Conflict of interest None.
The allergic emergency – management of severe allergic reactions
Article first published online: 27 MAR 2014
© 2014 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.
JDDG: Journal der Deutschen Dermatologischen Gesellschaft
Volume 12, Issue 5, pages 379–388, May 2014
How to Cite
Werner-Busse, A., Zuberbier, T. and Worm, M. (2014), The allergic emergency – management of severe allergic reactions. JDDG: Journal der Deutschen Dermatologischen Gesellschaft, 12: 379–388. doi: 10.1111/ddg.12309
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.
- Issue published online: 3 MAY 2014
- Article first published online: 27 MAR 2014
- Manuscript Accepted: 6 JAN 2014
- Manuscript Received: 22 OCT 2013
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.