Nowak Richard, Farrar Judith Rosen, Brenner Barry E, Lewis Lawrence, Silverman Robert A, Emerman Charles, Hays Daniel P, Russell W Scott, Schmitz Natalie, Miller Judi, Singer Ethan, Camargo Carlos A, Wood Joseph
Wayne State University School of Medicine, University of Michigan Medical School, Detroit, Michigan, USA.
J Emerg Med. 2013 Aug;45(2):299-306. doi: 10.1016/j.jemermed.2013.01.018. Epub 2013 Apr 30.
Most episodes of anaphylaxis are managed in emergency medical settings, where the cardinal signs and symptoms often differ from those observed in the allergy clinic. Data suggest that low recognition of anaphylaxis in the emergency setting may relate to inaccurate coding and lack of a standard, practical definition.
Develop a simple, consistent definition of anaphylaxis for emergency medicine providers, supported by clinically relevant consensus statements.
Definitions of anaphylaxis and criteria for diagnosis from current anaphylaxis guidelines were reviewed with regard to their utilization in emergency medical settings. The agreed-upon working definition is: Anaphylaxis is a serious reaction causing a combination of characteristic findings, and which is rapid in onset and may cause death. It is usually due to an allergic reaction but can be non-allergic. The definition is supported by Consensus Statements, each with referenced discussion. For a positive outcome, quick diagnosis and treatment of anaphylaxis are critical. However, even in the emergency setting, the patient may not present with life-threatening symptoms. Because mild initial symptoms can quickly progress to a severe, even fatal, reaction, the first-line treatment for any anaphylaxis episode--regardless of severity--is intramuscular injection of epinephrine into the anterolateral thigh; delaying its administration increases the potential for morbidity and mortality. When a reaction appears as "possible anaphylaxis," it is generally better to err on the side of caution and administer epinephrine.
We believe that this working definition and the supporting Consensus Statements are a first step to better management of anaphylaxis in the emergency medical setting.
大多数过敏反应发作是在急诊医疗环境中处理的，在这种环境下，主要体征和症状往往与过敏诊所中观察到的不同。数据表明，急诊环境中对过敏反应的低识别率可能与编码不准确以及缺乏标准、实用的定义有关。
为急诊医学提供者制定一个简单、一致的过敏反应定义，并得到临床相关共识声明的支持。
回顾了当前过敏反应指南中过敏反应的定义和诊断标准在急诊医疗环境中的应用情况。商定的工作定义是：过敏反应是一种严重反应，导致一系列特征性表现，起病迅速，可能导致死亡。它通常由过敏反应引起，但也可能是非过敏性的。该定义得到了共识声明的支持，每个声明都有相关讨论。为了取得良好的治疗效果，快速诊断和治疗过敏反应至关重要。然而，即使在急诊环境中，患者可能也不会出现危及生命的症状。由于轻微的初始症状可能迅速进展为严重甚至致命的反应，对于任何过敏反应发作——无论严重程度如何——一线治疗都是将肾上腺素肌肉注射到大腿前外侧；延迟给药会增加发病和死亡的可能性。当反应表现为“可能是过敏反应”时，一般宁可谨慎行事并给予肾上腺素。
我们认为，这个工作定义和支持性的共识声明是在急诊医疗环境中更好地管理过敏反应的第一步。
