Warning: imagejpeg(C:\Inetpub\vhosts\kidney.de\httpdocs\phplern\29123869
.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 Acute+Med+Surg
2017 ; 4
(3
): 235-245
Nephropedia Template TP
gab.com Text
Twit Text FOAVip
Twit Text #
English Wikipedia
Drug-induced anaphylaxis in the emergency room
#MMPMID29123869
Takazawa T
; Oshima K
; Saito S
Acute Med Surg
2017[Jul]; 4
(3
): 235-245
PMID29123869
show ga
Anaphylaxis is a life-threatening, systemic allergic reaction that presents
unique challenges for emergency care practitioners. Anaphylaxis occurs more
frequently than previously believed. Therefore, proper knowledge regarding the
epidemiology, mechanisms, symptoms, diagnosis, and treatment of anaphylaxis is
essential. In particular, the initial treatment strategy, followed by correct
diagnosis, in the emergency room is critical for preventing fatal anaphylaxis,
although making a diagnosis is not easy because of the broad and often atypical
presentation of anaphylaxis. To this end, the clinical criteria proposed by the
National Institute of Allergy and Infectious Diseases and the Food Allergy and
Anaphylaxis Network are useful, which, together with a differential diagnosis,
could enable a more accurate diagnosis. Additional in vitro tests, such as plasma
histamine and tryptase measurements, are also helpful. It should be emphasized
that adrenaline is the only drug recommended as first-line therapy in all
published national anaphylaxis guidelines. Most international anaphylaxis
guidelines recommend injecting adrenaline by the intramuscular route in the
mid-anterolateral thigh, whereas i.v. adrenaline is an option for patients with
severe hypotension or cardiac arrest unresponsive to intramuscular adrenaline and
fluid resuscitation. In addition to the route of administration, choosing the
appropriate dose of adrenaline is essential, because serious adverse effects can
potentially occur after an overdose of adrenaline. Furthermore, to avoid future
recurrence of anaphylaxis, providing adrenaline auto-injectors and making an
etiological diagnosis, including confirmation of the offending trigger, are
recommended for patients at risk of anaphylaxis before their discharge from the
emergency room.