This month, team JC is going to do a deep dive on the management of anaphylaxis in the ED. I want to thank Dr. Doug Browder for calling my attention to a lecture and website called AMAX-4 by Dr. Ben McKenzie an Australian EM physician who lost his 15-year-old son Max to anaphylaxis that was poorly managed by his own colleagues at his workplace. He provides a compelling framework regarding common mismanagement issues and a personal, but evidence-based perspective on becoming better informed about anaphylaxis. My deep dive into the multiple guidelines including the EEACI  and AAAAI/ACAII and a GRADE analysis by Shaker et al. was pretty informative and warrants review. I also found interesting the deemphasis on the use of steroids and their lack of efficacy (Alqurashi, Auth & Nagata). Or the frequency in which EPI is withheld in the “elderly” (PS that might include yours truly!) There is also an excellent grading system presented by Dribin et al., that may help with early recognition of the sicker patient. Some of the best available evidence for preventing bad outcomes comes from educational interventions and some examples of can be seen here ( UCSF, Kings College, Canada) and will be discussed by Dr. Demian. Considering access to cell phones by all, could e-discharge instructions with helpful educational links advance patient education and help save the trees.  Seems like low hanging fruit (pun intended).

Grunau BE, et al., Emergency Department Corticosteroid Use for Allergy or Anaphylaxis Is Not Associated With Decreased Relapses. Ann Emerg Med. 2015 Oct;66(4):381-9. Appraisal

 Kawano T, et al. Epinephrine use in older patients with anaphylaxis: Clinical outcomes and cardiovascular complications. Resuscitation. 2017 Mar;112:53-58 Appraisal

  Dodd A, et al. Evidence update for the treatment of anaphylaxis. Resuscitation. 2021 Apr 23;163:86-96 Appraisal

 Brockow K, et al.  Effects of a structured educational intervention on knowledge and emergency management in patients at risk for anaphylaxis. Working group on anaphylaxis training and education (AGATE) Allergy. 2015 Feb;70(2):227-35. Appraisal