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Î SS 65: Advise patients to stop exercising immediately at the first
onset of symptoms, because continued exertion results in worsening
of the episode. (S-D)
Î SS 66: Advise all patients to carry 2 epinephrine auto-injectors and
exercise with a partner who can recognize symptoms and administer
epinephrine. (S-D)
Î SS 67: Recognize that medications used prophylactically will not
universally prevent symptoms of EIA. (R-D)
IX. Anaphylaxis to Subcutaneous Allergen Immunotherapy
(AIT) Extract (vaccine)
Î SS 68: Before initiating subcutaneous AIT injections, inform patients
about the risk of immediate and late-onset (beginning after 30
minutes) systemic allergic reactions and the minimal risk of life-
threatening and fatal anaphylaxis. (R-C)
Î SS 69: Administer allergen injections in a supervised clinic setting
staffed by personnel trained in recognition and treatment of
anaphylaxis and observe patients for ≥30 minutes after injections.
(R-C)
Î SS 70: Because most fatal anaphylactic reactions to allergen
injections have been reported in patients with uncontrolled asthma,
assess current asthma control at each visit before administration of
allergen injection(s) in patients with asthma receiving immunotherapy.
(R-C)
Î SS 71: Consider alternatives to angiotensin-converting enzyme (ACE)
inhibitors and β-blockers as possible antihypertensive therapy in the
setting of immunotherapy for venom anaphylaxis. (R-C)
Î SS 72: Start or continue AIT in patients who take β-blockers only if the
benefits in such patients clearly outweigh the risks (eg, patients with
stinging insect hypersensitivity). (R-C)
Î SS 73: Recognize the potential possible risk factors that can
contribute to severe anaphylaxis from immunotherapy injections and
implement measures to prevent and manage severe systemic allergic
reactions. (R-C)
X. Unusual Presentations of Anaphylaxis
Î SS 79: Be aware that anaphylaxis can present with unusual clinical
manifestations such as chest pain and that these patients might
require treatment with epinephrine. (R-C)
