Allergic Reactions and Anaphylaxis


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In this episode, Sam Ashoo, MD, and TR Eckler, MD, discuss the July 2022 Emergency Medicine Practice article on the Management of Allergic Reactions and Anaphylaxis in the Emergency Department


  • The number of ED visits and hospitalizations
  • Studies show up to 57% of anaphylactic reactions are not recognized, and epinephrine is not administered in up to 80% of cases. 


  • 2006 Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network (NIAID/FAAN)
  • WAO revised the criteria in 2020 
  • Delphi group and Brown et al



  • Most common causes in children and adults
  • More than half of deaths from anaphylaxis occur within the first hour of symptom onset

Prehospital Care

  • Give epi, H1 blockers
  • Mainstay = recognition

ED Care

  • Airway
  • Epinephrine
  • Decontamination
  • H1 and H2 blockers
  • Corticosteroids
  • Biphasic reactions
  • Glucagon

Special Cases

  • Alpha-gal
  • Scombroid
  • Kounis syndrome

Last Updated on January 25, 2023

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