Prevention and management of office allergy emergencies

Acute anaphylaxis is a rare, potentially fatal, multisystem allergic reaction that every allergy office must be prepared to treat. Key points are reaction prevention, diagnosing the serious reaction, proper staff training, and keeping on hand (readily accessible and in functioning condition) adequate supplies to provide emergency treatment appropriate to the office locale. The diagnosis of, and treatment for, each common type of allergic reaction is discussed. Equipment and medicines suggested for office use are reviewed, and a sample allergy reaction management protocol is outlined. Office treatment of anaphylaxis is directed at stabilizing the patient for early transport to a hospital. Early administration of epinephrine is the most crucial step. The airway is maintained, circulation supported, and further mediator effects blocked. Cardiopulmonary resuscitation is used whenever respiration or circulation is insufficient. Stabilized patients should be transported as soon as possible by the most medically capable method available, preferably by ambulance with medical personnel in attendance. Because of the risk of subsequent delayed onset or late-phase reactions, and the possibility of multiorgan injury, anaphylaxis patients should be considered for admission to the hospital, extended observation, and appropriate specialist consultations.