System To Enhance Management of Life-Threatening Allergic Emergencies

“Be S.A.F.E.,” a system to enhance management of and education about anaphylaxis and other severe allergic reactions, was published by an expert panel of allergists and emergency physicians in the Annals of Allergy, Asthma and Immunology.

The article, “SAFE: A Multidisciplinary Approach to Anaphylaxis Education in the Emergency Department,” includes an overview of the medical literature showing inconsistencies and limitations in the treatment of anaphylaxis and provides health care professionals with resources to improve the recognition and ongoing management of severe allergic reactions. The new system and accompanying tools were created through a partnership of the American College of Allergy, Asthma and Immunology (ACAAI) and the American College of Emergency Physicians (ACEP).”As many as 1,500 people die each year from anaphylaxis related to food, insect stings, drug and latex allergies, with an estimated 3.29 million to 40.9 million people at risk,” said Philip Lieberman, M.D., departments of internal medicine and paediatrics, division of allergy and immunology, University of Tennessee College of Medicine, Memphis, Tenn. Dr. Lieberman is principal author of the journal article and co-chair of an expert panel of allergists and emergency physicians convened in Chicago last year by ACAAI and ACEP. “The article highlights the need to follow recommended guidelines for anaphylaxis treatment, including discharging patients with either a prescription for self-injectable epinephrine or information about how to obtain a kit and documenting referral for follow-up disease management.”Even when an initial allergic reaction is mild, there is a possibility that a subsequent reaction will be life-threatening, and self-injectable epinephrine is the standard of care for patients who face this risk,” he said. The article is based on recommendations made by the expert panel. “Anaphylaxis is under-recognized and under-reported. Allergists and emergency department personnel recognize the need for a multidisciplinary approach to increase public awareness, improve patient education and enhance emergency and long-term management of potentially deadly allergic reactions,” said Wyatt Decker, M.D., department of emergency medicine, Mayo Clinic, Rochester, Minn., and Jacksonville, Fla., and co-chair of the expert panel. “To do that effectively, healthcare workers need better tools to assist them in providing treatment, discharge instructions and follow-up care for patients in whom anaphylaxis is suspected.” Among recommendations made by the panel in the journal article is creation of a quick reference card to assist emergency physicians and other first responders in educating patients about anaphylaxis. It includes the Be S.A.F.E. system, a mnemonic device with four action steps:

• Seek Support – Advise the patient who has had an anaphylactic reaction that there is a risk of subsequent reactions. Direct the patient to call an ambulance and get to the nearest emergency facility at the first sign of another reaction, even if epinephrine has already been administered. Also refer the patient to educational resources on allergies and anaphylaxis.
• Allergen Identification and Avoidance – Question the patient regarding recent contact with food or other substances or activities that may have triggered the reaction. Emphasize the importance of testing to determine what caused the reaction and the need to avoid the allergen or other trigger in the future.
• Follow up for Specialty Care – Advise the patient to follow up with his or her primary care physician and ask for a referral to an allergist, or to seek consultation directly with an allergist for testing, diagnosis and ongoing management of the allergy.
• Epinephrine for Emergencies – Provide the patient with a prescription for a self-injectable epinephrine kit and instructions for its use or with information on how to obtain a kit from another source, such as a primary care physician or allergist. Explain the importance of carrying the kit at all times and of making sure that family and friends are aware of the risk of anaphylaxis, the triggers, and how to use epinephrine.

Healthcare professionals can download the reference card and Be S.A.F.E. consumer education brochure by clicking on the health professionals section of the ACAAI Web site, at www.acaai.org. Also on the Web site, healthcare professionals can find information on ordering multiple copies of the brochure.The Be S.A.F.E. campaign is supported by an educational grant from Dey, L.P.Co-authors with Drs. Lieberman and Decker of the article published in the Annals are Carlos A. Camargo, Jr., M.D. DrPH, department of emergency medicine, Massachusetts General Hospital, Boston; Robert O’Connor, M.D., department of emergency medicine, Christiana Care Health System, Newark, Del.; John Oppenheimer, M.D., department of medicine, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, N.J.; and F. Estelle Simons, M.D., department of paediatrics & child health, University of Manitoba, Winnipeg, Manitoba, Canada. Citation: Lieberman P, Decker W, et al. SAFE: a multidisciplinary approach to anaphylaxis education in the emergency department. Ann Allergy Asthma Immunol. 2007: 98:519-23.(Source: “SAFE: A Multidisciplinary Approach to Anaphylaxis Education in the Emergency Department.” Ann Allergy Asthma Immunol. 2007: 98:519-23. : American College of Allergy, Asthma and Immunology : July 2007)