34.1 Keep Calm and Give Epinephrine

Most of the time, an allergy practice runs smoothly with few issues. At some point though, a patient will experience anaphylaxis in the office. Long periods of calm hours are the norm, but these will be abruptly interrupted by a patient having a serious, possibly life-threatening, allergic reaction. So take these words of advice to heart: preparation is the key to treating anaphylaxis. Have an anaphylactic protocol posted at key places in the office. Post sign/symptoms of anaphylaxis so staff can quickly recognize it. Assign personnel to check emergency supplies regularly. Replace and discard expired medication and equipment. Run anaphylaxis drills regularly, and most important of all: Keep calm and give epinephrine.

34.2 An Ounce of Prevention

While it’s impossible to avoid all potential situations that could lead to anaphylaxis (other than not practicing allergy), there are certain measures that can be taken to help reduce or minimize the risk of a serious reaction occurring.

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  Select appropriate candidates for skin testing and immunotherapy. See ▶Table 34.1 for a list of patients who may be at increased risk of adverse reactions.

  
  
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  To help minimize human error have systems in place; double-check vial prescriptions and mixing notes. Double confirm patients’ identities and read back information on each vial to confirm it is the right vial for the right patient; double-check dosage prior to shot administration.

  
  
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  Have standard operating procedure (SOP) for testing, mixing, and shot administration. Review them with staff periodically, ensure they are following it, and that new staff are trained properly on it.

34.3 Prepare for the Worst

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  Establish an anaphylaxis protocol in the clinic. Post it in all patient treatment rooms or allergy patient care areas. See ▶Fig. 34.1 for an example of a protocol.

  
  
  
  

  If your anaphylaxis protocol does not clearly list medications and dosages, post a list of emergency medications with dosages as well. If you treat kids, post pediatric doses or mg/kg.

  
  
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  Keep an allergy emergency cart or anaphylaxis kit/cart (▶Fig. 34.2a, b; ▶Fig. 34.3).

  
  
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  Perform anaphylaxis drills at periodic intervals.

  
  
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  Assign personnel to check emergency supplies and replace/discard outdated equipment/medications.

  
  
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  Have a predetermined method of communication (calling for help, walkie talkies, intercom) for emergencies and designate in advance the roles staff play (who calls 911, etc.)