SAN FRANCISCO – The best way to prepare for optimal delivery of care to anaphylaxis patients is to make sure you have the proper equipment on hand.
Suggested universal equipment includes a stethoscope and sphygmomanometer, epinephrine, oxygen, IV fluid, tourniquets, syringes, hypodermic needles, and large-bore needles, according to a 2010 practice parameter update developed by the American Academy of Allergy, Asthma, and Immunology; the American College of Allergy, Asthma, and Immunology; and the Joint Council of Allergy, Asthma, and Immunology.
Dr. Phillip Lieberman
"These should be available in all medical facilities and ready to use at the drop of a hat," Dr. Phillip Lieberman, a chief editor of the practice parameter, said at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.
Depending on the availability of emergency support services, the parameter advises having on hand a one-way valve face mask, oxygen inlet port, diphenhydramine, corticosteroids for IV use, vasopressors, and atropine (J. Allergy Clin. Immunol. 2010;126:477-80). In addition, some clinicians may strongly consider having glucagon available, as well as a defibrillator and oral airway devices.
Prompt recognition of anaphylaxis signs and symptoms is crucial, said Dr. Lieberman of the departments of medicine and pediatrics at the University of Tennessee, Memphis.
"If there is any doubt, it is generally better to administer epinephrine, because a sin of omission in this case exceeds a sin of commission," he said. "The drug in general is safe to use and it very rarely causes any significant side effects."
The parameter also noted that "the more rapid the treatment, the better the outcome. Therefore, personnel in a medical office dealing directly with the patient’s medical care should be familiar with the manifestations of anaphylaxis and be able to recognize an event quickly."
Dr. Lieberman said this means that "you need to charge your medical personnel with the task of being able to recognize symptoms that are early suggestions of an anaphylactic event."
The parameter lists epinephrine and oxygen as the most important therapeutic agents to administer in anaphylaxis. It calls epinephrine "the drug of choice, and the appropriate dose should be administered promptly at the onset of apparent anaphylaxis. In general, treatment in order of importance is: epinephrine, patient position, oxygen, intravenous fluids, nebulized therapy, vasopressors, antihistamines, corticosteroids, and other agents."
Dr. Lieberman disclosed that he is a consultant or paid speaker for Dey, Sanofi-Aventis, Genentech, Ista, Merck-Schering, Teva, Novartis, Meda, and Alcon.