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Table 3 Preventive Measures to Reduce the Risk for Anaphylaxis

From: Epinephrine: The Drug of Choice for Anaphylaxis--A Statement of the World Allergy Organization

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
  1. Modified from Kemp[88].