Food allergy, dermatologic diseases, and anaphylaxis
Anaphylaxis, killer allergy: Long-term management in the community

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Traditionally, physicians are trained to diagnose and treat anaphylaxis as an acute emergency in a health care setting. In addition to this crucial and time-honored role, we should be cognizant of our wider responsibility to (1) provide a risk assessment for individuals with anaphylaxis, (2) prevent future anaphylaxis episodes by developing long-term personalized risk reduction strategies for affected individuals, and (3) emphasize anaphylaxis education. Risk assessment should include verification of the trigger factor or factors for the anaphylaxis episode by obtaining a comprehensive history and performing relevant investigations, including allergen skin tests and measurement of allergen-specific IgE in serum. In addition, the potential effect of comorbidities and concurrently administered medications on the recognition and emergency treatment of subsequent episodes should be determined. Risk reduction strategies should be personalized to include information about avoidance of specific triggers and initiation of relevant specific preventive treatment (eg, venom immunotherapy). At-risk individuals should be coached in the use of self-injectable epinephrine and equipped with an anaphylaxis emergency action plan and with accurate medical identification. Anaphylaxis education should be provided for these individuals, their families and caregivers, health care professionals, and the general public. Further development of an optimal diagnostic test for anaphylaxis and of tests and algorithms to predict future risk and prevent fatality are urgently needed.

Section snippets

Risk assessment

In the long-term management of anaphylaxis, risk assessment includes confirmation of the diagnosis by retaking the history of the acute episode and reviewing the results of laboratory tests, if any, obtained at the time; evaluation of comorbidities and concurrently administered medications; and verification of the trigger factor or factors.

Long-term risk reduction

Long-term risk reduction includes optimal management of relevant comorbidities (eg, asthma or cardiovascular disease), avoidance of confirmed triggers, and specific preventive treatment where relevant, as well as providing at-risk individuals with a personalized anaphylaxis emergency action plan and medical identification, and coaching them in the use of self-injectable epinephrine.

Anaphylaxis education

Education of individuals with anaphylaxis and their families and caregivers helps to banish anxiety and fear and instills confidence in their ability to cope, not only by preventing anaphylaxis episodes, but also by recognizing and treating them promptly if they occur. All health care professionals, including all physicians, nurses, emergency medical service technicians, and first responders need regular anaphylaxis education updates. Ideally, advanced cardiac life support instruction should

Summary

There is more to anaphylaxis than the acute and potentially life-threatening emergency itself, critically important as that is. Physicians, particularly allergy-immunology specialists, play a pivotal role in long-term management of anaphylaxis, which encompasses, yet goes beyond, their traditional role in diagnosing and treating the acute event. All individuals with anaphylaxis should be referred to a specialist physician who is knowledgeable about (1) risk assessment, including verification of

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