The allergic emergency – management of severe allergic reactions

Authors

  • Alexandra Werner-Busse,

    Corresponding author
    1. Allergy Center Charité, Department of Dermatology, Venerology and ­Allergology at the Charité – Central Campus, Berlin
    • Correspondence to

      Dr. med. Alexandra Werner-Busse

      Allergy Center Charité

      Department of Dermatology, Venerology and Allergology

      at the Charité – Central Campus

      Luisenstraße 2

      10117 Berlin, Germany

      E-mail: alexandra.werner-busse@charite.de

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  • Torsten Zuberbier,

    1. Allergy Center Charité, Department of Dermatology, Venerology and ­Allergology at the Charité – Central Campus, Berlin
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  • Margitta Worm

    1. Allergy Center Charité, Department of Dermatology, Venerology and ­Allergology at the Charité – Central Campus, Berlin
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  • Conflict of interest None.

  • Section Editor

    Prof. Dr. Jan C. Simon, Leipzig

  • Corrected after online publication on 27 March, 2014: the title was updated

  • Anaphylaxis is defined as a mast cell-­dependent reaction with acute onset and potentially fatal outcome.

  • Depending on age and geographic ­region, the most common triggers of anaphylaxis may vary.

  • The occurrence as well as the severity of anaphylaxis may be co-determined by risk factors.

  • The diagnosis of anaphylaxis or an allergic emergency is primarily made clinically.

  • In the aftermath of a reaction (2–4 weeks), an allergy work-up should always be performed.

  • The early, preferably intramuscular, administration of epinephrine has been recommended by European and ­German guidelines as first-line therapy.

  • Apart from the technical equipment, e.g. cardiac monitoring and CPR ­facilities, the physicians and nurses involved have to be trained in allergic emergency procedures.

  • All patients having suffered a severe ­allergic reaction to foods or insect venoms have to receive an emergency allergy kit.

Summary

Anaphylaxis is characterized by the sudden onset of acute allergic symptoms involving two or more organ systems. An acute allergic emergency is a challenge for physicians due to its life-threatening potential. The incidence of anaphylactic reactions has increased in recent years. Most frequent elicitors of mast cell and primarily histamine dependent anaphylactic reactions are food, insect venom or drugs. Allergic ­reactions are graded into four groups according to the classification by Ring and Messmer; grade I is defined by the onset of cutaneous symptoms only whereas grade IV is characterized by cardiovascular shock as well as cardiac and/or respiratory arrest.

The treatment of allergic reactions should be guided by the severity of the reaction. Initially an intramuscular epinephrine injection into the lateral thigh should be given if cutaneous, mucosal and cardiovascular/respiratory symptoms occur. Additionally, the patient should receive intravenous antihistamines and corticosteroids. For self-treatment in the case of an allergic emergency, oral antihistamines and corticosteroids should be prescribed to the patient.

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