An acute allergic reaction is a rapid-onset, IgE-mediated hypersensitivity reaction. Although it is most commonly caused by food, insect stings, and medications, there are many additional causes. Symptoms can range from mild urticaria and swelling, to abdominal cramping, to respiratory collapse. Anaphylaxis and anaphylactic shock are the most severe, life-threatening forms of allergic reaction, with fast onset and decompensation, requiring urgent airway monitoring and support.
Our recent issue Management of Allergic Reactions and Anaphylaxis in the Emergency Department reviews the current evidence on managing allergy and anaphylaxis with epinephrine, and reviews the evidence on corticosteroids, antihistamines, and other adjunctive therapies.
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Here are a few key points:
- Allergic reactions are a common cause of ED presentations, accounting for about 1% of U.S. visits annually.
- Up to 57% of anaphylactic reactions are not recognized, and in up to 80% of cases of anaphylaxis, patients were not given epinephrine.
- Many of the treatment recommendations considered to be standard of care in management of allergic reactions are based on weak or absent evidence.
- The NIAID/FAAN clinical criteria have been found to have a 95% sensitivity for diagnosing anaphylaxis.