16
Management
Table 11. Prevention of Further Episodes
e patient who has experienced a drug-related episode should be educated regarding
possible cross-reacting agents
If a food was the cause, the patient should be educated about cross-reactivity of foods
(eg, peanuts and lupin flour)
Drugs that place patients at risk for a more severe episode or complicate therapy should
be discontinued if possible. Potential agents include:
• β-adrenergic blocking agents
• Angiotensin-converting enzyme inhibitor
• Angiotensin blockers
• Monoamine oxidase inhibitors
• Certain tricyclic antidepressants
If the patient must be re-exposed to a drug which triggered an event, specialized
procedures such as desensitization and pretreatment can be performed
III. Anaphylaxis to Foods
Î SS 23: Consider food allergies in the etiology of anaphylaxis because
they are a common trigger for anaphylaxis. (R-C)
Î SS 24: Recognize that peanuts, tree nuts, fish, shellfish, milk, and
egg are the most commonly implicated foods, but that any food can
theoretically trigger anaphylaxis. (R-C)
Î SS 25: Test patients with unexplained anaphylaxis or a known delayed
SR to red meat for IgE specific antibodies for the oligosaccharide
alpha-gal particularly if they have a history of tick bites, because this
oligosaccharide allergen is expressed on the tissues of all nonhuman
mammals. Advise patients allergic to alpha-gal to avoid all mammalian
meats. (R-C)
Î SS 26: Do NOT instruct patients about the prognosis of food allergy
and anaphylaxis based on the severity of a previous reaction to a food
allergen or current diagnostic test reaction. (R-C)
Î SS 27: Recognize that some patients are at high risk for fatal,
food-induced anaphylaxis, such as (1) adolescents, (2) patients
with a history of reaction, (3) patients allergic to peanut or tree
nuts, (4) patients with a history of asthma, (5) those presenting
with the absence of cutaneous symptoms, or (6) those with delayed
administration of epinephrine. (R-C)
