How should severe allergic reactions be managed in the community?

Anaphylaxis is a severe allergic reaction most commonly caused by various food, venom and drug allergies. It leads to widespread effects on the body, and most importantly can damage the function of the heart and lungs that can have life-threatening consequences. A recent study published in the Medical Journal of Australia summarised the current evidence and research regarding this disorder. This study hopefully will allow doctors to develop safe and appropriate management plans for patients who present with this condition. The mainstay of treatment for anaphylaxis continues to be adrenaline which can also be self administered by patients using EpiPen devices in the community.

Anaphylaxis is a severe and life-threatening allergic reaction that affects nearly one out of 170 school children at some time in their life. In children it frequently occurs due to allergies to certain foods, whilst adults usually react to insect venoms and certain medications. A severe reaction to a bee sting (involving swelling of the face and throat and difficulty breathing) is a common example of anaphylaxis. When the sensitive individual is exposed to these allergens, special cells called mast cells, release numerous allergic mediators. These affect many systems within the body including the integumentary (skin), cardiovascular, respiratory and gastrointestinal systems. This can present as rashes, itchiness of the skin, fall in blood pressure, and difficult or noisy breathing. If you experience these symptoms it is important to see a doctor immediately. Unfortunately it is almost impossible to predict who will experience these reactions or necessarily prevent them from occurring so doctors and patients require an appropriate plan of action to combat this disorder. A recent study published in the Medical Journal of Australia provided a thorough overview of how anaphylaxis should be diagnosed and treated. Hopefully this will help doctors in emergency departments and community practices know how to treat this disorder appropriately. Researchers confirmed that the best treatment of anaphylaxis is the drug called adrenaline. This needs to be injected into the muscle on the side of the thigh, promptly following the development of symptoms. In a hospital setting this can be followed with fluid therapy to restore blood pressure and close monitoring. However in the community, management is by using a pen device to inject the dose of adrenaline. If you have ever experienced an allergic reaction you should be equipped with an EpiPen device and a medical alert bracelet highlighting your condition. Children of 10-20 kg required a lower dose (0.15mg) EpiPen junior device whilst older children and adults use 0.3mg. In the event of severe allergic symptoms the dose should be self injected. This is done by removing the grey cap, holding the device in a closed fist, and pushing the black end into the side of the thigh (through clothes if needed). This should be held for 10 seconds and the area massaged following removal. Your doctor will demonstrate this process to you. Even if you respond to the dose, follow up is still required. If you experience anaphylaxis you will be referred to an allergy specialist who will investigate the cause of your reaction and teach you how to avoid triggers. They will also explain how to detect early symptoms of reactions and devise an appropriate action plan in case the condition occurs again. Hopefully with the information offered by this study, doctors will be better able to understand and treat anaphylaxis in order to help the increasing number of patients suffering from this disorder.