What the standard says
A patient with acute-onset clinical deterioration with signs or symptoms of an allergic response is rapidly assessed for anaphylaxis, especially in the presence of an allergic trigger or a history of allergy.
What this means for you
Assess patients immediately for possible anaphylaxis if they present with rapid development of airway, breathing and/or circulation problems, with or without skin or mucosal changes. The presence of an allergic trigger or a history of allergy should heighten suspicion even if the patient is not in severe distress. Symptoms typically occur in two or more body systems, but this can be variable.
The most common triggers of anaphylaxis are food, insect venom and medicines (Table 1).
After exposure to a trigger, the time until onset of signs and symptoms of anaphylaxis (Table 2) may range from minutes to several hours.
Obtain a history from the patient, noting:
- Recent exposure to substances known to cause an allergic reaction
- Any known allergies for the patient, including previous reactions and treatment
- Any history of anaphylaxis.
Document the time of symptom onset in the patient’s healthcare record.
Consider patient risk factors that potentially contribute to fatal anaphylaxis (for example, older age and cardiovascular and respiratory diseases) and cofactors that are likely to amplify the severity of an allergic reaction (such as exercise or acute infection).
Common differential diagnoses include acute asthma, syncope, panic attacks and septic shock. Rule out other sudden-onset multisystem illnesses. However, a patient who experiences sudden difficulty in breathing, has asthma, and is known to be at risk of anaphylaxis, should be treated as having anaphylaxis.
Monitor patients with allergy symptoms who do not meet the criteria for anaphylaxis, to allow prompt recognition of progression of a mild-to-moderate allergic reaction to anaphylaxis. Reactions can progress to severe involvement of more than one body organ system and rapidly become life-threatening.
Rehearse the anaphylaxis management protocol regularly to ensure prompt recognition of anaphylaxis for patients presenting with allergic reactions.
Consider serial measurements of mast cell tryptase concentrations. Taken during anaphylaxis, results can be useful for identifying the trigger when reviewed after the event, usually by a clinical immunology or allergy specialist.