Martelli Alberto, Ghiglioni Daniele, Sarratud Teresita, Calcinai Elena, Veehof Suzanne, Terracciano Luigi, Fiocchi Alessandro
Melloni Paediatria, University of Milan Medical School at the Fatebenefratelli/Melloni Hospital, Milan, Italy.
Curr Opin Allergy Clin Immunol. 2008 Aug;8(4):321-9. doi: 10.1097/ACI.0b013e328307a067.
Correct management of anaphylactic manifestations in the emergency department is crucial to prevent mortality and future episodes, in particular for paediatric patients. We make here recommendations based on a critical review of the evidence for the management of anaphylaxis in emergency department with particular emphasis on children.
Available information suggests that anaphylaxis must be promptly recognized keeping in mind the airway patency, breathing (ventilation and respiration), circulation and mental status and treated. The first treatment is epinephrine. After successful treatment of an anaphylactic episode, attention must be paid at prevention of early recurrences (biphasic anaphylaxis) and assessment of causes. Patients should not be discharged before prescribing self-injectable epinephrine and explain how and in under what circumstances it must be injected; giving an action plan to be communicated to their communities; inform the school about the possible occurrence of reactions and the appropriate avoidance and rescue measures; and consider the necessity of a Medic-Alert identification.
As gross differences have been described in the awareness of the disease and its management between allergists and nonallergists, allergists should interact with emergency doctors to improve education in this area.
急诊科对过敏反应的正确处理对于预防死亡和未来发作至关重要，尤其是对儿科患者。在此，我们基于对急诊科过敏反应处理证据的批判性综述提出建议，特别强调儿童。
现有信息表明，必须迅速识别过敏反应，同时牢记气道通畅、呼吸（通气和呼吸）、循环及精神状态并进行治疗。首要治疗是肾上腺素。在成功治疗过敏发作后，必须注意预防早期复发（双相性过敏反应）并评估病因。在开具自动注射肾上腺素并解释如何以及在何种情况下必须注射之前，患者不应出院；给出一份行动计划以便传达给其社区；告知学校可能发生的反应以及适当的避免和急救措施；并考虑佩戴医疗警报标识的必要性。
由于过敏症专科医生和非过敏症专科医生在对该疾病的认识及其处理方面存在显著差异，过敏症专科医生应与急诊科医生互动，以改善该领域的教育。
