Anaphylaxis:

Definition, Criteria for Identifying & Management Guidelines

The following guidelines were agreed upon by members of the National Institutes of Health (NIH) and the Food Allergy & Anaphylaxis Network (FAAN). Published in the April-May 2006 edition of Food Allergy News, the newsletter published by the Food Allergy & Anaphylaxis Network.

Definition of Anaphylaxis:

"Anaphylaxis is a serious allergic reaction that is rapid in onset and may cause death."

Diagnostic Criteria for Identifying Anaphylaxis:

("Believed to identify most (up to 95%) cases of anaphylaxis.")

Anaphylaxis is highly likely to occur when any ONE of the following occurs quickly(within minutes to hours):

1. An individual has skin symptoms or swollen lips and either

a. Difficulty breathing or

b. Reduced blood pressure

2. An individual had exposure to a suspected allergen, and two or more of the  following occur:

a. Skin symptoms or swollen lips

b. Difficulty breathing

c. Reduced blood pressure

d. Gastrointestinal symptoms (such as vomiting, diarrhea, or cramping)

3. An individual has had exposure to a known allergen, and experiences:

a. Reduced blood pressure

Management of Anaphylaxis:

1. Epinephrine is the treatment of choice for anaphylaxis.

2. When any of the three criteria are met, epinephrine should be given immediately.

3. For patients with a history of life-threatening reactions, who have had exposure to their allergen and begin to have symptoms quickly, even if they are mild (hives), epinephrine should be given immediately.

4. Epinephrine should be given intramuscularly into the outside part of the thigh.

5. Individuals who have low blood pressure during a reaction should be asked to lie down with their legs elevated, unless they are having difficulty breathing or are vomiting.

6. Call 9-1-1 any time epinephrine is used. Further medical treatment may be required.

7. All individuals receiving epinephrine should be observed for a period of time, usually 4-6 hours. This may vary according to the severity of symptoms and access to a medical care facility.

All Patients Who Experienced Anaphylaxis Should:

1. Receive a prescription for self-injectable epinephrine.

2. Be advised to follow up with an allergist and report the reaction to their primary care physician, and

3. Be provided with patient education about anaphylaxis and avoiding the allergen.