With a new disaster popping up every few weeks here in the U.S., it is natural to focus on the latest, most critical, and most life-threatening events. It is what we must do. At the College, our support is with all our members who have suffered personal or business losses in the latest California wildfires, and we hope we can be of some help in your recovery as well as in helping your patients who have been affected. We have not lost sight of those still recovering from hurricane damage in the southern states as well.
Meanwhile, we must relegate “everyday” problems to a slightly lower tier of concern. But as allergists/immunologists, we all share the constant anxiety of our patients who are at risk from anaphylaxis. Many of these children, adults and caregivers have their own potential disaster waiting for them every day if they are not careful.
According to two studies presented at our recent Annual Scientific Meeting, patients, caregivers and the public (including emergency personnel) are not always clear on what to do when someone is having an anaphylactic reaction.
The College aims to keep allergists, patients and caregivers, and primary care and emergency response professionals up to date on the latest and best practices for managing and treating anaphylaxis. With that, as many of you know, our Joint Task Force on Practice Parameters developed an updated parameter on anaphylaxis in 2023 (with AAAAI).
I want to bring your attention to the main changes in this guidance and give you a list of College resources to help you and your patients cope with this issue. In another development related to this condition, intranasal epinephrine (Neffy) was approved in 2024 and is now available for some patients. The College has education and information about this as well, please see the resources listed below.
One of the biggest changes the practice parameter addresses is whether patients must go to the emergency room if they use their epinephrine autoinjector. In the past, the standard advice was that you should automatically contact emergency medical services (EMS) afterward, or head to the emergency room. The new guidance suggests that it may not be necessary to call EMS if you experience prompt, complete, and long-lasting response to the epinephrine treatment. However, this new recommendation only applies if the person has additional epinephrine and medical care available if needed. If the patient is not improving, they should obviously still head to the ER or call EMS.
We hope this relieves some of the burden that patients and caregivers feel – the reluctance to use their epi because they do not want to have to go to the ER. The parameter still recommends physicians counsel and educate patients to use it at the first sign of suspected anaphylaxis; but also suggests that, in general, allergists and other clinicians advise against giving epi to a patient who does not have symptoms if they have been in contact with their allergen.
The 2023 guidelines have many other recommendations, including awareness that anaphylaxis may present differently in infants, and how best to manage this condition in community settings. I encourage you to check out one or more of the educational resources listed below to learn more.
In addition, we now have Neffy to consider as a tool for helping our patients who weigh more than 30 kg. It is nice to have more tools in our toolbox to help our patients with anaphylaxis. The recommendations still apply for contacting EMS after taking the first dose – it is not necessary if you have additional Neffy on hand and access to medical care. But, as with autoinjectors, patients and caregivers must use good judgment regarding how well they are responding to the initial dose(s).
Here is a list of College resources to get you well positioned with the latest information and insights for counseling your patients who are at risk for anaphylaxis.
- Webinar: Anaphylaxis Update and Treatment Options on Wednesday, Jan. 22 at 7:00 pm CST
- Office-based Anaphylaxis Toolkit: Includes links to 2023 Practice Parameter; mock scenarios and more.
- Neffy prior authorization letter generator
- MicroCME: Evolving Treatments for Anaphylaxis | College Learning Connection
- AllergyTalk podcast episodes on anaphylaxis/angioedema (includes an episode on Neffy)
- Emergency Planning for Children with Asthma and Anaphylaxis
The College aims to keep both medical professionals and the public up to date on best practices in anaphylaxis treatment. A patient’s risk factors for severe anaphylaxis, their values and preferences, and the burden of both anaphylaxis and epinephrine autoinjectors (EAI) prescription are crucial factors to consider when deciding whether to prescribe EAIs, and how many EAIs to prescribe.
