pediatric patients and their families better understand anaphylaxis and its management, and to improve current knowledge and treatment guidelines adherence. Methods: From June 2019 to May 2022, 128 pediatric patients with history of food-triggered anaphylaxis who presented to the allergy outpatient clinics at the study institution were recruited. Consenting families were asked to complete 6 questions related to the triggers, recognition, and management of anaphylaxis at the time of presentation to the clinic. Participants were shown a 5-min animated video on the causes, presentation, and management of anaphylaxis. At the end of the video, the participants were redirected to the same 6 questions to respond again. The scores were recorded in proportion of correct answers (minimum 0.0; maximum 1.0). Results: The mean age of the patients was 5.8 ± 4.5 years (range: 0.5-18.8 years). The majority were males (70 patients; 54.7%). The mean baseline prevideo education questionnaire score was 0.76 ± 0.2 (range: 0.3-1.0), whereas the mean follow-up score was 0.82 ± 0.2 (range: 0.3-1.0). This score difference of 0.06 was statistically significant (P < 0.001). There were no significant associations between change in scores and age or gender of the participants. Conclusion: Our video teaching method was successful in educating patients and their families to better understand anaphylaxis and its management at the moment of the clinical encounter. Retention of knowledge at long-term follow-up should be assessed.

Disparities in the Diagnosis and Management of Anaphylaxis.

The goal of this review is to characterize health disparities impacting the recognition and treatment of anaphylaxis. Previous research has identified major health disparities related to atopic conditions including asthma, atopic dermatitis, and food allergies (FA); however, disparities related to anaphylaxis have yet to be examined in depth. We found widespread health disparities in the incidence and severity of anaphylaxis, as well as in the management of allergies (particularly food allergies) that place individuals at risk of anaphylaxis. Sociodemographic factors are associated with numerous negative health outcomes related to anaphylaxis. We highlight several key steps that must be taken to address these disparities.

Impact of Reaction Setting on the Management, Severity, and Outcome of Pediatric Food-Induced Anaphylaxis: A Cross-Sectional Study

Prompt epinephrine autoinjector (EAI) use is the primary treatment for anaphylaxis. However, limited Canadian data exist on the impact of reaction location on EAI use for food-induced anaphylaxis (FIA). We sought to investigate the setting, management, and severity of pediatric FIA. We recruited children presenting with FIA from 11 Canadian emergency departments. Patient demographics and the setting, management, and symptoms of FIA were collected by standardized questionnaire. Factors associated with prehospital EAI use and reaction severity were determined by logistic regression. We recruited 3,604 children; 60.2% were male and the median age was 5.0 years (interquartile range 1.8-11.0). Among cases with a known location of FIA (85.0%), home was the most common setting (68.1%), followed by school/daycare (12.8%), other locations (11.4%; eg, park, car), and restaurants (7.4%). In the prehospital setting, EAI was administered in 36.7% of reactions at home, 66.7% in school/daycare, 40.2% in other locations, and 44.5% in restaurants. Relative to reactions occurring at school/daycare, prehospital EAI use was less likely at home (adjusted odds ratio [aOR] 0.80; 95% CI 0.76-0.84), in restaurants (aOR 0.81; 95% CI 0.75-0.87), and in other settings (aOR 0.77; 95% CI 0.73-0.83), when data were adjusted for reaction severity, sex, age, comorbidities, and province. The FIA setting was not associated with reaction severity or hospitalization. Prehospital EAI use was higher at school/daycare than in other settings, potentially owing to the presence of policies and training on FIA. Setting-specific interventions including educational programs and policies/laws mandating training and stocking an EAI may improve anaphylaxis recognition and treatment.

Benefit of educational intervention on Autoinjector Technique for caregivers and paediatric patients with food allergies: A literature review.

The incidence of food allergy among children is on the rise. Children who are diagnosed with a food allergy receive long-term treatment for allergy management from allergy specialists, nurses and dieticians. This management may include the prescription of an adrenaline autoinjector (AAI) if the child is at risk of a severe allergic reaction (anaphylaxis). Therefore, it is important that parents of children with allergies are trained in the recognition of anaphylaxis and in the correct administration of an AAI. However, many parents are unable to correctly administer an AAI when assessed. The aim of this study is to review the current literature on caregiver's and paediatric patients' ability to use an AAI. An electronic search to evaluate AAI technique in caregivers and children with food allergy was conducted. A total of 323 articles were screened in which 10 studies were reviewed. Seventy-eight percent of parents who had never been trained in the use of an AAI were unable to trigger it. In studies where paediatric patients' ability to use an AAI was assessed, a mean score of 7.78/9 was derived for AAI knowledge among adolescents. Caregivers and patient's ability to use an AAI was inconclusive, and further research should address the validation of an assessment tool for AAI use. A significant improvement in AAI use was found after an educational intervention. This highlights the need for improved education for allergic individuals and their caregivers, and further study should explore what are the best educational methods to meet these needs.

Anaphylaxis in Children.

Anaphylaxis is a potentially life-threatening event in children, commonly encountered in the prehospital and emergency department settings. Recently published clinical guidelines emphasize early recognition of anaphylaxis and administration of epinephrine as the mainstay of management. Literature regarding adjuvant therapies, biphasic reactions, observation times, and disposition of patients with anaphylaxis remains controversial. In this article, we will review the background and pathophysiology of anaphylaxis, as well as the diagnostic approach, management, and future directions of anaphylaxis in children.

Outcomes of simulation-based anaphylaxis education in a diverse group of participants

Anaphylaxis, a life-threatening and systemic disease, is often under-recognized.1,2 Prompt recognition of anaphylaxis and administration of epinephrine is critical in the acute management1 and can prevent significant patient morbidity and mortality. Studies have revealed that case simulation is more effective when compared with standard classroom learning.3,4 Anaphylaxis simulation cases are effective in educating medical students, physicians, mid-level providers, and nurses in varied settings.5-9 Our study aim was to identify knowledge deficits in the diagnosis and acute management of anaphylaxis among various medical personnel through a case-based simulation activity.