Allergy Asthma Proc. 2023 Jan 1;44(1):35-44. doi: 10.2500/aap.2023.44.220089.
Anaphylaxis is an acute life-threatening event that requires emergent diagnosis and treatment. However, focus on prevention of anaphylaxis is essential in reducing anaphylaxis recurrences and associated mortality. This literature review was aimed to be a comprehensive resource for practicing allergists in managing anaphylaxis in the long term. We discussed the role of the allergist in the long-term outpatient management of anaphylaxis through identifying risk factors, allergen avoidance, prevention of recurrences, and patient education. A medical literature search that focused on several areas of long-term management of anaphylaxis was conducted. Patients evaluated by an allergist are more likely to have their anaphylaxis trigger identified, to have their underlying mast cell disorder diagnosed, and to receive desensitization or allergen immunotherapy. Allergists can prevent fatal anaphylaxis by preventing and treating anaphylaxis in patients with ischemic heart disease and by optimally treating patients with comorbid asthma. Allergists can offer specific prevention strategies for allergenic trigger and cofactor avoidance. Education should be focused on patients with a higher risk for recurrence of anaphylaxis, such as those patients with a history of severe symptoms or anaphylaxis, with a peanut and/or tree nut trigger, or with a history of asthma, or female gender. Patient counseling involves providing individualized action plans at each visit and discussing proper use, storage, and safety of epinephrine autoinjectors. Multiple doses of epinephrine need to be prescribed to those who are at risk for severe food-induced, venom immunotherapy-related, or venom-induced anaphylaxis. Wording on medical identification products should be reviewed by the allergist. Anaphylaxis resources for health-care providers are summarized in the article. Ongoing education, providing personalized anaphylaxis action plans, reducing risk factors, and avoiding triggers are key to anaphylaxis prevention and long-term management.
过敏反应是一种危及生命的急性事件，需要紧急诊断和治疗。然而，预防过敏反应对于减少过敏反应的复发和相关死亡率至关重要。 本文献综述旨在为过敏专科医生提供全面的资源，以长期管理过敏反应。我们讨论了过敏专科医生在过敏反应的长期门诊管理中的作用，包括识别危险因素、过敏原回避、预防复发和患者教育。 我们进行了一项医学文献搜索，重点关注过敏反应长期管理的几个领域。 由过敏专科医生评估的患者更有可能确定其过敏反应的触发因素，诊断其潜在的肥大细胞疾病，并接受脱敏或过敏原免疫治疗。过敏专科医生可以通过预防和治疗缺血性心脏病患者的过敏反应以及通过最佳治疗合并哮喘的患者来预防致命的过敏反应。过敏专科医生可以为过敏原和共刺激因素的回避提供特定的预防策略。教育应侧重于过敏反应复发风险较高的患者，如那些有严重症状或过敏反应史、有花生和/或树坚果触发因素或哮喘史或女性的患者。患者咨询包括在每次就诊时提供个性化的行动计划，并讨论肾上腺素自动注射器的正确使用、储存和安全性。那些有发生严重食物诱发的、免疫治疗相关的或毒液引起的过敏反应风险的患者需要开多剂量的肾上腺素。过敏专科医生应审查医疗识别产品上的文字。本文总结了过敏反应患者的医疗资源。 持续的教育、提供个性化的过敏反应行动计划、降低风险因素和避免触发因素是过敏反应预防和长期管理的关键。
