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Anaphylaxis

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Key Points ÎAnaphylaxis is an acute, life-threatening systemic reaction with varied mechanisms, clinical presentations, and severity that results from the sudden systemic release of mediators from mast cells and basophils. (B) ÎThe more rapidly anaphylaxis develops, the more likely the reaction is to be severe and potentially life-threatening. (C) ÎPrompt recognition of signs and symptoms of anaphylaxis is crucial. If there is any doubt, it is generally better to administer epinephrine. (C) ÎEpinephrine and oxygen are the most important therapeutic agents administered in anaphylaxis. Epinephrine is the drug of choice, and the appropriate dose should be administered promptly at the onset of apparent anaphylaxis. (C) ÎAppropriate volume replacement either with colloid or crystalloids and rapid transport to the hospital are essential for patients who are unstable or refractory to initial therapy for anaphylaxis in the office setting. (B) ÎMedical facilities should have an established plan of action to deal with anaphylaxis that is regularly practiced and the appropriate equipment to treat anaphylaxis. (B) ÎPhysicians and office staff should maintain clinical proficiency in anaphylaxis management. (D) ÎIn addition, telephone numbers for paramedical rescue squads and ambulance services might be helpful to have on hand. (C) Diagnosis and Assessment ÎThe history is the most important tool to determine whether a patient has had anaphylaxis and the cause of the episode. (C) ÎA thorough differential diagnosis should be considered, and other conditions should be ruled out. (C) ÎLaboratory tests can be helpful to confirm a diagnosis of anaphylaxis or rule out other causes. Proper timing of such tests (eg, serum tryptase) is essential. (B) ÎIn the management of a patient with a previous episode of anaphylaxis, education is necessary. Emphasis on early treatment, specifically the self-administration of epinephrine, is essential. (C) ÎThe patient can be instructed to wear and/or carry identification denoting his or her condition (eg, Medic Alert jewelry), and can also be instructed to have telephone numbers for paramedic rescue squads and ambulance services on hand. A written action plan can be helpful in this regard. (C)

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