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Anaphylaxis: A 2023 practice parameter update.

David B K Golden1, Julie Wang2, Susan Waserman3

  • 1Johns Hopkins School of Medicine, Baltimore, Maryland.

Annals of Allergy, Asthma & Immunology : Official Publication of the American College of Allergy, Asthma, & Immunology
|December 18, 2023
PubMed
Summary
This summary is machine-generated.

This updated guidance revises anaphylaxis diagnosis and management. Key changes include serum tryptase measurement, age-specific symptoms, and optimized epinephrine autoinjector use for better patient outcomes.

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Area of Science:

  • Allergy and Immunology
  • Clinical Practice Guidelines

Background:

  • Anaphylaxis diagnosis and management guidelines have been updated based on new evidence.
  • Revised diagnostic criteria and defined patterns of anaphylaxis are presented.

Framework:

  • Serum tryptase measurement is crucial for diagnosing anaphylaxis and identifying mast cell disorders.
  • Age-specific symptoms in infants and toddlers differ; reaction severity is not age-correlated.
  • Anaphylaxis is unlikely to be the initial reaction upon first allergen exposure.

Implementation:

  • Community settings require tailored anaphylaxis prevention and treatment strategies.
  • Optimal epinephrine autoinjector prescribing and use necessitate patient/caregiver training.
  • Prompt epinephrine administration may negate immediate emergency medical services activation if a durable response occurs.

Implications:

  • Continuing beta-blockers or ACE inhibitors may be safer than stopping them in certain anaphylaxis cases, particularly insect sting reactions.
  • Mastocytosis evaluation, including bone marrow biopsy, is recommended for adults with severe insect sting or recurrent idiopathic anaphylaxis.
  • Repeat anesthesia after perioperative anaphylaxis can proceed with shared decision-making and diagnostic evaluation.