4
Diagnosis
I. Evaluation and Management of Patients with a History of
Anaphylaxis
Î Summary Statement (SS) 1: Evaluate any patient who has experienced
an episode of anaphylaxis for which the cause is not readily identified
to determine the cause and refer to an allergist or immunologist to
conduct this evaluation. (R-D)
Î SS 2: Supply any patient who has experienced an episode of
anaphylaxis for which the allergen cannot be easily and completely
avoided with auto-injectable epinephrine (AIE) and instructions as
to when and how to administer this injector and emphasize that they
should carry 2 AIEs with them at all times. (S-C)
Î SS 3: Instruct the patient to wear and/or carry identification denoting
his or her condition (eg, MedicAlert, 2193 West Chester Pike,
Broomall, PA 19008) and give the patient an anaphylaxis action plan.
(S-D)
Î SS 4: Individualize avoidance measures taking into consideration
factors such as the patient's age, activity, occupation, hobbies,
residential conditions, access to medical care, and level of personal
anxiety. (R-D)
Î SS 5: Use pharmacologic prophylaxis such as glucocorticosteroids
and antihistamines in select situations (eg, to prevent recurrent
anaphylactic reactions to radiocontrast material (RCM) or to prevent
idiopathic anaphylaxis). (R-C)
Î SS 6: When necessary, induce a temporary tolerance (desensitization)
in patients who have experienced anaphylaxis from medications. (R-C)
Î SS 7: Educate patients about hidden allergens and cross-reactivity
between various allergens and drugs. (R-C)
Î SS 8: Counsel patients at risk for future episodes regarding the use
of medications that could worsen an event or complicate therapy (eg,
β-adrenergic blockers). (R-C)
