PMC:4631427 / 20659-23466
Annnotations
{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/4631427","sourcedb":"PMC","sourceid":"4631427","source_url":"https://www.ncbi.nlm.nih.gov/pmc/4631427","text":"Treatment of anaphylactic reactions\nThe USA, European, and international guidelines (World Allergy Organization [WAO]) all recommend epinephrine as the drug of choice for all causes of anaphylaxis including food-induced anaphylaxis.65 The appropriate dose should be promptly administered upon onset of symptoms. Failure to receive epinephrine in a timely manner is a risk factor for fatality due to anaphylaxis, and studies have demonstrated that epinephrine is administered in only 25%–44% of patients with anaphylactic reactions.55,56,66 Additional therapies for anaphylactic reactions include supplemental oxygen and volume repletion for hypotension when appropriate. Symptom-specific adjunctive therapies may also be considered. These would include bronchodilators for wheezing and H1-antihistamines for pruritus, cutaneous symptoms, or rhinorrhea. Systemic corticosteroids in the acute management of anaphylaxis have been shown to be of questionable value, though they are routinely used as a second-line agent for possible prevention of late-phase reactions.67\nAll patients and parents of patients allergic to peanut or tree nut should be educated about the signs and symptoms of anaphylaxis. The treatment of choice for food-related anaphylaxis is injectable epinephrine in the lateral thigh. Currently, two doses of epinephrine autoinjectors are available. It is suggested that the 0.15 mg dose epinephrine autoinjector be prescribed for children weighing 10–25 kg (22–55 lb) and an autoinjector with 0.30 mg of epinephrine for those weighing ≥25 kg (55 lb).68 The correct use of an epinephrine autoinjector, including return demonstration, should be reviewed not only upon initial evaluation, but also at least on a yearly basis. This yearly instruction is important as it has been shown that many patients do not properly use epinephrine autoinjectors or forget how to use them after as little as a few months.69 Patients should be provided with written instructions including an action plan, which details signs and symptoms of anaphylaxis and indications for the use of emergency medications, including epinephrine. It is also important to review the proper storage of self-injectable epinephrine away from temperature extremes in order to protect the drug from degradation. Many preparations of self-injectable epinephrine now come equipped with a second dose, which may be required for refractory or severe anaphylactic reactions. For these reasons, it has been recommended that both doses of injectable epinephrine be kept together and not split between environments (school/home). A second dose of epinephrine should be administered if anaphylactic symptoms persist beyond 10 minutes, as 12%–19% of food-induced anaphylactic reactions require more than one dose of epinephrine.12,18,55,56,70","divisions":[{"label":"title","span":{"begin":0,"end":35}},{"label":"p","span":{"begin":36,"end":1066}}],"tracks":[{"project":"TEST0","denotations":[{"id":"26604803-196-202-1382685","span":{"begin":232,"end":234},"obj":"[\"16546624\"]"},{"id":"26604803-232-238-1382686","span":{"begin":531,"end":533},"obj":"[\"20819321\"]"},{"id":"26604803-235-241-1382687","span":{"begin":534,"end":536},"obj":"[\"20621344\"]"},{"id":"26604803-235-241-1382688","span":{"begin":537,"end":539},"obj":"[\"14767453\"]"},{"id":"26604803-211-217-1382689","span":{"begin":1064,"end":1066},"obj":"[\"23507835\"]"},{"id":"26604803-230-236-1382690","span":{"begin":1566,"end":1568},"obj":"[\"17332221\"]"},{"id":"26604803-196-202-1382691","span":{"begin":2793,"end":2795},"obj":"[\"18547626\"]"},{"id":"26604803-199-205-1382692","span":{"begin":2796,"end":2798},"obj":"[\"15969665\"]"},{"id":"26604803-202-208-1382693","span":{"begin":2799,"end":2801},"obj":"[\"20819321\"]"},{"id":"26604803-205-211-1382694","span":{"begin":2802,"end":2804},"obj":"[\"20621344\"]"},{"id":"26604803-208-214-1382695","span":{"begin":2805,"end":2807},"obj":"[\"18051213\"]"}],"attributes":[{"subj":"26604803-196-202-1382685","pred":"source","obj":"TEST0"},{"subj":"26604803-232-238-1382686","pred":"source","obj":"TEST0"},{"subj":"26604803-235-241-1382687","pred":"source","obj":"TEST0"},{"subj":"26604803-235-241-1382688","pred":"source","obj":"TEST0"},{"subj":"26604803-211-217-1382689","pred":"source","obj":"TEST0"},{"subj":"26604803-230-236-1382690","pred":"source","obj":"TEST0"},{"subj":"26604803-196-202-1382691","pred":"source","obj":"TEST0"},{"subj":"26604803-199-205-1382692","pred":"source","obj":"TEST0"},{"subj":"26604803-202-208-1382693","pred":"source","obj":"TEST0"},{"subj":"26604803-205-211-1382694","pred":"source","obj":"TEST0"},{"subj":"26604803-208-214-1382695","pred":"source","obj":"TEST0"}]},{"project":"2_test","denotations":[{"id":"26604803-16546624-55579380","span":{"begin":232,"end":234},"obj":"16546624"},{"id":"26604803-20819321-55579381","span":{"begin":531,"end":533},"obj":"20819321"},{"id":"26604803-20621344-55579382","span":{"begin":534,"end":536},"obj":"20621344"},{"id":"26604803-14767453-55579383","span":{"begin":537,"end":539},"obj":"14767453"},{"id":"26604803-23507835-55579384","span":{"begin":1064,"end":1066},"obj":"23507835"},{"id":"26604803-17332221-55579385","span":{"begin":1566,"end":1568},"obj":"17332221"},{"id":"26604803-18547626-55579386","span":{"begin":2793,"end":2795},"obj":"18547626"},{"id":"26604803-15969665-55579387","span":{"begin":2796,"end":2798},"obj":"15969665"},{"id":"26604803-20819321-55579388","span":{"begin":2799,"end":2801},"obj":"20819321"},{"id":"26604803-20621344-55579389","span":{"begin":2802,"end":2804},"obj":"20621344"},{"id":"26604803-18051213-55579390","span":{"begin":2805,"end":2807},"obj":"18051213"}],"attributes":[{"subj":"26604803-16546624-55579380","pred":"source","obj":"2_test"},{"subj":"26604803-20819321-55579381","pred":"source","obj":"2_test"},{"subj":"26604803-20621344-55579382","pred":"source","obj":"2_test"},{"subj":"26604803-14767453-55579383","pred":"source","obj":"2_test"},{"subj":"26604803-23507835-55579384","pred":"source","obj":"2_test"},{"subj":"26604803-17332221-55579385","pred":"source","obj":"2_test"},{"subj":"26604803-18547626-55579386","pred":"source","obj":"2_test"},{"subj":"26604803-15969665-55579387","pred":"source","obj":"2_test"},{"subj":"26604803-20819321-55579388","pred":"source","obj":"2_test"},{"subj":"26604803-20621344-55579389","pred":"source","obj":"2_test"},{"subj":"26604803-18051213-55579390","pred":"source","obj":"2_test"}]}],"config":{"attribute types":[{"pred":"source","value type":"selection","values":[{"id":"TEST0","color":"#d8ec93","default":true},{"id":"2_test","color":"#e593ec"}]}]}}