Treating Severe Anaphylaxis
Adrenaline is the first-line emergency treatment for anaphylaxis. Early administration can reduce the risk of hospitalization and death.
The most common anaphylactic triggers are:
• Foods such as peanuts, tree nuts, shellfish, fish, milk eggs;
• Insect bites or stings; and
• Medications such as β-lactam antibiotics, NSAIDs and biological agents including vaccines.
For many, anaphylaxis has a chronic relapse rate where future events are unpredictable in both nature and severity.3 Despite high anaphylaxis recurrence rates, a recent Australian study found that compliance with carrying and using adrenaline was poor.
There are now two adrenaline autoinjectors (AAI) listed on the Pharmaceutical Benefits Scheme (PBS), Anapen® and Epipen®.
Increased choice and availability of AAI raises the importance of adequate education and training in;
• Recognising early signs and symptoms of anaphylaxis; and
• How to use the AAI correctly.
Although both AAIs have the same function, they differ significantly in technique and dose application. Specific training is required for each AAI.
Training is available to all health professionals via pharmaceutical companies.
Community education and training are conducted by Government and Non-Government organisations (i.e. First-aid Trainers). Anaphylaxis Guidelines for schools and child care centres are also widely available. The Anaphylaxis Australia website lists anaphylaxis management guidelines for each state and territory. www.allergyfacts.org.au
When prescribing adrenaline autoinjectors, GPs should;
• Check and follow ASCIA (Australasian Society of Clinical Immunology and Allergy) Guidelines;
• Check which device the patient carries prior to repeat prescription.
• Ensure face-to-face training for appropriate device is carried out upon prescription.
In addition to specific AAI training, GPs must ensure all patients who are prescribed an AAI have a comprehensive anaphylaxis management plan that includes;
• Referral to an appropriate specialist;
• Identification of relevant allergen(s);
• Education on avoiding allergen(s);
• Anaphylaxis action plan; and
• Appropriate follow-up and review.
Useful URLs
ASCIA guidelines and anaphylaxis action plans www.allergy.org.au
Anaphylaxis guidelines for schools and childcare centres www.allergyfacts.org.au/
ANAlert 2010 www.ANAlert.com.au