Table 8 Treatment of anaphylaxis in healthcare settings: summary of unmet needs
High-resource countries1 | Limited-resource countries2 | |
|---|---|---|
Prompt initial treatment of anaphylaxis | need to encourage the “be prepared” approach: have a protocol, inject epinephrine promptly IM in mid-outer thigh, call for help, and position the patient appropriately; need to reduce the fear factor associated with epinephrine use by stressing the good benefit/harm ratio of prompt IM epinephrine compared with IV epinephrine | need to develop simple protocols, and focus on essentials: inject epinephrine promptly IM in mid-outer thigh, call for help, position the patient appropriately; need to ensure the availability of epinephrine as an essential drug in 1 mg/mL ampules in all healthcare facilities, and improve availability of low-cost EAIs (or if EAIs are unaffordable, factory-sealed syringes prefilled with epinephrine 1 mg/mL) |
Initial treatment (cont.) | need ↑ awareness that H1-antihistamines, H2-antihistamines, and glucocorticoids are not initial medications of choice in anaphylaxis and should not be used as monotherapy | need ↑ availability of supplemental oxygen and IV fluids; where oxygen cylinders are not available, oxygen concentrators can be useful; lack of availability of supplemental oxygen and IV fluids is more critical than lack of second-line medications such as antihistamines and glucocorticoids, which are not essential for survival |
Management of anaphylaxis refractory to initial treatment | need to identify hospitals where patients with refractory anaphylaxis can receive skilled ventilatory and inotropic support from experienced, well-equipped personnel, and to list the contact information for these facilities on the anaphylaxis protocol | need ↑ availability of supplemental oxygen and IV fluids such as 0.9% saline; need regular reassessment of availability of epinephrine, supplemental oxygen and IV fluids, supplies and equipment in hospitals |
Observation and monitoring in healthcare settings | need ↑ availability of continuous electronic monitoring of cardiac rate, function, and blood pressure, and of pulse oximetry | need ↑ availability of basic supplies and equipment for monitoring in many hospitals; and improved availability of continuous electronic monitoring of cardiac rate, function, and blood pressure, and pulse oximetry in teaching hospitals |