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Table 9 Treatment of anaphylaxis in community settings: summary of unmet needs

From: International consensus on (ICON) anaphylaxis

  High-resource countries1 Limited-resource countries2
Discharge management of patients treated for anaphylaxis need ↑ public awareness of the importance of prompt anaphylaxis recognition and first-aid treatment for patients with anaphylaxis in the community; need ↑ availability of low-cost EAIs and of “stock” epinephrine3 in schools, shopping malls, etc.; need a wider range of epinephrine doses in auto-injectors, eg. 0.1 mg and 0.5 mg need ↑ availability of low-cost EAIs or even factory-sealed prefilled epinephrine syringes; need ↑ awareness of alternative but not preferred options (epinephrine 1 mg/1 mL ampules and 1 mL syringes, and unsealed syringes prefilled by healthcare professionals); need more information about epinephrine shelf-life in extreme climates
Investigations to confirm anaphylaxis triggers need improved standardization of allergens and of test and challenge protocols; need ↑ awareness that allergen sensitization is far more common than clinical symptoms; and that tests for sensitization must be selected and interpreted based on the history of the anaphylactic episode need ↑ awareness that if sterile needles are available, allergen skin tests can be performed by skin prick or prick-prick testing with relevant foods, or skin testing with IV formulations of medications
Prevention of anaphylaxis recurrences need improved public policies with regard to food labeling, improved school policies for anaphylaxis prevention and treatment, and improved access to specialists, including those who can document sensitization to novel triggers need improved training of healthcare professionals to identify anaphylaxis triggers, symptoms, and signs; need ↑ availability of tests to confirm sensitization; (in their absence, trigger avoidance is based on the history); need ↑ availability of venom immunotherapy and desensitization to drugs
Anaphylaxis education need ↑ availability of personalized anaphylaxis education by trained healthcare professionals and development of personalized emergency action plans that focus on recognition of symptoms and signs, implementation of the plan, prompt use of EAI, and wearing medical ID need ↑ awareness of anaphylaxis, improved training of healthcare professionals, and development of action plans to aid in recognition of anaphylaxis symptoms and signs; need improved availability of EAIs
Follow-up need ↑ awareness of importance of follow-up with an allergist/ immunologist to provide training in anaphylaxis recognition, EAI use, allergen avoidance; and when indicated, immune modulation, eg. VIT need ↑ awareness of the importance of follow-up after an acute anaphylactic episode; availability of follow-up will depend on local conditions
  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. 3Rationale: preventable deaths, especially in children, teenagers, and young adults occur in these venues; this issue is also listed in the research agenda (Table 11) because of the need to gather additional data.
  4. EAIs, epinephrine auto-injectors; ID, identification; VIT, venom immunotherapy.