High-resource countries1 | Limited-resource countries2 | |
---|---|---|
Symptoms and signs (typically with onset in minutes to a few hours after exposure; multi-system; rapid progression) | need improved recognition and diagnosis of anaphylaxis and its sudden onset in relationship to exposure to a trigger (the context) among all healthcare professionals (including EMS personnel), patients, caregivers and the public | need improved recognition and diagnosis of anaphylaxis and its sudden onset in relationship to exposure to a trigger (the context) among all healthcare professionals, patients, caregivers, and the public |
Clinical diagnosis of anaphylaxis | need to operationalize the clinical criteria for the diagnosis of anaphylaxis by healthcare professionals; need improved coding for anaphylaxis and training of coders | need to operationalize the clinical criteria for the diagnosis of anaphylaxis; need ↑ availability of basic equipment and supplies to aid in recognition, eg. pulse oximetry and sphygmomanometers with arm cuffs of various sizes |
Laboratory tests to confirm the clinical diagnosis eg. serum total tryptase measurement 3 | need ↑ awareness of optimal timing of tests, and lack of test specificity (eg. ↑ tryptase in some patients with MI); need ↑ awareness that current lab tests are not useful at the time of patient presentation; need ongoing development of tests for biologic markers | need awareness that inability to measure tryptase levels (which is unlikely to be a priority for change due to high cost) is not a barrier to prompt diagnosis of anaphylaxis, which depends on recognition of symptoms and signs |
Differential diagnosis | need ↑ awareness that among the >40 entities in the differential diagnosis, acute asthma, acute urticaria, and panic or anxiety attacks are most common | need awareness that in some countries, pneumonia and sepsis are the most likely diagnoses in patients with sudden-onset respiratory distress and sudden-onset hypotension/ distributive shock, respectively |
Diagnosis of anaphylaxis in special populations | need improved prompt recognition of anaphylaxis in infancy, adolescence, pregnancy, and advanced age | need improved prompt recognition of anaphylaxis in infancy, adolescence, pregnancy, and advanced age |