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