Management of a Patient With Anaphylaxis

PROGRAM DESCRIPTION: Anaphylaxis is an acute, potentially life-threatening systemic allergic reaction that may have a wide range of clinical manifestations. The lifetime prevalence of anaphylaxis has been estimated at 1.6% to 5.1%. Medications and stinging insects are the leading triggers in adults, with foods and stinging insects the most frequently implicated triggers in children and adolescents. Food allergy impacts 8% to 11% of children and adults in the United States. IgE binding and cross-linking of the high affinity IgE receptor (FcεRI) on the surface of mast cells and basophils is an important
mechanism in many cases of anaphylaxis. Anaphylaxis involves additional cell types that may include neutrophils, monocytes, macrophages, and platelets.

Epinephrine administered intramuscularly into the anterolateral thigh is the first-line treatment for anaphylaxis. Epinephrine is the cornerstone of anaphylaxis management but continues to be underutilized. Antihistamines and/or glucocorticoids are not reliable interventions to prevent biphasic anaphylaxis.

This session will work through case-based scenarios of allergy emergencies and anaphylaxis. Elements of the patient’s history and physical exam findings will be used to determine the diagnosis. Treatment strategies will be discussed, with particular attention to allergy emergencies encountered in the clinical setting.

The presenters will lead the participants through the Anaphylaxis— A 2020 Practice Parameter Update, Systematic Review, and Grading of
Recommendations, Assessment, Development and Evaluation (GRADE) analysis by working through several real world scenarios.

We will work through a case that presents as an episode of anaphylaxis triggered from allergy testing. It is important that otolaryngologists offering allergy services be competent in the management of anaphylaxis.

OUTCOME OBJECTIVE 1: Recognize the signs and symptoms of anaphylaxis

OUTCOME OBJECTIVE 2: Acknowledge that epinephrine is the first line treatment for anaphylaxis

OUTCOME OBJECTIVE 3: Demonstrate competence in treating anaphylaxis

BACKGROUND STATEMENT: Management of anaphylaxis and other allergy emergencies has been identified in a comprehensive gap analysis conducted by the AAO-HNSF Education Committees. Many members may not be aware that there has been a recent practice parameter update to anaphylaxis published.