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Table 8 Treatment of anaphylaxis in healthcare settings: summary of unmet needs

From: International consensus on (ICON) anaphylaxis

  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
  1. 1Within high-resource countries, limited-resource areas can be found in inner cities, some rural areas, many public venues, and situations such as anaphylaxis on airplanes.
  2. 2In this Table, “limited-resource countries” include mid- and low-resource countries.
  3. EAIs, epinephrine auto-injectors; IM, intramuscular; IV, intravenous.