Anaphylaxis - Twitter summary from #ACAAI16 meeting

This is a Twitter summary from #ACAAI16 meeting. The post is a part of series. See the rest here:

Several allergists did a great job posting updates on Twitter from the 2016 meeting of ACAAI, the hashtag was #ACAAI16. I used the website Symplur to review the tweets:

Presentation handouts are available from the ACAAI website:

@dranneellis: Gearing up to moderate "Leading the Pack - Allergists as Anaphylaxis Experts" Hear from me, @DrStanFineman and @danavwallace!

Dr Wallace explains importance of being prepared to treat anaphylaxis:

@danavwallace recommends that all staff in Allergy clinic, including clerical staff take CPR courses. Allergy practices must run mock anaphylaxis drills to ensure all are prepared. Have an anaphylaxis protocol and post it in the office.

Have a standing order that RN can give first dose of epinephrine 4 anaphylaxis without requiring clearance from attending physician.

No need to fear the epinephrine use in anaphylaxis - only 4 fatalities in literature - all were overdoses and IV administration of epinephrine. There is NO absolute contraindication for epinephrine in the setting of anaphylaxis. Repeat after me.

Before prescribing immunotherapy, think - would this patient be able to survive anaphylaxis should it occur? For example, 2015 Anaphylaxis PP suggest a "cautious approach" for using inhalant AIT in patients on beta-blockers.

Glucagon 1 mg to 5 mg may be effective in the setting of beta-blockers leading to epinephrine resistance to anaphylaxis management. Glucagon kit should be in all our treatment trays.

The AAAAI survey showed that 14% of systemic reactions post AIT occurred after 30 minutes.

@DrStanFineman presented on Anaphylaxis Action Plans in Practice.

Only about 40% of patients prescribed an epinephrine autoinjector were also give a written action plan in one study.

In a European anaphylaxis registry for kids/adolescents, 46% events occurred at home. Epinephrine only used in 25%. Non health care personnel initiated treatment in 30% of anaphylaxis cases in that registry (likely parents). The rate of epinephrine autoinjector use increased 4 fold however from 2011 to 2015, indicating better awareness of best management.

Prevalence of children at risk for anaphylaxis increased 41% over a 6 year period in one Australian study. While rate of epinephrine autoinjector prescriptions significantly rose as well, rate of actual autoinjector use remained stable.

It is not necessary to meet full NIAID criterion for anaphylaxis to give epinephrine - giving earlier in anaphylaxis better.

"Show us your Epi". Ask your patients at each clinic visit to produce their autoinjector.

The @ACAAI has developed an anaphylaxis preparedness questionnaire to use as a discussion tool for patients at risk for anaphylaxis.

Dr Ann Ellis explained biphasic anaphylactic reactions:

Dr Ellis explained that delay in epi treatment can predispose to biphasic reaction.

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