Anaphylaxis (cont.)

Preventing anaphylaxis is the ideal form of treatment. However, that may not always be easy since insect stings are frequently unanticipated, and allergens in foods are often hidden in a variety of different preparations. A consultation with an allergist is vital in helping you identify the trigger(s) and providing you with information and instruction on how to best avoid them. You will learn how to use emergency kits and how to become prepared for any reaction in the future.

These are three situations in which preventive treatment might be offered by the allergist.

1. Allergy shots may be suggested to some people with wasp, yellow jacket, hornet, honey bee, or fire ant reactions. This form of treatment gives 98% protection against the first four insect reactions, though somewhat less protection against fire ant reactions.
2. Pre-medication is most helpful in preventing anaphylaxis from X-ray dyes. Alternative dyes that are less likely to cause reactions may be available.
3. Desensitization to problematic medications is often effective. This process is accomplished by gradually increasing the amount of the medication given under controlled conditions. Sensitivities to penicillin, sulfa drugs, and insulin have been successfully treated in this way.

Anyone known to be at risk for anaphylaxis should wear a Medic-Alert bracelet that clearly states the allergic trigger, the risk of anaphylaxis, and the availability of an epinephrine kit.

People with anaphylaxis to medications should take new medications by mouth whenever possible since the risk of anaphylaxis is higher with injections.

Table 2: Basic Avoidance Measures for Anaphylaxis

Trigger	Avoidance Principle
Drugs/Medications	Advise all health-care personnel of your allergies. Ask your doctor whether the prescribed medication contains the drug(s) you are allergic to. Take all drugs by mouth if possible.
Insect Stings	Avoid areas such as outdoor garbage, barbecues, and insect nests. Avoid bright clothing, perfume, hair spray, or lotion that might attract insects. Wear long-sleeved clothing, long trousers, and shoes while outdoors.
Food	Carefully read all labels. Ask what the ingredients are when eating out. Avoid foods that may cross react such as bananas, kiwi fruit, and avocado.
Latex	Avoid all latex products. Ask if your hospital has latex safety issues if you need to be hospitalized.

Since avoidance is not fail-safe, a person at risk for an anaphylactic reaction must be adequately prepared in an emergency to handle a reaction. It is recommended that everyone at risk carry epinephrine injection kits designed for self-administration. These kits are available by prescription only and come in two forms:

• EpiPen is a spring-loaded automatic syringe that delivers a predetermined dose (0.3 mg) when the tip is pressed hard for several seconds. An EpiPen junior is available for children under 33 pounds and contains half of the dose.
• Ana-kit contains a preloaded syringe and needles with two 0.3 mg doses of epinephrine. These are injected under the skin or into the muscle of the thigh. An antihistamine, alcohol swab, and a tourniquet are included in the kit.

Here are some important points to remember regarding the kits:

• Ask you doctor to explain the use of the kit carefully and practice with the demonstrator kit.

• Check expiration dates and replace outdated kits.

• Keep kits out of direct sunlight, which may affect the drug.

• Additional kits should be brought to school or work.

• Always have kits with you or readily available.

• Make sure that your friends, relatives, exercise buddies, and coworkers are aware of your condition and know what to do in case of a reaction.

REFERENCE:

Tintinalli, Judith E., ed. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 7th ed. New York: McGraw-Hill, 2011.

Source: MedicineNet.com
http://www.medicinenet.com/anaphylaxis/article.htm