Larcan Alain, Moneret-Vautrin Denise Anne
Faculté de médecine de Nancy, réseau allergo-vigilance 15, rue du Bois de la Champelle, 54500 Vandœuvre-Lès-Nancy, France.
Presse Med. 2013 Jun;42(6 Pt 1):922-9. doi: 10.1016/j.lpm.2012.11.012. Epub 2013 Mar 6.
Anaphylaxis is the most serious form of the IgE-dependent food allergy, with lethal risk. The incidence is sharply rising.
Analysis of the actual management of anaphylaxis, searching for the appropriateness with the International Guidelines highlighting the absolute need of epinephrine, and further suggestions for the improvement of treatment.
A general review of international studies stemming from Emergency Departments (ED), Paediatric, Resuscitation, Cardiologic or Allergy Departments over 1999-2012, as well of International Guidelines about the management of anaphylaxis.
The self-injectable epinephrine by the patients is under-used. Treatment by epinephrine in ED has a low concordance with recommended guidelines. The discharge prescriptions of self-injectable epinephrine and referral to allergy testing are quite insufficient.
The actual management of anaphylaxis does not fit with the International Guidelines. Anaphylaxis treatment protocols according to the international criteria should be applied in ED. Risk reduction strategies cannot rely only on the self-administration of epinephrine by the patient and should put forward a better efficiency of all first-aid care providers. A targeted educational intervention should be developed to improve the care of emergency medical services providers. They should have self-injectable-epinephrine available and should be coached to use it properly.
过敏反应是IgE介导的食物过敏最严重的形式，存在致死风险。其发病率正在急剧上升。
分析过敏反应的实际管理情况，对照国际指南寻找其合理性，强调肾上腺素的绝对必要性，并提出改进治疗的进一步建议。
对1999年至2012年期间来自急诊科、儿科、复苏科、心脏病科或过敏科的国际研究以及关于过敏反应管理的国际指南进行综合回顾。
患者自行注射肾上腺素的使用率较低。急诊科使用肾上腺素进行治疗与推荐指南的一致性较低。自行注射肾上腺素的出院处方以及转诊进行过敏测试的情况相当不足。
过敏反应的实际管理不符合国际指南。急诊科应采用符合国际标准的过敏反应治疗方案。降低风险的策略不能仅依赖患者自行使用肾上腺素，而应提高所有急救护理人员的效率。应开展有针对性的教育干预，以改善急诊医疗服务人员的护理。他们应备有自行注射用肾上腺素，并应接受正确使用的培训。
