Allergy

Anaphylaxis, epinephrine.

Objectives

1. In all patients, always inquire about any allergy and clearly document it in the chart. Re-evaluate this periodically.
2. Clarify the manifestations of a reaction in order to try to diagnose a true allergic reaction (e.g., do not misdiagnose viral rashes as antibiotic allergy, or medication intolerance as true allergy).
3. In a patient reporting allergy (e.g., to food, to medications, environmental), ensure that the patient has the appropriate medication to control symptoms (e.g., antihistamines, bronchodilators, steroids, an EpiPen).
4. Prescribe an EpiPen to every patient who has a history of, or is at risk for, anaphylaxis.
5. Educate appropriate patients with allergy (e.g., to food, medications, insect stings) and their families about the symptoms of anaphylaxis and the self-administration of the EpiPen, and advise them to return for immediate reassessment and treatment if those symptoms develop or if the EpiPen has been used.
6. Advise patients with any known drug allergy or previous major allergic reaction to get a MedicAlert bracelet.
7. In a patient presenting with an anaphylactic reaction:
   • Recognize the symptoms and signs.
   • Treat immediately and aggressively.
   • Prevent a delayed hypersensitivity reaction through observation and adequate treatment (e.g., with steroids).
8. In patients with anaphylaxis of unclear etiology refer to an allergist for clarification of the cause.
9. In the particular case of a child with an anaphylactic reaction to food:
   • Prescribe an EpiPen for the house, car, school, and daycare. Clinical Reasoning Treatment
   • Advise the family to educate the child, teachers, and caretakers about signs and symptoms of anaphylaxis, and about when and how to use the EpiPen.
10. In a patient with unexplained recurrent respiratory symptoms, include allergy (e.g., sick building syndrome, seasonal allergy) in the differential diagnosis.