Page 12 - Anaphylaxis in Schools & Other Settings, 3rd Edition

An individual is diagnosed as being at risk by obtaining a detailed personal history and confirmation of an allergy through appropriate investigations such as skin and/or blood tests. Once a diagnosis is made, a person should do the following:4,5
ƒ Avoid the allergenic substance;
ƒ Carry an epinephrine auto-injector at all times;
ƒ Wear medical identification such as MedicAlert® (available as bracelets, bands and necklaces);
ƒ Have a written Anaphylaxis Emergency Plan which describes the signs and symptoms of anaphylaxis and what to do in case of a reaction (See Appendix D.);
ƒ Receive instruction on a regular basis from their healthcare professional on when and how to use epinephrine auto-injectors. Local pharmacists can also provide information on anaphylaxis and the use of epinephrine auto-injectors.
Factors that may increase the risk of a severe anaphylactic reaction
1. Anaphylaxis and asthma
People with asthma who are also diagnosed with life-threatening allergies are more susceptible to severe breathing problems when experiencing an anaphylactic reaction. It is extremely important for asthmatic individuals to keep their asthma well controlled. In cases where an anaphylactic reaction is suspected but there is uncertainty whether or not the person is experiencing an asthma attack, epinephrine should be used first. Epinephrine can be used to treat life-threatening asthma attacks as well as anaphylactic reactions. People with asthma who are at risk of anaphylaxis should carry their asthma medications (e.g. puffers/inhalers) with their epinephrine auto-injector. Both anaphylaxis and asthma should be listed on their medical identification (e.g. MedicAlert® bracelet).
2. Under-utilization and delay in the use of epinephrine
Epinephrine is the drug of choice to treat an anaphylactic reaction and needs to be given early in
the course of a reaction. It is extremely important that all individuals at risk of anaphylaxis, parents/ guardians of children at risk, teachers, and caregivers know the signs and symptoms of anaphylaxis and the correct use of emergency medication (i.e. epinephrine auto-injector). In studies of individuals who have died as a result of anaphylaxis, epinephrine was underused, not used at all, or administration was delayed.6-9
There are no contraindications to using epinephrine for a life-threatening allergic reaction. This means that in normally healthy individuals, epinephrine will not cause harm if given unnecessarily. Possible side effects from epinephrine can include: rapid heart rate, pallor (paleness), dizziness, weakness, tremors and headache. These side effects are generally mild and subside within a few minutes.
3. Underlying cardiac diseases
People with heart disease or high blood pressure should speak to their physician about their cardiac medications and their need for epinephrine. Some medications (e.g. beta-blockers, ACE inhibitors) may interfere with the action of epinephrine and worsen the allergic reaction. (See Appendix K.)
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Anaphylaxis in Schools & Other Settings
Copyright © 2005-2015 Canadian Society of Allergy and Clinical Immunology
Consensus Statement