Allergists And Emergency Physicians Publish System To Enhance Management Of Life-Threatening Allergic Emergencies

Main Category: Respiratory / Asthma
Also Included In: Allergy;  Immune System / Vaccines
Article Date: 11 Aug 2007 - 1:00 PDT

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"Be S.A.F.E.," a system to enhance management of and education about anaphylaxis and other severe allergic reactions, was published by an expert panel of allergists and emergency physicians in the current issue of Annals of Allergy, Asthma and Immunology.

The article, "SAFE: A Multidisciplinary Approach to Anaphylaxis Education in the Emergency Department," includes an overview of the medical literature showing inconsistencies and limitations in the treatment of anaphylaxis and provides health care professionals with resources to improve the recognition and ongoing management of severe allergic reactions. The new system and accompanying tools were created through a partnership of the American College of Allergy, Asthma and Immunology (ACAAI) and the American College of Emergency Physicians (ACEP).

"As many as 1,500 people die each year from anaphylaxis related to food, insect stings, drug and latex allergies, with an estimated 3.29 million to 40.9 million people at risk," said Philip Lieberman, M.D., departments of internal medicine and pediatrics, division of allergy and immunology, University of Tennessee College of Medicine, Memphis, Tenn. Dr. Lieberman is principal author of the journal article and co-chair of an expert panel of allergists and emergency physicians convened in Chicago last year by ACAAI and ACEP.

"The article highlights the need to follow recommended guidelines for anaphylaxis treatment, including discharging patients with either a prescription for self-injectable epinephrine or information about how to obtain a kit and documenting referral for follow-up disease management.

"Even when an initial allergic reaction is mild, there is a possibility that a subsequent reaction will be life-threatening, and self-injectable epinephrine is the standard of care for patients who face this risk," he said.

The article is based on recommendations made by the expert panel.
"Anaphylaxis is under-recognized and under-reported. Allergists and emergency department personnel recognize the need for a multidisciplinary approach to increase public awareness, improve patient education and enhance emergency and long-term management of potentially deadly allergic reactions," said Wyatt Decker, M.D., department of emergency medicine, Mayo Clinic, Rochester, Minn., and Jacksonville, Fla., and co-chair of the expert panel. "To do that effectively, healthcare workers need better tools to assist them in providing treatment, discharge instructions and follow-up care for patients in whom anaphylaxis is suspected."

In the immediate aftermath of an anaphylactic event, emergency professionals can:

-- help identify the suspected allergen by asking patients about substances to which they were exposed before the allergic reaction;
-- raise patient awareness of future risks;
-- direct patients to appropriate follow-up resources, such as referral to an allergist for further testing, treatment and preventive measures;
-- prescribe epinephrine, widely accepted as the first-line therapy for anaphylaxis, and thoroughly instruct patients in its use.

Among recommendations made by the panel in the journal article is creation of a quick reference card to assist emergency physicians and other first responders in educating patients about anaphylaxis. It includes the Be S.A.F.E. system, a mnemonic device with four action steps:

1. Seek Support - Advise the patient who has had an anaphylactic reaction that there is a risk of subsequent reactions. Direct the patient to call an ambulance and get to the nearest emergency facility at the first sign of another reaction, even if epinephrine has already been administered. Also refer the patient to educational resources on allergies and anaphylaxis.

2. Allergen Identification and Avoidance - Question the patient regarding recent contact with food or other substances or activities that may have triggered the reaction. Emphasize the importance of testing to determine what caused the reaction and the need to avoid the allergen or other trigger in the future.

3. Follow up for Specialty Care - Advise the patient to follow up with his or her primary care physician and ask for a referral to an allergist, or to seek consultation directly with an allergist for testing, diagnosis and ongoing management of the allergy.

4. Epinephrine for Emergencies - Provide the patient with a prescription for a self-injectable epinephrine kit and instructions for its use or with information on how to obtain a kit from another source, such as a primary care physician or allergist. Explain the importance of carrying the kit at all times and of making sure that family and friends are aware of the risk of anaphylaxis, the triggers, and how to use epinephrine.

Healthcare professionals can download the reference card and Be S.A.F.E. consumer education brochure by clicking on the health professionals section of the ACAAI Web site, at http://www.acaai.org. Also on the Web site, healthcare professionals can find information on ordering multiple copies of the brochure.

The Be S.A.F.E. campaign is supported by an educational grant from Dey, L.P.

Co-authors with Drs. Lieberman and Decker of the article published in the Annals are Carlos A. Camargo, Jr., M.D. DrPH, department of emergency medicine, Massachusetts General Hospital, Boston; Robert O'Connor, M.D., department of emergency medicine, Christiana Care Health System, Newark, Del.; John Oppenheimer, M.D., department of medicine, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, N.J.; and F. Estelle Simons, M.D., department of pediatrics & child health, University of Manitoba, Winnipeg, Manitoba, Canada. Citation: Lieberman P, Decker W, et al. SAFE: a multidisciplinary approach to anaphylaxis education in the emergency department. Ann Allergy Asthma Immunol. 2007: 98:519-23.

About the American College of Allergy, Asthma and Immunology

ACAAI is a professional medical organization headquartered in Arlington Heights, Ill., that promotes excellence in the practice of the subspecialty of allergy and immunology. The College, comprising more than 5,200 allergists-immunologists and related health care professionals, fosters a culture of collaboration and congeniality in which its members work together and with others toward the common goals of patient care, education, advocacy and research. http://www.acaai.org

About the American College of Emergency Physicians

ACEP is a national medical society with more than 23,000 members who specialize in emergency medicine. ACEP is committed to advancing of emergency care through continuing education, research, and public education. Headquartered in Dallas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies. http://www.acep.org

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