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Î SS 28: Make a diagnosis of food-induced anaphylaxis based on signs
and symptoms in association with likely or known exposure to an
allergen. (R-C)
Î SS 29: Recognize that anaphylactoid reactions such as ingestion of
histamine from contaminated scombroid fish can produce reactions
mimicking anaphylaxis. (R-C)
Î SS 30: Do NOT rely on elevated serum tryptase to make the diagnosis
of food-induced anaphylaxis. (R-C)
Î SS 31: Insure that patients remain under medical supervision for a
minimum of 4-8 hours to observe for recurrence of symptoms from
anaphylaxis. (R-D)
Î SS 32: Prescribe 2 epinephrine auto-injectors for all patients at risk
for food-induced anaphylaxis. (R-B)
Î SS 33: Advise patients that avoidance of food allergens remains the
mainstay of long-term treatment of food-induced anaphylaxis. (S-C)
Î SS 34: Do NOT use immunotherapeutic treatments (desensitization)
in clinical practice to prevent food-induced anaphylaxis owing to
inadequate evidence for therapeutic benefit over risks of therapy. (R-A)
IV. Anaphylaxis to Drugs and Biological Agents
Î SS 35: Consider drug-induced vocal cord dysfunction if the patient
presents with a history of throat tightness and swelling without visible
orofacial angioedema and has been diagnosed as having anaphylaxis.
(S-D)
Î SS 36: Perform skin tests for the major (benzylpenicilloyl polylysine)
and a minor determinant (penicillin G) of penicillin in patients who
present with possible anaphylaxis to penicillin, recognizing that the
negative predictive value is 95%-99%. (S-B)
Î SS 37: Consider patients with a history of penicillin induced-
anaphylaxis, especially if it is a remote history, to be at very low
risk to react to cephalosporins, recognizing that life-threatening
reactions have occurred when patients allergic to penicillin are given
cephalosporins. (S-B)
Î SS 38: Recognize that vancomycin can produce manifestations similar
to anaphylaxis that are not mediated by IgE and can be prevented by
slow infusion of the drug. (S-C)
Î SS 39: Recognize that anaphylactic reactions to omalizumab can be
delayed in onset and progressive. Therefore, observe patients for 2
hours after the first 3 injections and 30 minutes after subsequent
injections. (S-C)
