Table 3 Preventive Measures to Reduce the Risk for Anaphylaxis

I. General measures

   Obtain thorough history to diagnose life-threatening food or drug allergy

   Identify cause of anaphylaxis and those individuals at risk for future attacks

   Provide instruction on proper reading of food and medication labels, where appropriate

   Avoidance of exposure to antigens and cross-reactive substances

   Optimal management of asthma and coronary artery disease

   Implement a waiting period of 20 to 30 min after injections of drugs or other biologic agents

   In the physician's office, consider a waiting period of 2 h if a patient receives an oral medication he/she has never previously taken

II. Specific measures for high-risk patients

   Individuals at high risk for anaphylaxis should carry self-injectable syringes of epinephrine at all times and receive instruction on proper use with placebo trainer

   MedicAlert (MedicAlert Foundation, Turlock, Calif) or similar warning bracelets or chains

   Substitute other agents for β-adrenergic blockers, angiotensin-converting enzyme inhibitors, tricyclic antidepressants, and monoamine oxidase inhibitors, whenever possible

   Agents suspected of causing anaphylaxis should be given orally if possible; if the intravenous route is needed, a slow supervised rate of administration is required

   Where appropriate, use specific preventive strategies, including pharmacological prophylaxis, short-term challenge and desensitization, and long-term desensitization